CASE STUDY:A MALIGNANT MYSTERY

I recently underwent a radical prostate tomy in Athens. It was successful, and I praise the Greek surgeons. But was it necessary? When in the US I had decided to have a check up, since a recent PSA count had been rather high. I had no symptoms except an occasional urge to urinate more frequently. The biopsy report, sent to me in Athens, noted five slides showing benign prostate hyperplasia and one showing “a single focus of adenocarcinoma”.

The Athens surgeon (Edinburgh trained) recommended immediate surgery. “Watchful waiting” was discouraged. So was a second biopsy: “Even if we found a negative, we would have to honour the findings that show adenocarcinoma.” It was done. But when the gland was examined in the lab, there was no sign of malignancy. Was it possible that the biopsy removed the single speck of carcinoma? “Possible, but not likely,” I was told.

I had the surgeon write to the US clinic. They sent the slides, with a letter from the pathologist saying the rest of his department had reviewed them and all had “independently agreed” his finding.

I began to feel borderline suspicion. Members of the same department that’s not what I call independent. Someone told me about the American Medical Association, and the fear of claims being brought. The chief pathologist at the Athens hospital reviewed the slides, and found no malignancy whatever. On his own initiative, he sent them to the professor of pathology at the University. The finding: the same.

“Claims” was not my intention. But I wanted to understand. The Athens pathologist suggested an eminent US specialist, who agreed to review the slides. I sent them with nothing to identify their source, apart from the accession numbers (sent at his request). When he returned them, he enclosed a letter not to me, but to the US clinic, and the very pathologist involved!

The letter backs up the clinic’s finding and adds: “If follow up becomes available I would appreciate your letting me know.” In other words: “If this bloke gives you any trouble, I’m on your side!”

Am I being overly suspicious? I don’t believe so. After hearing a few stories about the AMA, it all smacks of collusion. A L, Athens.