Usual thorough evaluation, difficult topic

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The gamble is; will l die of something else before I die of prostate cancer. If I were overweight, a heavy drinker, junk food junkie, that didn’t work out religiously, I would bet I don’t die of prostate cancer. Whoopi.

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Granted, an anecdotal "study" of a sample of one isn't worth much, but the process from my positive PSA to an MRI and CT scan (done the same day), to implanting fiducials, to four Cyberknife radiation sessions, as of three years later, completely eliminated my prostate cancer.

Observation though: I live in Cary, NC. A couple of big hospitals here, and a lot of docs. The first doc I went to was a surgeon and the only option he offered was surgery. His description of the possible consequences of that scared me off entirely--I decided not to treat the cancer and let it do as it would. Fortunately, a friend of mine is a nephrologist, a graduate of the UNC medical school about 30 miles away, and he gave me a bigger picture: the Cary medical culture, at least regarding prostates, is way behind the times; if you want "modern," go to UNC.

The moral of this story isn't the question "Should We Stop Treating Most Prostate Cancers?", it's that those who treat prostate cancer should stay up to date on the treatment options. So far as I know, there are no Cyberknife machines in Cary, but that's no excuse for the docs in Cary not to know about the availability of Cyberknife, or other forms of prostate cancer treatment, at UNC-Chapel Hill or elsewhere.

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I’m a 12 year survivor with no treatment.

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The data used by the government health task force to give their recommendations has been rereviewed and found to be flawed.

PSA screening saves lives.

If people do not want to be screened and are afraid of evidence based active surveillance that’s an individual decision.

Making it for them is more based on ego than having a patient centered approach .

Almost every day I deal with a delay in diagnosis because PSA screening was not performed and rectal exams were either not performed or inadequately performed.. Especially in younger and older patients whose prostates were ignored.

The 12 year build up of undiagnosed now incurable prostate cancer is just now becoming apparent.

Just like Einstein supposedly said, doing the same thing over and over again and expecting a different outcome is the definition of insanity; going. Back to 1985 where over 70% of Prostate cancer presented metastatic is plain old foolish.

By 2005 well over 95% of Prostate Cancer was diagnosed organ contained.

Studies from Europe were pioneering who to watch and when to intervene ,

Things were really looking good until a group of non Urologist got out of their lane and here we are. Back to the future.

James A Betti MD FACS past Vice Chair Lahey Health Dept of Urology

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Zero out prostate cancer? Easy… Just kill all male children before puberty, and no one will die of prostate cancer ever again. /sarc

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Mar 21·edited Mar 21

Treatment may not decrease OVERALL mortality rates, but it certainly decreased MINE.

Call me selfish, I guess... lol

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If we talk about cancers that are generally more aggressive within someone's life expectancy, it is clearly a fallacy to base individual decisions on population averages. It is especially misguided when the public health screening recommendations are based on cost. If universal mammograms cost more than isolated breast cancer treatment, the public health doctor of cost accounting will come out against screening. But nobody gets 1% breast cancer. For the individual, it's binary. You should get screened even if everybody's screening costs too much. Prostate cancer is different. Another way of making Dr Hollander's point is that prostate cancer isn't binary in the way other cancers are. This complicates the individual decision.

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The recommendation to save money by not diagnosing turns the whole millennial history of medicine on its head. What if Hippocrates had taken this advice? Remember that in many cases he could only diagnose, but not offer effective treatment. But the whole subsequent progress depended precisely on those diagnoses. Medical reforms designed to save money, generally cost both money and lives. Was this ever the approach of the great pioneers like Harvey, Jenner, Pasteur, Lister, or Jonas Salk?

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Asking questions like this will lead to ALOT of missed boat payments. Shame on you.

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The problem with a non-Urologist pretending to be one is they come to the conclusion they wanted to have. In the study mentioned a good percentage of patients that were followed expectantly eventually had either surgery or Radiation, and that is what made the life expectancies the same.

America tried the author's approach for the last 13 years and now prostate cancers are being dx at an incurable stage. It is always better to make informed decisions rather than put one's head in the sand.

It is also best to understand the natural course of a disease and not pretend you are an expert at something you are not.

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Mar 20·edited Mar 20

I’m not sure that I would “shrug off” a large, well run study like this.

Certainly prostate cancer care has changed over 20 years, but this study, which has been published before at earlier phases, is a useful confirmation of the validity of less aggressive prostate cancer care for men with low risk cancers.

And I agree that Unfortunately, when it comes to PSAs, MRIs, biopsies, etc there is no silver bullet for delineating which people will truly remain “low risk” without meaningful progression, metastasis and morbidity with perfect precision. It’s a game a probability and there are chances of both good and bad outcomes with any approach.

But it is useful to know that men with low risk cancers (mostly Gleason 6, and all PSAs <20) did fairly well (and had similar rates of mortality) even if they didn’t intervene early. Further, there was a nearly 10-fold higher chance that men in this study would die of something other than prostate cancer over the 15 year followup.

That’s useful knowledge, even if it is based upon 20 year old treatment protocols.

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