RE: Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

[Guest guest]

You’d have put money on the majority

of people being referred to a brachytherapy clinic choosing brachytherapy,

wouldn’t you? And that’s what this study shows with 48.2% doing

just that.

But the thing that I thought demonstrated

how far things have change is that the next biggest group (31.8%) chose what

was termed in this study Expectant Management – more commonly known as Active

Surveillance.

This was only a small study – and a

Canadian one at that, but wouldn’t it be terrific if more men in the US

followed this path and took the advice of Dr Oppenheimer who says on his http://theprostateblog.blogspot.com

blog :

For the vast majority of men with a recent diagnosis of

prostate cancer the most important question is not what treatment is needed,

but whether any treatment at all is required. Active surveillance is the

logical choice for most men (and the families that love them) to make.

How many men and heir families would

be spared the inevitable side effects that conventional therapy brings?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of B

Sent: Sunday, 21 December 2008

12:38 AM

To:

malemedicalproblems ; malemedicalproblemsgooglegroups; ProstateCancerSupport

Subject:

Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

This Canadian study aimed to analyze factors influencing treatment

decisions in patients diagnosed with low risk prostate cancer who were referred

to a brachytherapy clinic and had to choose from four treatment options:

expectant management (watchful waiting), radical prostatectomy, external beam

radiation therapy, and permanent seed brachytherapy.

Click on below link for

the full story:

<http://www.urotoday.com/61/browse_categories/prostate_cancer/factors_influencing_treatment_decisions_in_patients_with_low_risk_prostate_cancer_referred_to_a_brachytherapy_clinic__abstract.html>

[Guest guest]

You’d have put money on the majority

of people being referred to a brachytherapy clinic choosing brachytherapy,

wouldn’t you? And that’s what this study shows with 48.2% doing

just that.

But the thing that I thought demonstrated

how far things have change is that the next biggest group (31.8%) chose what

was termed in this study Expectant Management – more commonly known as Active

Surveillance.

This was only a small study – and a

Canadian one at that, but wouldn’t it be terrific if more men in the US

followed this path and took the advice of Dr Oppenheimer who says on his http://theprostateblog.blogspot.com

blog :

For the vast majority of men with a recent diagnosis of

prostate cancer the most important question is not what treatment is needed,

but whether any treatment at all is required. Active surveillance is the

logical choice for most men (and the families that love them) to make.

How many men and heir families would

be spared the inevitable side effects that conventional therapy brings?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of B

Sent: Sunday, 21 December 2008

12:38 AM

To:

malemedicalproblems ; malemedicalproblemsgooglegroups; ProstateCancerSupport

Subject:

Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

This Canadian study aimed to analyze factors influencing treatment

decisions in patients diagnosed with low risk prostate cancer who were referred

to a brachytherapy clinic and had to choose from four treatment options:

expectant management (watchful waiting), radical prostatectomy, external beam

radiation therapy, and permanent seed brachytherapy.

Click on below link for

the full story:

<http://www.urotoday.com/61/browse_categories/prostate_cancer/factors_influencing_treatment_decisions_in_patients_with_low_risk_prostate_cancer_referred_to_a_brachytherapy_clinic__abstract.html>

[Guest guest]

....

> For the vast majority of men with a recent diagnosis of

> prostate cancer the most important question is not what

> treatment is needed, but whether any treatment at all is

> required. Active surveillance is the logical choice for most

> men (and the families that love them) to make.

....

One day, maybe in the not too distant future, we'll have better

diagnostic tools that will make it clearer who should and who

should not have treatment.  We need better ways to determine who

doesn't need primary treatment now, who needs it now, and who

is too far gone for primary treatment.

However we do have some useful guidelines today related to PSA,

Gleason score, number and percent of biopsy cores with cancer,

and PSA doubling time which ought to be able to skim off the

easy cases - i.e., men for whom it is pretty clear that their

cancer is not currently a threat. 

I suspect that urologists are becoming more sensitive to this

issue and taking better advantage of the guidelines than in the

past.  However there are still some urologists out there who,

either because they are true believers in treatment or because

of financial incentives in promoting treatment, are not

following the guidelines and are pushing their patients into

unnecessary treatment.

I'm thinking that the best thing that we can do is to make

new patients and their families aware of the guidelines.

Alan

[Guest guest]

....

> For the vast majority of men with a recent diagnosis of

> prostate cancer the most important question is not what

> treatment is needed, but whether any treatment at all is

> required. Active surveillance is the logical choice for most

> men (and the families that love them) to make.

....

One day, maybe in the not too distant future, we'll have better

diagnostic tools that will make it clearer who should and who

should not have treatment.  We need better ways to determine who

doesn't need primary treatment now, who needs it now, and who

is too far gone for primary treatment.

However we do have some useful guidelines today related to PSA,

Gleason score, number and percent of biopsy cores with cancer,

and PSA doubling time which ought to be able to skim off the

easy cases - i.e., men for whom it is pretty clear that their

cancer is not currently a threat. 

I suspect that urologists are becoming more sensitive to this

issue and taking better advantage of the guidelines than in the

past.  However there are still some urologists out there who,

either because they are true believers in treatment or because

of financial incentives in promoting treatment, are not

following the guidelines and are pushing their patients into

unnecessary treatment.

I'm thinking that the best thing that we can do is to make

new patients and their families aware of the guidelines.

Alan

[Guest guest]

....

> For the vast majority of men with a recent diagnosis of

> prostate cancer the most important question is not what

> treatment is needed, but whether any treatment at all is

> required. Active surveillance is the logical choice for most

> men (and the families that love them) to make.

....

One day, maybe in the not too distant future, we'll have better

diagnostic tools that will make it clearer who should and who

should not have treatment.  We need better ways to determine who

doesn't need primary treatment now, who needs it now, and who

is too far gone for primary treatment.

However we do have some useful guidelines today related to PSA,

Gleason score, number and percent of biopsy cores with cancer,

and PSA doubling time which ought to be able to skim off the

easy cases - i.e., men for whom it is pretty clear that their

cancer is not currently a threat. 

I suspect that urologists are becoming more sensitive to this

issue and taking better advantage of the guidelines than in the

past.  However there are still some urologists out there who,

either because they are true believers in treatment or because

of financial incentives in promoting treatment, are not

following the guidelines and are pushing their patients into

unnecessary treatment.

I'm thinking that the best thing that we can do is to make

new patients and their families aware of the guidelines.

Alan

[Guest guest]

I guess I'll have to disagree with Terry again on this. Just because a person has a low grade, low gleason score prostate cancer doesn't mean the cancer won't eventually spread. And watching it grow with multiple PSA tests and biopsies doesn't sound like a lot fun to me. Nobody can really predict the rate of progression of an individual's cancer; if you wait around long enough you may end up with hormonal ablation therapy and then when that fails after 2 years what do you do? I feel a person ought to do surgery or radiation. How can you sleep at night knowing that a cancer is growing inside you, albeit, at a slow rate, and that the cancer may get out of control at any time and kill you? My father died of cancer in his fifties, my mother in her sixties.I vowed I'd never let that happen to me if I could do anything about it. I went the surgery route and have no regrets, early cancer or not..........SCARED TO DEATH BY CATerry Herbert

wrote: You’d have put money on the majority of people being referred to a brachytherapy clinic choosing brachytherapy, wouldn’t you? And that’s what this study shows with 48.2% doing just that. But the thing that I thought demonstrated how far things have change is that the next biggest group (31.8%) chose what was termed in this study Expectant Management – more commonly known as Active Surveillance. This was only a small study – and a Canadian one at that, but wouldn’t it be terrific if more men in the US followed this path and took the advice of Dr Oppenheimer who says on his http://theprostateblog.blogspot.com blog : For the vast majority of men with a recent diagnosis of prostate cancer the most important question is not what treatment is needed, but whether any treatment at all is required. Active surveillance is the logical choice for most men (and the families that love them) to make. How many men and heir families would be spared the inevitable side effects that conventional therapy brings? All the best Terry Herbert I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then. My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard

to prostate cancer are made with inadequate data" From: ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of BSent: Sunday, 21 December 2008 12:38 AMTo: malemedicalproblems ; malemedicalproblemsgooglegroups; ProstateCancerSupport Subject: Re: Treatment Decisions in Patients with Low Risk Prostate Cancer This Canadian study aimed to analyze factors influencing treatment decisions in patients diagnosed with low risk prostate cancer who were referred to a brachytherapy clinic and had to choose from four treatment options: expectant management (watchful waiting), radical prostatectomy, external beam radiation therapy, and permanent seed brachytherapy. Click on below link for the full story: <http://www.urotoday.com/61/browse_categories/prostate_cancer/factors_influencing_treatment_decisions_in_patients_with_low_risk_prostate_cancer_referred_to_a_brachytherapy_clinic__abstract.html>

[Guest guest]

I guess I'll have to disagree with Terry again on this. Just because a person has a low grade, low gleason score prostate cancer doesn't mean the cancer won't eventually spread. And watching it grow with multiple PSA tests and biopsies doesn't sound like a lot fun to me. Nobody can really predict the rate of progression of an individual's cancer; if you wait around long enough you may end up with hormonal ablation therapy and then when that fails after 2 years what do you do? I feel a person ought to do surgery or radiation. How can you sleep at night knowing that a cancer is growing inside you, albeit, at a slow rate, and that the cancer may get out of control at any time and kill you? My father died of cancer in his fifties, my mother in her sixties.I vowed I'd never let that happen to me if I could do anything about it. I went the surgery route and have no regrets, early cancer or not..........SCARED TO DEATH BY CATerry Herbert

wrote: You’d have put money on the majority of people being referred to a brachytherapy clinic choosing brachytherapy, wouldn’t you? And that’s what this study shows with 48.2% doing just that. But the thing that I thought demonstrated how far things have change is that the next biggest group (31.8%) chose what was termed in this study Expectant Management – more commonly known as Active Surveillance. This was only a small study – and a Canadian one at that, but wouldn’t it be terrific if more men in the US followed this path and took the advice of Dr Oppenheimer who says on his http://theprostateblog.blogspot.com blog : For the vast majority of men with a recent diagnosis of prostate cancer the most important question is not what treatment is needed, but whether any treatment at all is required. Active surveillance is the logical choice for most men (and the families that love them) to make. How many men and heir families would be spared the inevitable side effects that conventional therapy brings? All the best Terry Herbert I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then. My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard

to prostate cancer are made with inadequate data" From: ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of BSent: Sunday, 21 December 2008 12:38 AMTo: malemedicalproblems ; malemedicalproblemsgooglegroups; ProstateCancerSupport Subject: Re: Treatment Decisions in Patients with Low Risk Prostate Cancer This Canadian study aimed to analyze factors influencing treatment decisions in patients diagnosed with low risk prostate cancer who were referred to a brachytherapy clinic and had to choose from four treatment options: expectant management (watchful waiting), radical prostatectomy, external beam radiation therapy, and permanent seed brachytherapy. Click on below link for the full story: <http://www.urotoday.com/61/browse_categories/prostate_cancer/factors_influencing_treatment_decisions_in_patients_with_low_risk_prostate_cancer_referred_to_a_brachytherapy_clinic__abstract.html>

[Guest guest]

I think we all accept that there are many reasons to consider active surveillance and then many personal reasons to have immediate treatment.

AS is a way of putting off major treatment and the side effects that come with it. To some men, and/or their partners/wives etc., it is important to be without erectile dysfunction and incontinence. This overrides the doubts about missing the point where early intervention is required.

The 2 years for one hormone ablation drug maybe right for many people, but there are other options, concurrent treatment or alternative hormone ablations. I was diagnosed 12 years ago last July and had radical prostatectomy. It wasn't an easy operation and the pathology results came back with tumour very close to the edge. By the next spring I had rising PSA, for 4 years it didn't do a lot, but in 2000 I started Casodex, then when this failed went on a vaccine trial, after that finished we found a regrowth near he right ureter, I started Zoledex and had radiotherapy, this year I started low dose Diethylstilbesterol, with an anti-clotting agent. Clopidogrel.

Men with stats that point to Active Surveillance will most likely have slow growing tumours which are on the lower scales of agression. A good AS scheme should spot almost all of the rogues very early into the programme.

Terry very rightly makes sure you all know about AS being an option, we all understand if you still chose a radical treatment for personal reasons.

Best wishes

By the way welcome to the many new members who have joined us recently, we now have over 1040 members to exchange concerns with and get support from.

RE: Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

I guess I'll have to disagree with Terry again on this. Just because a person has a low grade, low gleason score prostate cancer doesn't mean the cancer won't eventually spread. And watching it grow with multiple PSA tests and biopsies doesn't sound like a lot fun to me. Nobody can really predict the rate of progression of an individual's cancer; if you wait around long enough you may end up with hormonal ablation therapy and then when that fails after 2 years what do you do? I feel a person ought to do surgery or radiation. How can you sleep at night knowing that a cancer is growing inside you, albeit, at a slow rate, and that the cancer may get out of control at any time and kill you? My father died of cancer in his fifties, my mother in her sixties.I vowed I'd never let that happen to me if I could do anything about it. I went the surgery route and have no regrets, early cancer or not..........SCARED TO DEATH BY CATerry Herbert <ghenesh_49optusnet.au> wrote:

You’d have put money on the majority of people being referred to a brachytherapy clinic choosing brachytherapy, wouldn’t you? And that’s what this study shows with 48.2% doing just that.

But the thing that I thought demonstrated how far things have change is that the next biggest group (31.8%) chose what was termed in this study Expectant Management – more commonly known as Active Surveillance.

This was only a small study – and a Canadian one at that, but wouldn’t it be terrific if more men in the US followed this path and took the advice of Dr Oppenheimer who says on his http://theprostateblog.blogspot.com blog :

For the vast majority of men with a recent diagnosis of prostate cancer the most important question is not what treatment is needed, but whether any treatment at all is required. Active surveillance is the logical choice for most men (and the families that love them) to make.

How many men and heir families would be spared the inevitable side effects that conventional therapy brings?

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data"

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of BSent: Sunday, 21 December 2008 12:38 AMTo: malemedicalproblems ; malemedicalproblemsgooglegroups; ProstateCancerSupport Subject: Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

This Canadian study aimed to analyze factors influencing treatment decisions in patients diagnosed with low risk prostate cancer who were referred to a brachytherapy clinic and had to choose from four treatment options: expectant management (watchful waiting), radical prostatectomy, external beam radiation therapy, and permanent seed brachytherapy.

Click on below link for the full story:

<http://www.urotoday.com/61/browse_categories/prostate_cancer/factors_influencing_treatment_decisions_in_patients_with_low_risk_prostate_cancer_referred_to_a_brachytherapy_clinic__abstract.html>

[Guest guest]

I think we all accept that there are many reasons to consider active surveillance and then many personal reasons to have immediate treatment.

AS is a way of putting off major treatment and the side effects that come with it. To some men, and/or their partners/wives etc., it is important to be without erectile dysfunction and incontinence. This overrides the doubts about missing the point where early intervention is required.

The 2 years for one hormone ablation drug maybe right for many people, but there are other options, concurrent treatment or alternative hormone ablations. I was diagnosed 12 years ago last July and had radical prostatectomy. It wasn't an easy operation and the pathology results came back with tumour very close to the edge. By the next spring I had rising PSA, for 4 years it didn't do a lot, but in 2000 I started Casodex, then when this failed went on a vaccine trial, after that finished we found a regrowth near he right ureter, I started Zoledex and had radiotherapy, this year I started low dose Diethylstilbesterol, with an anti-clotting agent. Clopidogrel.

Men with stats that point to Active Surveillance will most likely have slow growing tumours which are on the lower scales of agression. A good AS scheme should spot almost all of the rogues very early into the programme.

Terry very rightly makes sure you all know about AS being an option, we all understand if you still chose a radical treatment for personal reasons.

Best wishes

By the way welcome to the many new members who have joined us recently, we now have over 1040 members to exchange concerns with and get support from.

RE: Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

I guess I'll have to disagree with Terry again on this. Just because a person has a low grade, low gleason score prostate cancer doesn't mean the cancer won't eventually spread. And watching it grow with multiple PSA tests and biopsies doesn't sound like a lot fun to me. Nobody can really predict the rate of progression of an individual's cancer; if you wait around long enough you may end up with hormonal ablation therapy and then when that fails after 2 years what do you do? I feel a person ought to do surgery or radiation. How can you sleep at night knowing that a cancer is growing inside you, albeit, at a slow rate, and that the cancer may get out of control at any time and kill you? My father died of cancer in his fifties, my mother in her sixties.I vowed I'd never let that happen to me if I could do anything about it. I went the surgery route and have no regrets, early cancer or not..........SCARED TO DEATH BY CATerry Herbert <ghenesh_49optusnet.au> wrote:

You’d have put money on the majority of people being referred to a brachytherapy clinic choosing brachytherapy, wouldn’t you? And that’s what this study shows with 48.2% doing just that.

But the thing that I thought demonstrated how far things have change is that the next biggest group (31.8%) chose what was termed in this study Expectant Management – more commonly known as Active Surveillance.

This was only a small study – and a Canadian one at that, but wouldn’t it be terrific if more men in the US followed this path and took the advice of Dr Oppenheimer who says on his http://theprostateblog.blogspot.com blog :

For the vast majority of men with a recent diagnosis of prostate cancer the most important question is not what treatment is needed, but whether any treatment at all is required. Active surveillance is the logical choice for most men (and the families that love them) to make.

How many men and heir families would be spared the inevitable side effects that conventional therapy brings?

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data"

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of BSent: Sunday, 21 December 2008 12:38 AMTo: malemedicalproblems ; malemedicalproblemsgooglegroups; ProstateCancerSupport Subject: Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

This Canadian study aimed to analyze factors influencing treatment decisions in patients diagnosed with low risk prostate cancer who were referred to a brachytherapy clinic and had to choose from four treatment options: expectant management (watchful waiting), radical prostatectomy, external beam radiation therapy, and permanent seed brachytherapy.

Click on below link for the full story:

<http://www.urotoday.com/61/browse_categories/prostate_cancer/factors_influencing_treatment_decisions_in_patients_with_low_risk_prostate_cancer_referred_to_a_brachytherapy_clinic__abstract.html>

[Guest guest]

I think we all accept that there are many reasons to consider active surveillance and then many personal reasons to have immediate treatment.

AS is a way of putting off major treatment and the side effects that come with it. To some men, and/or their partners/wives etc., it is important to be without erectile dysfunction and incontinence. This overrides the doubts about missing the point where early intervention is required.

The 2 years for one hormone ablation drug maybe right for many people, but there are other options, concurrent treatment or alternative hormone ablations. I was diagnosed 12 years ago last July and had radical prostatectomy. It wasn't an easy operation and the pathology results came back with tumour very close to the edge. By the next spring I had rising PSA, for 4 years it didn't do a lot, but in 2000 I started Casodex, then when this failed went on a vaccine trial, after that finished we found a regrowth near he right ureter, I started Zoledex and had radiotherapy, this year I started low dose Diethylstilbesterol, with an anti-clotting agent. Clopidogrel.

Men with stats that point to Active Surveillance will most likely have slow growing tumours which are on the lower scales of agression. A good AS scheme should spot almost all of the rogues very early into the programme.

Terry very rightly makes sure you all know about AS being an option, we all understand if you still chose a radical treatment for personal reasons.

Best wishes

By the way welcome to the many new members who have joined us recently, we now have over 1040 members to exchange concerns with and get support from.

RE: Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

I guess I'll have to disagree with Terry again on this. Just because a person has a low grade, low gleason score prostate cancer doesn't mean the cancer won't eventually spread. And watching it grow with multiple PSA tests and biopsies doesn't sound like a lot fun to me. Nobody can really predict the rate of progression of an individual's cancer; if you wait around long enough you may end up with hormonal ablation therapy and then when that fails after 2 years what do you do? I feel a person ought to do surgery or radiation. How can you sleep at night knowing that a cancer is growing inside you, albeit, at a slow rate, and that the cancer may get out of control at any time and kill you? My father died of cancer in his fifties, my mother in her sixties.I vowed I'd never let that happen to me if I could do anything about it. I went the surgery route and have no regrets, early cancer or not..........SCARED TO DEATH BY CATerry Herbert <ghenesh_49optusnet.au> wrote:

You’d have put money on the majority of people being referred to a brachytherapy clinic choosing brachytherapy, wouldn’t you? And that’s what this study shows with 48.2% doing just that.

But the thing that I thought demonstrated how far things have change is that the next biggest group (31.8%) chose what was termed in this study Expectant Management – more commonly known as Active Surveillance.

This was only a small study – and a Canadian one at that, but wouldn’t it be terrific if more men in the US followed this path and took the advice of Dr Oppenheimer who says on his http://theprostateblog.blogspot.com blog :

For the vast majority of men with a recent diagnosis of prostate cancer the most important question is not what treatment is needed, but whether any treatment at all is required. Active surveillance is the logical choice for most men (and the families that love them) to make.

How many men and heir families would be spared the inevitable side effects that conventional therapy brings?

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data"

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of BSent: Sunday, 21 December 2008 12:38 AMTo: malemedicalproblems ; malemedicalproblemsgooglegroups; ProstateCancerSupport Subject: Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

This Canadian study aimed to analyze factors influencing treatment decisions in patients diagnosed with low risk prostate cancer who were referred to a brachytherapy clinic and had to choose from four treatment options: expectant management (watchful waiting), radical prostatectomy, external beam radiation therapy, and permanent seed brachytherapy.

Click on below link for the full story:

<http://www.urotoday.com/61/browse_categories/prostate_cancer/factors_influencing_treatment_decisions_in_patients_with_low_risk_prostate_cancer_referred_to_a_brachytherapy_clinic__abstract.html>

[Guest guest]

G’day . Not too sure which part

of my mail you are disagreeing with :- ) As said in his mail we all

accept that there are many personal reasons to have immediate treatment. I

would never criticize anyone for their treatment choice and have never

suggested to anyone that they should take the Active Surveillance path. What I

have done and what I will do is summed up on the opening page of my website:

We want to provide comfort to any man diagnosed with

prostate cancer, to offer thoughtful support to him and his family and to help

them to decide how best to deal with the diagnosis by providing them with and

guiding them to suitable information, being mindful at all times that it is the

individual's ultimate choice that the path he decides to follow is his own and

that of his family, based on his particular circumstances.

Part of that support and part of the

suitable information is to be sure that men are aware of the possibility of Active

Surveillance being a suitable choice for them.

I’d like to just go through what you

have said, not in a critical way, but to demonstrate that you may, perhaps not

be fully aware of the issues.

<snip>

Just because a person has a low grade, low gleason score prostate cancer

doesn't mean the cancer won't eventually spread. <snip> Agreed that

is so, but by the same token there are many low grade, low gleason score

prostate cancers that will never become life threatening. This is one of

the few areas where there is agreement across the entire spectrum of views

in the prostate cancer industry: what is not agreed is what percentage will

not become life threatening.

<snip>

And watching it grow with multiple PSA tests and biopsies doesn't sound

like a lot fun to me. <snip> That is your personal view, but

everyone who is diagnosed with PCa will have multiple PSA tests, as I am

sure you do, because there is no treatment that guarantees ‘cure’.

There are instances of failure of surgery 20 years and more after

treatment. For some men PSA tests are frightening, for others they are

not. I’m with you on the biopsy not being much fun – and my

personal view, not supported by good scientific studies, is that there is

a potential danger in multiple biopsy. But biopsy is not the only way of

keeping an eye on what is happening.

<snip>

Nobody can really predict the rate of progression of an individual's

cancer; <snip> No they cannot. But as more information is gathered

the chances are growing of accurately predicting which version

of the disease is likely to be indolent – slow growing and non-life

threatening – and which are likely to be aggressive and deserving of

early treatment

<snip>

if you wait around long enough you may end up with hormonal ablation

therapy and then when that fails after 2 years what do you do? <snip>

You imply that hormonal therapy [ADT (Androgen Deprivation Therapy)] fails

after two years, but there is simply no evidence that this is so and by

your saying that, you can put real fear into the hearts of people like vjk63

who is concerned about how long their father’s ADT will be

effective. There is ample evidence that ADT can and does last many years

longer than two – a leading oncologist has suggested that this

therapy, properly applied can result in no dimunition of life expectancy. I

waited twelve years before I went onto ADT in August last tear –

I am now off ADT to see what happens, but whatever the future holds, I can

guarantee that I will still be here two years after starting ADT, unless

of course I’m carried off by some other disease or accident –

none of which are predictable either. And of course, there are other

options, even for men with failed ADT

<snip>

I feel a person ought to do surgery or radiation. <snip> That’s

fine; that’s your opinion and you’re entitled to your opinion,

but as is often said, there is no scientific study that demonstrates that

these options are always the best choices.

<snip>

How can you sleep at night knowing that a cancer is growing inside you,

albeit, at a slow rate, and that the cancer may get out of control at any

time and kill you? <snip> I personally do not have a problem

with this issue, but that’s me. I understand how other men would be

very concerned indeed and be disturbed by this thought. It is of interest to

read the only study I know of that has studied this aspect of human behavior

which found that the levels of anxiety in men choosing Active Surveillance

were no different to those in men who had conventional treatment and who

were concerned about their disease returning.

<snip>

My father died of cancer in his fifties, my mother in her sixties. I vowed I'd

never let that happen to me if I could do anything about it. <snip>

I understand where you are coming from, believe me, but again I have

to say that other people have different reactions. This is where issues

get really personal and where we all need be understanding and empathetic –

and not judgmental about being ‘right’ and ‘wrong’.

There is no right and wrong.

<snip>

I went the surgery route and have no regrets, early cancer or not..........SCARED

TO DEATH BY CA <snip> I am glad that you have no regrets about your

surgery. To me that is the right attitude: make a decision and don’t

look back. I sincerely hope that, like the majority of men who have

surgery, your PSAs will stay low as long as you live – and that you

have a long and happy life.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Harwood

Sent: Monday, 22 December 2008

6:53 AM

To: ProstateCancerSupport

Subject: RE:

Re: Treatment Decisions in Patients with Low Risk

Prostate Cancer

I guess

I'll have to disagree with Terry again on this. Just because a person has a low

grade, low gleason score prostate cancer doesn't mean the cancer won't

eventually spread. And watching it grow with multiple PSA tests and biopsies

doesn't sound like a lot fun to me. Nobody can really predict the rate of

progression of an individual's cancer; if you wait around long enough you may

end up with hormonal ablation therapy and then when that fails after 2 years

what do you do? I feel a person ought to do surgery or radiation. How can

you sleep at night knowing that a cancer is growing inside you, albeit, at a

slow rate, and that the cancer may get out of control at any time and kill you?

My father died of cancer in his fifties, my mother in her sixties.I vowed I'd

never let that happen to me if I could do anything about it. I

went the surgery route and have no regrets, early cancer or not..........SCARED

TO DEATH BY CA

Terry

Herbert <ghenesh_49optusnet.au>

wrote:

You’d have put money on the majority

of people being referred to a brachytherapy clinic choosing brachytherapy,

wouldn’t you? And that’s what this study shows with 48.2% doing

just that.

But the thing that I thought

demonstrated how far things have change is that the next biggest group (31.8%)

chose what was termed in this study Expectant Management – more commonly

known as Active Surveillance.

This was only a small study –

and a Canadian one at that, but wouldn’t it be terrific if more men in

the US

followed this path and took the advice of Dr Oppenheimer who says on his http://theprostateblog.blogspot.com

blog :

For the vast majority of men with a recent diagnosis

of prostate cancer the most important question is not what treatment is needed,

but whether any treatment at all is required. Active surveillance is the

logical choice for most men (and the families that love them) to make.

How many men and heir families

would be spared the inevitable side effects that conventional therapy

brings?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that

most of the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of B

Sent: Sunday, 21 December 2008

12:38 AM

To: malemedicalproblems ;

malemedicalproblemsgooglegroups; ProstateCancerSupport

Subject:

Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

This Canadian study aimed to analyze

factors influencing treatment decisions in patients diagnosed with low risk

prostate cancer who were referred to a brachytherapy clinic and had to choose

from four treatment options: expectant management (watchful waiting), radical

prostatectomy, external beam radiation therapy, and permanent seed

brachytherapy.

Click on below link for the

full story:

<http://www.urotoday.com/61/browse_categories/prostate_cancer/factors_influencing_treatment_decisions_in_patients_with_low_risk_prostate_cancer_referred_to_a_brachytherapy_clinic__abstract.html>

[Guest guest]

G’day . Not too sure which part

of my mail you are disagreeing with :- ) As said in his mail we all

accept that there are many personal reasons to have immediate treatment. I

would never criticize anyone for their treatment choice and have never

suggested to anyone that they should take the Active Surveillance path. What I

have done and what I will do is summed up on the opening page of my website:

We want to provide comfort to any man diagnosed with

prostate cancer, to offer thoughtful support to him and his family and to help

them to decide how best to deal with the diagnosis by providing them with and

guiding them to suitable information, being mindful at all times that it is the

individual's ultimate choice that the path he decides to follow is his own and

that of his family, based on his particular circumstances.

Part of that support and part of the

suitable information is to be sure that men are aware of the possibility of Active

Surveillance being a suitable choice for them.

I’d like to just go through what you

have said, not in a critical way, but to demonstrate that you may, perhaps not

be fully aware of the issues.

<snip>

Just because a person has a low grade, low gleason score prostate cancer

doesn't mean the cancer won't eventually spread. <snip> Agreed that

is so, but by the same token there are many low grade, low gleason score

prostate cancers that will never become life threatening. This is one of

the few areas where there is agreement across the entire spectrum of views

in the prostate cancer industry: what is not agreed is what percentage will

not become life threatening.

<snip>

And watching it grow with multiple PSA tests and biopsies doesn't sound

like a lot fun to me. <snip> That is your personal view, but

everyone who is diagnosed with PCa will have multiple PSA tests, as I am

sure you do, because there is no treatment that guarantees ‘cure’.

There are instances of failure of surgery 20 years and more after

treatment. For some men PSA tests are frightening, for others they are

not. I’m with you on the biopsy not being much fun – and my

personal view, not supported by good scientific studies, is that there is

a potential danger in multiple biopsy. But biopsy is not the only way of

keeping an eye on what is happening.

<snip>

Nobody can really predict the rate of progression of an individual's

cancer; <snip> No they cannot. But as more information is gathered

the chances are growing of accurately predicting which version

of the disease is likely to be indolent – slow growing and non-life

threatening – and which are likely to be aggressive and deserving of

early treatment

<snip>

if you wait around long enough you may end up with hormonal ablation

therapy and then when that fails after 2 years what do you do? <snip>

You imply that hormonal therapy [ADT (Androgen Deprivation Therapy)] fails

after two years, but there is simply no evidence that this is so and by

your saying that, you can put real fear into the hearts of people like vjk63

who is concerned about how long their father’s ADT will be

effective. There is ample evidence that ADT can and does last many years

longer than two – a leading oncologist has suggested that this

therapy, properly applied can result in no dimunition of life expectancy. I

waited twelve years before I went onto ADT in August last tear –

I am now off ADT to see what happens, but whatever the future holds, I can

guarantee that I will still be here two years after starting ADT, unless

of course I’m carried off by some other disease or accident –

none of which are predictable either. And of course, there are other

options, even for men with failed ADT

<snip>

I feel a person ought to do surgery or radiation. <snip> That’s

fine; that’s your opinion and you’re entitled to your opinion,

but as is often said, there is no scientific study that demonstrates that

these options are always the best choices.

<snip>

How can you sleep at night knowing that a cancer is growing inside you,

albeit, at a slow rate, and that the cancer may get out of control at any

time and kill you? <snip> I personally do not have a problem

with this issue, but that’s me. I understand how other men would be

very concerned indeed and be disturbed by this thought. It is of interest to

read the only study I know of that has studied this aspect of human behavior

which found that the levels of anxiety in men choosing Active Surveillance

were no different to those in men who had conventional treatment and who

were concerned about their disease returning.

<snip>

My father died of cancer in his fifties, my mother in her sixties. I vowed I'd

never let that happen to me if I could do anything about it. <snip>

I understand where you are coming from, believe me, but again I have

to say that other people have different reactions. This is where issues

get really personal and where we all need be understanding and empathetic –

and not judgmental about being ‘right’ and ‘wrong’.

There is no right and wrong.

<snip>

I went the surgery route and have no regrets, early cancer or not..........SCARED

TO DEATH BY CA <snip> I am glad that you have no regrets about your

surgery. To me that is the right attitude: make a decision and don’t

look back. I sincerely hope that, like the majority of men who have

surgery, your PSAs will stay low as long as you live – and that you

have a long and happy life.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Harwood

Sent: Monday, 22 December 2008

6:53 AM

To: ProstateCancerSupport

Subject: RE:

Re: Treatment Decisions in Patients with Low Risk

Prostate Cancer

I guess

I'll have to disagree with Terry again on this. Just because a person has a low

grade, low gleason score prostate cancer doesn't mean the cancer won't

eventually spread. And watching it grow with multiple PSA tests and biopsies

doesn't sound like a lot fun to me. Nobody can really predict the rate of

progression of an individual's cancer; if you wait around long enough you may

end up with hormonal ablation therapy and then when that fails after 2 years

what do you do? I feel a person ought to do surgery or radiation. How can

you sleep at night knowing that a cancer is growing inside you, albeit, at a

slow rate, and that the cancer may get out of control at any time and kill you?

My father died of cancer in his fifties, my mother in her sixties.I vowed I'd

never let that happen to me if I could do anything about it. I

went the surgery route and have no regrets, early cancer or not..........SCARED

TO DEATH BY CA

Terry

Herbert <ghenesh_49optusnet.au>

wrote:

You’d have put money on the majority

of people being referred to a brachytherapy clinic choosing brachytherapy,

wouldn’t you? And that’s what this study shows with 48.2% doing

just that.

But the thing that I thought

demonstrated how far things have change is that the next biggest group (31.8%)

chose what was termed in this study Expectant Management – more commonly

known as Active Surveillance.

This was only a small study –

and a Canadian one at that, but wouldn’t it be terrific if more men in

the US

followed this path and took the advice of Dr Oppenheimer who says on his http://theprostateblog.blogspot.com

blog :

For the vast majority of men with a recent diagnosis

of prostate cancer the most important question is not what treatment is needed,

but whether any treatment at all is required. Active surveillance is the

logical choice for most men (and the families that love them) to make.

How many men and heir families

would be spared the inevitable side effects that conventional therapy

brings?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that

most of the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of B

Sent: Sunday, 21 December 2008

12:38 AM

To: malemedicalproblems ;

malemedicalproblemsgooglegroups; ProstateCancerSupport

Subject:

Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

This Canadian study aimed to analyze

factors influencing treatment decisions in patients diagnosed with low risk

prostate cancer who were referred to a brachytherapy clinic and had to choose

from four treatment options: expectant management (watchful waiting), radical

prostatectomy, external beam radiation therapy, and permanent seed

brachytherapy.

Click on below link for the

full story:

<http://www.urotoday.com/61/browse_categories/prostate_cancer/factors_influencing_treatment_decisions_in_patients_with_low_risk_prostate_cancer_referred_to_a_brachytherapy_clinic__abstract.html>

[Guest guest]

G’day . Not too sure which part

of my mail you are disagreeing with :- ) As said in his mail we all

accept that there are many personal reasons to have immediate treatment. I

would never criticize anyone for their treatment choice and have never

suggested to anyone that they should take the Active Surveillance path. What I

have done and what I will do is summed up on the opening page of my website:

We want to provide comfort to any man diagnosed with

prostate cancer, to offer thoughtful support to him and his family and to help

them to decide how best to deal with the diagnosis by providing them with and

guiding them to suitable information, being mindful at all times that it is the

individual's ultimate choice that the path he decides to follow is his own and

that of his family, based on his particular circumstances.

Part of that support and part of the

suitable information is to be sure that men are aware of the possibility of Active

Surveillance being a suitable choice for them.

I’d like to just go through what you

have said, not in a critical way, but to demonstrate that you may, perhaps not

be fully aware of the issues.

<snip>

Just because a person has a low grade, low gleason score prostate cancer

doesn't mean the cancer won't eventually spread. <snip> Agreed that

is so, but by the same token there are many low grade, low gleason score

prostate cancers that will never become life threatening. This is one of

the few areas where there is agreement across the entire spectrum of views

in the prostate cancer industry: what is not agreed is what percentage will

not become life threatening.

<snip>

And watching it grow with multiple PSA tests and biopsies doesn't sound

like a lot fun to me. <snip> That is your personal view, but

everyone who is diagnosed with PCa will have multiple PSA tests, as I am

sure you do, because there is no treatment that guarantees ‘cure’.

There are instances of failure of surgery 20 years and more after

treatment. For some men PSA tests are frightening, for others they are

not. I’m with you on the biopsy not being much fun – and my

personal view, not supported by good scientific studies, is that there is

a potential danger in multiple biopsy. But biopsy is not the only way of

keeping an eye on what is happening.

<snip>

Nobody can really predict the rate of progression of an individual's

cancer; <snip> No they cannot. But as more information is gathered

the chances are growing of accurately predicting which version

of the disease is likely to be indolent – slow growing and non-life

threatening – and which are likely to be aggressive and deserving of

early treatment

<snip>

if you wait around long enough you may end up with hormonal ablation

therapy and then when that fails after 2 years what do you do? <snip>

You imply that hormonal therapy [ADT (Androgen Deprivation Therapy)] fails

after two years, but there is simply no evidence that this is so and by

your saying that, you can put real fear into the hearts of people like vjk63

who is concerned about how long their father’s ADT will be

effective. There is ample evidence that ADT can and does last many years

longer than two – a leading oncologist has suggested that this

therapy, properly applied can result in no dimunition of life expectancy. I

waited twelve years before I went onto ADT in August last tear –

I am now off ADT to see what happens, but whatever the future holds, I can

guarantee that I will still be here two years after starting ADT, unless

of course I’m carried off by some other disease or accident –

none of which are predictable either. And of course, there are other

options, even for men with failed ADT

<snip>

I feel a person ought to do surgery or radiation. <snip> That’s

fine; that’s your opinion and you’re entitled to your opinion,

but as is often said, there is no scientific study that demonstrates that

these options are always the best choices.

<snip>

How can you sleep at night knowing that a cancer is growing inside you,

albeit, at a slow rate, and that the cancer may get out of control at any

time and kill you? <snip> I personally do not have a problem

with this issue, but that’s me. I understand how other men would be

very concerned indeed and be disturbed by this thought. It is of interest to

read the only study I know of that has studied this aspect of human behavior

which found that the levels of anxiety in men choosing Active Surveillance

were no different to those in men who had conventional treatment and who

were concerned about their disease returning.

<snip>

My father died of cancer in his fifties, my mother in her sixties. I vowed I'd

never let that happen to me if I could do anything about it. <snip>

I understand where you are coming from, believe me, but again I have

to say that other people have different reactions. This is where issues

get really personal and where we all need be understanding and empathetic –

and not judgmental about being ‘right’ and ‘wrong’.

There is no right and wrong.

<snip>

I went the surgery route and have no regrets, early cancer or not..........SCARED

TO DEATH BY CA <snip> I am glad that you have no regrets about your

surgery. To me that is the right attitude: make a decision and don’t

look back. I sincerely hope that, like the majority of men who have

surgery, your PSAs will stay low as long as you live – and that you

have a long and happy life.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Harwood

Sent: Monday, 22 December 2008

6:53 AM

To: ProstateCancerSupport

Subject: RE:

Re: Treatment Decisions in Patients with Low Risk

Prostate Cancer

I guess

I'll have to disagree with Terry again on this. Just because a person has a low

grade, low gleason score prostate cancer doesn't mean the cancer won't

eventually spread. And watching it grow with multiple PSA tests and biopsies

doesn't sound like a lot fun to me. Nobody can really predict the rate of

progression of an individual's cancer; if you wait around long enough you may

end up with hormonal ablation therapy and then when that fails after 2 years

what do you do? I feel a person ought to do surgery or radiation. How can

you sleep at night knowing that a cancer is growing inside you, albeit, at a

slow rate, and that the cancer may get out of control at any time and kill you?

My father died of cancer in his fifties, my mother in her sixties.I vowed I'd

never let that happen to me if I could do anything about it. I

went the surgery route and have no regrets, early cancer or not..........SCARED

TO DEATH BY CA

Terry

Herbert <ghenesh_49optusnet.au>

wrote:

You’d have put money on the majority

of people being referred to a brachytherapy clinic choosing brachytherapy,

wouldn’t you? And that’s what this study shows with 48.2% doing

just that.

But the thing that I thought

demonstrated how far things have change is that the next biggest group (31.8%)

chose what was termed in this study Expectant Management – more commonly

known as Active Surveillance.

This was only a small study –

and a Canadian one at that, but wouldn’t it be terrific if more men in

the US

followed this path and took the advice of Dr Oppenheimer who says on his http://theprostateblog.blogspot.com

blog :

For the vast majority of men with a recent diagnosis

of prostate cancer the most important question is not what treatment is needed,

but whether any treatment at all is required. Active surveillance is the

logical choice for most men (and the families that love them) to make.

How many men and heir families

would be spared the inevitable side effects that conventional therapy

brings?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that

most of the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of B

Sent: Sunday, 21 December 2008

12:38 AM

To: malemedicalproblems ;

malemedicalproblemsgooglegroups; ProstateCancerSupport

Subject:

Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

This Canadian study aimed to analyze

factors influencing treatment decisions in patients diagnosed with low risk

prostate cancer who were referred to a brachytherapy clinic and had to choose

from four treatment options: expectant management (watchful waiting), radical

prostatectomy, external beam radiation therapy, and permanent seed

brachytherapy.

Click on below link for the

full story:

<http://www.urotoday.com/61/browse_categories/prostate_cancer/factors_influencing_treatment_decisions_in_patients_with_low_risk_prostate_cancer_referred_to_a_brachytherapy_clinic__abstract.html>

[Guest guest]

When I was first diagnosed with prostate cancer and learned that

there is more than one approach to dealing with it I thought,

I'll read the literature, find out what the consensus view of

the best scientists and doctors is, and do that. But as all of

us who have been down that road now know, it's not that simple.

It turns out that experts don't all agree, and we don't know for

certain when treatment is required, what the best treatment will

be, whether it will work and for how long, or what side effects

we're going to have.

Then on top of all that, we find that personal preferences

really do play a role in what we should do.

Imagine that you have been told that you have a cancer that has

a 25% chance of becoming dangerous during your lifetime. If you

get treatment, you won't know if the cancer is cured, but the

odds are now that you only have a 10% chance of the cancer

becoming dangerous. However the treatment gives you a 50%

chance of long term impotence and a 50% chance of long term

incontinence.

What do you do?

You might choose treatment and get the best outcome - no cancer,

no impotence, no incontinence. Or you might get the worst

outcome - impotence and incontinence, and you still have cancer.

Alternatively, you might choose no treatment and get the best

outcome - no symptoms from your cancer and no side effects of

treatment. Or you might get the worst outcome - an agonizing

disease and death ten years before you might otherwise have gone

by a peaceful heart attack.

" Active surveillance " is something of a middle course. You

don't reject treatment, but you decide to wait and see whether

and how much the cancer grows before you opt for treatment.

This approach may incur more risk of cancer death because it

gives the cancer more time to become metastatic, but it also

gives you more information about whether the cancer is really

dangerous and really needs treatment, and also gives you more

time without the risks and side effects of treatment.

If I were a doctor, I think I'd advise most of my patients that

had signs of aggressive cancers to seek immediate treatment.

However for patients that appear to have indolent cancers I'd

explain the advantages and disadvantages of each course and

encourage the patients to take a little time and consider the

issues, consider their own circumstances, and consider their own

priorities, before deciding.

Alan

[Guest guest]

I do not want to offend anybody, I feel your email sums it all up . I chose robotic prostatectomy due to strong family history of cancer (not prostatic but colon, breast; father mother respectively). My outcome is somewhat mixed, my incontinence is totally gone (yay!), my impotence remains, need to have injections with trimix/bimix for sex with wife. Active Surveillence seems like such a foreign concept to me, maybe because my father did nothing about his blood in his stool for over a year until he was too weak to go to work . When he finally went for treatment he was so advanced that he had surgery/chemo/radiation all for naught, died of colon cancer in his fifties. And I know prostate cancer is not colon cancer. My urologist who did the robotic prostatecomy actually said I could wait at least 6 months before doing anything. I would hear none of that, I just could not live day to day knowing I had a cancer growing in me, but that is just me......

When I was first diagnosed with prostate cancer and learned thatthere is more than one approach to dealing with it I thought,I'll read the literature, find out what the consensus view ofthe best scientists and doctors is, and do that. But as all ofus who have been down that road now know, it's not that simple.It turns out that experts don't all agree, and we don't know forcertain when treatment is required, what the best treatment willbe, whether it will work and for how long, or what side effectswe're going to have.Then

on top of all that, we find that personal preferencesreally do play a role in what we should do.Imagine that you have been told that you have a cancer that hasa 25% chance of becoming dangerous during your lifetime. If youget treatment, you won't know if the cancer is cured, but theodds are now that you only have a 10% chance of the cancerbecoming dangerous. However the treatment gives you a 50%chance of long term impotence and a 50% chance of long termincontinence.What do you do?You might choose treatment and get the best outcome - no cancer,no impotence, no incontinence. Or you might get the worstoutcome - impotence and incontinence, and you still have cancer.Alternatively, you might choose no treatment and get the bestoutcome - no symptoms from your cancer and no side effects oftreatment. Or you might get the worst outcome - an agonizingdisease and death ten years before you might otherwise

have goneby a peaceful heart attack."Active surveillance" is something of a middle course. Youdon't reject treatment, but you decide to wait and see whetherand how much the cancer grows before you opt for treatment.This approach may incur more risk of cancer death because itgives the cancer more time to become metastatic, but it alsogives you more information about whether the cancer is reallydangerous and really needs treatment, and also gives you moretime without the risks and side effects of treatment.If I were a doctor, I think I'd advise most of my patients thathad signs of aggressive cancers to seek immediate treatment.However for patients that appear to have indolent cancers I'dexplain the advantages and disadvantages of each course andencourage the patients to take a little time and consider theissues, consider their own circumstances, and consider their ownpriorities, before

deciding.Alan

[Guest guest]

I do not want to offend anybody, I feel your email sums it all up . I chose robotic prostatectomy due to strong family history of cancer (not prostatic but colon, breast; father mother respectively). My outcome is somewhat mixed, my incontinence is totally gone (yay!), my impotence remains, need to have injections with trimix/bimix for sex with wife. Active Surveillence seems like such a foreign concept to me, maybe because my father did nothing about his blood in his stool for over a year until he was too weak to go to work . When he finally went for treatment he was so advanced that he had surgery/chemo/radiation all for naught, died of colon cancer in his fifties. And I know prostate cancer is not colon cancer. My urologist who did the robotic prostatecomy actually said I could wait at least 6 months before doing anything. I would hear none of that, I just could not live day to day knowing I had a cancer growing in me, but that is just me......

When I was first diagnosed with prostate cancer and learned thatthere is more than one approach to dealing with it I thought,I'll read the literature, find out what the consensus view ofthe best scientists and doctors is, and do that. But as all ofus who have been down that road now know, it's not that simple.It turns out that experts don't all agree, and we don't know forcertain when treatment is required, what the best treatment willbe, whether it will work and for how long, or what side effectswe're going to have.Then

on top of all that, we find that personal preferencesreally do play a role in what we should do.Imagine that you have been told that you have a cancer that hasa 25% chance of becoming dangerous during your lifetime. If youget treatment, you won't know if the cancer is cured, but theodds are now that you only have a 10% chance of the cancerbecoming dangerous. However the treatment gives you a 50%chance of long term impotence and a 50% chance of long termincontinence.What do you do?You might choose treatment and get the best outcome - no cancer,no impotence, no incontinence. Or you might get the worstoutcome - impotence and incontinence, and you still have cancer.Alternatively, you might choose no treatment and get the bestoutcome - no symptoms from your cancer and no side effects oftreatment. Or you might get the worst outcome - an agonizingdisease and death ten years before you might otherwise

have goneby a peaceful heart attack."Active surveillance" is something of a middle course. Youdon't reject treatment, but you decide to wait and see whetherand how much the cancer grows before you opt for treatment.This approach may incur more risk of cancer death because itgives the cancer more time to become metastatic, but it alsogives you more information about whether the cancer is reallydangerous and really needs treatment, and also gives you moretime without the risks and side effects of treatment.If I were a doctor, I think I'd advise most of my patients thathad signs of aggressive cancers to seek immediate treatment.However for patients that appear to have indolent cancers I'dexplain the advantages and disadvantages of each course andencourage the patients to take a little time and consider theissues, consider their own circumstances, and consider their ownpriorities, before

deciding.Alan

[Guest guest]

I do not want to offend anybody, I feel your email sums it all up . I chose robotic prostatectomy due to strong family history of cancer (not prostatic but colon, breast; father mother respectively). My outcome is somewhat mixed, my incontinence is totally gone (yay!), my impotence remains, need to have injections with trimix/bimix for sex with wife. Active Surveillence seems like such a foreign concept to me, maybe because my father did nothing about his blood in his stool for over a year until he was too weak to go to work . When he finally went for treatment he was so advanced that he had surgery/chemo/radiation all for naught, died of colon cancer in his fifties. And I know prostate cancer is not colon cancer. My urologist who did the robotic prostatecomy actually said I could wait at least 6 months before doing anything. I would hear none of that, I just could not live day to day knowing I had a cancer growing in me, but that is just me......

When I was first diagnosed with prostate cancer and learned thatthere is more than one approach to dealing with it I thought,I'll read the literature, find out what the consensus view ofthe best scientists and doctors is, and do that. But as all ofus who have been down that road now know, it's not that simple.It turns out that experts don't all agree, and we don't know forcertain when treatment is required, what the best treatment willbe, whether it will work and for how long, or what side effectswe're going to have.Then

on top of all that, we find that personal preferencesreally do play a role in what we should do.Imagine that you have been told that you have a cancer that hasa 25% chance of becoming dangerous during your lifetime. If youget treatment, you won't know if the cancer is cured, but theodds are now that you only have a 10% chance of the cancerbecoming dangerous. However the treatment gives you a 50%chance of long term impotence and a 50% chance of long termincontinence.What do you do?You might choose treatment and get the best outcome - no cancer,no impotence, no incontinence. Or you might get the worstoutcome - impotence and incontinence, and you still have cancer.Alternatively, you might choose no treatment and get the bestoutcome - no symptoms from your cancer and no side effects oftreatment. Or you might get the worst outcome - an agonizingdisease and death ten years before you might otherwise

have goneby a peaceful heart attack."Active surveillance" is something of a middle course. Youdon't reject treatment, but you decide to wait and see whetherand how much the cancer grows before you opt for treatment.This approach may incur more risk of cancer death because itgives the cancer more time to become metastatic, but it alsogives you more information about whether the cancer is reallydangerous and really needs treatment, and also gives you moretime without the risks and side effects of treatment.If I were a doctor, I think I'd advise most of my patients thathad signs of aggressive cancers to seek immediate treatment.However for patients that appear to have indolent cancers I'dexplain the advantages and disadvantages of each course andencourage the patients to take a little time and consider theissues, consider their own circumstances, and consider their ownpriorities, before

deciding.Alan