Re: Things That Puzzle Me About PCa # 14 in an unlimited series

[Guest guest]

Terry Herbert wrote:

> I have written before about my puzzlement as to why prostate

> cancer is not treated as the chronic disease which it is in so

> many cases.

...

> Of course there are side effects to ADT, as there are with all

> therapies. But in most early stage, low aggressive cases if an

> intermittent therapy is applied – and especially if it is what

> might be termed “ADT-lite†– just one form of ADT instead of

> the real heavyweight CAB or ADT3 - the permanent side effects

> will be few and far between.

I think more men are treating the disease as you say, but I can

understand why so many seek more radical treatment.

One reason is the ADT side effect issue that you mention. Many

men hope for one big " hit " from surgery or radiation, after which

they hope to recover and have fewer and fewer side effects. They

often wind up with long term side effects, but they're hoping not

to (and they may be given false hopes by their doctors about how

likely they are to have long term side effects.)

Another is that men look at the odds and say (I'm making up the

numbers here), 10% chance of a really painful and debilitating

final illness, vs. 50% chance of impotence and/or incontinence.

Set those numbers anywhere you please. However you do it, death

from PCa has to be weighted a lot heavier than impotence and

incontinence for most men, so that when they multiply the odds by

the weight, radical treatment seems like a better choice for

them.

Finally, there is the understanding that radical treatment can

only be applied before the disease spreads. Patients worry that

later on they might wish they had had radical treatment, but now

it's too late. So if they're undecided, they may be

uncomfortable giving up the radical treatment option, and fearful

of waiting too long.

Of course all of these decisions and calculations would work much

better if we could really tell the odds of success, the tipping

point when radical treatment won't work, and the odds of side

effects. But alas, those are impossible to determine with any

precision at all in advance of treatment.

Alan

[Guest guest]

Alan you say:

<snip> Another is that men look at

the odds and say (I'm making up the numbers here), 10% chance of a really

painful and debilitating final illness, vs. 50% chance of impotence and/or

incontinence. Set those numbers anywhere you please. However you do it, death

from PCa has to be weighted a lot heavier than impotence and incontinence for

most men, so that when they multiply the odds by the weight, radical treatment

seems like a better choice for them. <snip> I understand what you are

saying about the odds, so we wont go down that road, but the point is that the

claims are that ADT starves tumours – very large, very aggressive tumours

– and that even these very bad boys will then be held at bay for many

years – maybe even permanently. So how well would ADT deal with the

pitifully small cells that are discovered in early stage, confined disease?

<snip> Finally, there is the

understanding that radical treatment can only be applied before the disease

spreads. Patients worry that later on they might wish they had had radical

treatment, but now it's too late. So if they're undecided, they may be

uncomfortable giving up the radical treatment option, and fearful of waiting

too long. <snip> If, as is claimed ADt stops the cells in their tracks,

thereis no need to be concerned about spread.

<snip> Of course all of these

decisions and calculations would work much better if we could really tell the

odds of success, the tipping point when radical treatment won't work, and the

odds of side effects. But alas, those are impossible to determine with any precision

at all in advance of treatment.<snip> Does this not apply to all

disease and all therapies? Do I REALLY know the odds of surviving my hert

failure and subsequent therapy (which differs from my brother’s who had

the same diagnosis!!). My experience is that no matter what the problem is,

there is a tremendous amount of guesswork in diagnosing, choosing treatment and

the outcome. In my cardio case I was told by one doctor that about one third of

men who are having my treatment recover well, about one third maintain their

condition and about one third fail!! Very rough and ready sort of treatment

choiceJ

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 Alan Meyer

Sent: Saturday, 6 February 2010

3:24 PM

To: ProstateCancerSupport

Subject: Re:

Things That Puzzle Me About PCa # 14 in an unlimited

series

Terry Herbert <ghenesh_49optusnet.au>

wrote:

> I have written before about my puzzlement as to why prostate

> cancer is not treated as the chronic disease which it is in so

> many cases.

....

> Of course there are side effects to ADT, as there are with all

> therapies. But in most early stage, low aggressive cases if an

> intermittent therapy is applied – and especially if it is what

> might be termed “ADT-lite” – just one form of ADT

instead of

> the real heavyweight CAB or ADT3 - the permanent side effects

> will be few and far between.

I think more men are treating the disease as you say, but I can

understand why so many seek more radical treatment.

One reason is the ADT side effect issue that you mention. Many

men hope for one big " hit " from surgery or radiation, after which

they hope to recover and have fewer and fewer side effects. They

often wind up with long term side effects, but they're hoping not

to (and they may be given false hopes by their doctors about how

likely they are to have long term side effects.)

Another is that men look at the odds and say (I'm making up the

numbers here), 10% chance of a really painful and debilitating

final illness, vs. 50% chance of impotence and/or incontinence.

Set those numbers anywhere you please. However you do it, death

from PCa has to be weighted a lot heavier than impotence and

incontinence for most men, so that when they multiply the odds by

the weight, radical treatment seems like a better choice for

them.

Finally, there is the understanding that radical treatment can

only be applied before the disease spreads. Patients worry that

later on they might wish they had had radical treatment, but now

it's too late. So if they're undecided, they may be

uncomfortable giving up the radical treatment option, and fearful

of waiting too long.

Of course all of these decisions and calculations would work much

better if we could really tell the odds of success, the tipping

point when radical treatment won't work, and the odds of side

effects. But alas, those are impossible to determine with any

precision at all in advance of treatment.

Alan