Re: Active surveillance patient selection and management

[Guest guest]

You do not understand what has happened to American care in Hospitals. 1. After surgy they are out in one or two days. 2. There are no antibodies and test conducted-all are considered extra. 3. Dr.s are managed by Health care associations and insurance not need of care. 4. Minimal care and assembly line surgies with the cheapest methods-not the best or even what is good for your care and recovery.

I could go on but you get the idea. Health care under for profit has reduced care to the very minimal of anything to get the job done. They do not about comfort or recovery times etc.

Tom W.

To: ProstateCancerSupport ; newdx@...; ww@...Sent: Sat, October 23, 2010 6:47:10 AMSubject: Active surveillance patient selection and management

Active surveillance for prostate cancer: patient selection and management L. Klotz, MD is a paper published in last month’s Current Oncology. I think it gives a very useful overview of the current issues surrounding Active Surveillance and should be read by any newly diagnosed man or anyone contemplating Active Surveillance as their ‘therapy’ of choice.

Some of the key points are:

1. A diagnosis of cancer often results, at least initially, in “cancer hysteriaâ€â€”that is, a perfectly understandable reflexive fear of an aggressive life-threatening condition. For some cancers this fear is warranted, but for most men with favourable-risk prostate cancer, their condition is far removed from that of a rampaging, aggressive disease. Most men with favourable-risk prostate cancer are not destined to die of their disease, even in the absence of treatment. This view is echoed by luminaries such as Dr Logothetis who said many years ago

“One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.â€

And Dr Jonathon Oppenheimer who said

“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.â€

2. Some studies demonstrated that prostate cancer typically begins in the third or fourth decade of life yet the median age of death from prostate cancer is about 80 years. Dr Klotz says this implies a 50-year time course from inception to mortality and that most patients have a long window of curability, which is particularly true for patients with favourable-risk, low-volume disease. It also implies that young age at diagnosis should not preclude a surveillance approach. Of course there are tragic cases of young men dying from the disease, but as Dr Klotz says they generally have high-grade disease at the outset and represent a very small proportion of prostate cancer patients. According to the current SEER data less than 10% of cancer deaths (which account for about 3% of all male deaths) occur in men under the age of 54.

3. Although approximately 200 patients have been followed for between 10 and 15 years, it is acknowledged that most of the studies have immature data and it will be another 5-7 years before a median follow-up of fifteen years can be achieved. This will be a good deal longer than many of the published studies for other therapies which often have a median follow-up of five years or even less. In one study where 50% of the surveillance patients were eventually treated, absolutely no difference was observed in the mortality or the metastasis rate at a median follow up of about 8 years.

4. The paper sets out various criteria for the clinical follow-up for men who choose Active Surveillance and it is interesting to note the move away from the concept of frequent biopsy procedures once the basic diagnosis has been confirmed after 12 months. This will diminish what is sometimes referred to as a ‘side effect’ of Active Surveillance.

Choosing Active Surveillance is not without its risks, as are all options for the man diagnosed with prostate cancer. This paper does not deal with any potential loss of quality of life (QOL) that may come with the election of the AS option or make any comparison with QOL issues associated other therapy options.

The paper can be accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

[Guest guest]

Terry

I agree with this, but we have to be careful that active surveillance criteria is followed. It can't be diagnose and forget.

Active surveillance patient selection and management

Active surveillance for prostate cancer: patient selection and management L. Klotz, MD is a paper published in last month’s Current Oncology. I think it gives a very useful overview of the current issues surrounding Active Surveillance and should be read by any newly diagnosed man or anyone contemplating Active Surveillance as their ‘therapy’ of choice.

Some of the key points are:

1. A diagnosis of cancer often results, at least initially, in “cancer hysteria”—that is, a perfectly understandable reflexive fear of an aggressive life-threatening condition. For some cancers this fear is warranted, but for most men with favourable-risk prostate cancer, their condition is far removed from that of a rampaging, aggressive disease. Most men with favourable-risk prostate cancer are not destined to die of their disease, even in the absence of treatment. This view is echoed by luminaries such as Dr Logothetis who said many years ago

“One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.”

And Dr Jonathon Oppenheimer who said

“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.”

2. Some studies demonstrated that prostate cancer typically begins in the third or fourth decade of life yet the median age of death from prostate cancer is about 80 years. Dr Klotz says this implies a 50-year time course from inception to mortality and that most patients have a long window of curability, which is particularly true for patients with favourable-risk, low-volume disease. It also implies that young age at diagnosis should not preclude a surveillance approach. Of course there are tragic cases of young men dying from the disease, but as Dr Klotz says they generally have high-grade disease at the outset and represent a very small proportion of prostate cancer patients. According to the current SEER data less than 10% of cancer deaths (which account for about 3% of all male deaths) occur in men under the age of 54.

3. Although approximately 200 patients have been followed for between 10 and 15 years, it is acknowledged that most of the studies have immature data and it will be another 5-7 years before a median follow-up of fifteen years can be achieved. This will be a good deal longer than many of the published studies for other therapies which often have a median follow-up of five years or even less. In one study where 50% of the surveillance patients were eventually treated, absolutely no difference was observed in the mortality or the metastasis rate at a median follow up of about 8 years.

4. The paper sets out various criteria for the clinical follow-up for men who choose Active Surveillance and it is interesting to note the move away from the concept of frequent biopsy procedures once the basic diagnosis has been confirmed after 12 months. This will diminish what is sometimes referred to as a ‘side effect’ of Active Surveillance.

Choosing Active Surveillance is not without its risks, as are all options for the man diagnosed with prostate cancer. This paper does not deal with any potential loss of quality of life (QOL) that may come with the election of the AS option or make any comparison with QOL issues associated other therapy options.

The paper can be accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

[Guest guest]

Before my surgery, the Dr. placed me on a "cocktail" of antibiotics for some three days. He also insisted that a perform a colonoscopy prep-like bowel cleansing prior to surgery, and continued me on antibiotics for some two to three days afterwords. Because he was using the perineal access approach, he was most concerned of infection should the bowel be nicked during surgery and these precaution would prevent the need to perform a temporary colostomy should nicking happen. I was in the hospital for just a day and a half. Recovery time for the perineal approach, though considered to be old-fashioned by many Drs. has the advantage of recovery time comparable to that of robotic surgery. The hospital used was a non-profit hospital.Louis. . . To: ProstateCancerSupport Sent: Sat, October 23, 2010 2:32:14 AMSubject: Re: Active surveillance patient selection and management

You do not understand what has happened to American care in Hospitals. 1. After surgy they are out in one or two days. 2. There are no antibodies and test conducted-all are considered extra. 3. Dr.s are managed by Health care associations and insurance not need of care. 4. Minimal care and assembly line surgies with the cheapest methods-not the best or even what is good for your care and recovery.

I could go on but you get the idea. Health care under for profit has reduced care to the very minimal of anything to get the job done. They do not about comfort or recovery times etc.

Tom W.

To: ProstateCancerSupport ; newdx@...; ww@...Sent: Sat, October 23, 2010 6:47:10 AMSubject: Active surveillance patient selection and management

Active surveillance for prostate cancer: patient selection and management L. Klotz, MD is a paper published in last month’s Current Oncology. I think it gives a very useful overview of the current issues surrounding Active Surveillance and should be read by any newly diagnosed man or anyone contemplating Active Surveillance as their ‘therapy’ of choice.

Some of the key points are:

1. A diagnosis of cancer often results, at least initially, in “cancer hysteriaâ€â€”that is, a perfectly understandable reflexive fear of an aggressive life-threatening condition. For some cancers this fear is warranted, but for most men with favourable-risk prostate cancer, their condition is far removed from that of a rampaging, aggressive disease. Most men with favourable-risk prostate cancer are not destined to die of their disease, even in the absence of treatment. This view is echoed by luminaries such as Dr Logothetis who said many years ago

“One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.â€

And Dr Jonathon Oppenheimer who said

“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.â€

2. Some studies demonstrated that prostate cancer typically begins in the third or fourth decade of life yet the median age of death from prostate cancer is about 80 years. Dr Klotz says this implies a 50-year time course from inception to mortality and that most patients have a long window of curability, which is particularly true for patients with favourable-risk, low-volume disease. It also implies that young age at diagnosis should not preclude a surveillance approach. Of course there are tragic cases of young men dying from the disease, but as Dr Klotz says they generally have high-grade disease at the outset and represent a very small proportion of prostate cancer patients. According to the current SEER data less than 10% of cancer deaths (which account for about 3% of all male deaths) occur in men under the age of 54.

3. Although approximately 200 patients have been followed for between 10 and 15 years, it is acknowledged that most of the studies have immature data and it will be another 5-7 years before a median follow-up of fifteen years can be achieved. This will be a good deal longer than many of the published studies for other therapies which often have a median follow-up of five years or even less. In one study where 50% of the surveillance patients were eventually treated, absolutely no difference was observed in the mortality or the metastasis rate at a median follow up of about 8 years.

4. The paper sets out various criteria for the clinical follow-up for men who choose Active Surveillance and it is interesting to note the move away from the concept of frequent biopsy procedures once the basic diagnosis has been confirmed after 12 months. This will diminish what is sometimes referred to as a ‘side effect’ of Active Surveillance.

Choosing Active Surveillance is not without its risks, as are all options for the man diagnosed with prostate cancer. This paper does not deal with any potential loss of quality of life (QOL) that may come with the election of the AS option or make any comparison with QOL issues associated other therapy options.

The paper can be accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

[Guest guest]

Dear Louis,My husband had the same surgery this past Feb. Exactly!! However, he ended up with a hematoma after 5 days, that was not detected until the 7th day, as no one came to visit or check him out after he left the hospital after 1 day in the hospital. Then we went back to dr.s office, and had catheter out on day 8. They thought his urethra was healed, (no test) but when we got home, he urinated through the incision site, and not the penis. Back to the doctors office, where the catheter was re-inserted for another 3 weeks, (test done here)... then another 3 weeks with catheter and finally removed with no test at 8 weeks post surgery. The last week of catheter, husband had terrible bladder spasms...! This doctor did not work with insurance companies, in order to provide

the best care possible. We submitted all our own cost to our insurance company and they reimbursed us.Now today, my husband is still not healed, 8 months after surgery, he cannot sit, and has rectal pain internally and at the site of the perineal prostatectomy incision that is disabling so much, he has not been able to return to his medical profession! Basically may have to retire and collect disability at age 57. Results of the Perineal Prostatectomy is being called, Pudendal nerve damage...that we finally diagnosed through the internet by finding other patients with this very un-researched medical complication. No doctor has even hinted it could be due to his surgery, or post op problems. However, my husband had NO problems ever in this area before.The reason my husband had the surgery -- like you-- was because our very knowledgeable, and good doctor said it had less complications! We believed him totally, and were

reacting too emotionally to the "dealing with of cancer", that we did not do more investigation of the many different ways to treat PC, and get other second, third or even 4 opinions. Today, the POST OP COMPLICATIONS are reported to be so numerous and devistating to the people who have had PC surgery, that the ACTIVE WATCHING and MONITORING of the disease is becoming a way of the future! WISH WE WOULD have been told this too...but our doctor was truly in the belief, "take it out, and have no worry!" He was right! No worry...but instead...My husband lives with much pain, emotional turmoil and social complications!Living with "knowing cancer is in you" is something that is hard. But if you have to live the rest of your life in excruciating pain, or debilitating circumstances (incontinence, impotence, loss of employment and social life)...they can be just as "worrisome" and

debilitating! If you look at the statistics...my husbands post op complications are rare...but it is a possible complication that others should know about! When anyone decides to have PC surgery ...I think they should be made aware of ALL the complications that HAVE occured thus far from these surgeries...even if it is rare! Pudendal nerve damage usually results in a LIFE TIME of pain...and living with constant physical pain, for the rest of your life, is much worse than living with other PC post op problems. It is our own faults, and we should have gotten many other opinions on PC surgery before choosing what our home town EXPERT doctor said, was the BEST! We believed what we wanted to...and what the convincing doctor led us to believe. He said "check out the statistics"....however, there is not ONE PLACE that statistics are gathered that truly show the post op complications that each different PC surgery have resulted in! Each doctor keeps (and records) his own stats...and the post op complications are often "over looked" or made to look "less complicated" then they are! In our case...we can get NO ONE who will help with his condition now! We have to go out of state to find help. Our urologist and area doctors are very leary to get involved in the results of a doctors surgery complications, most likely because of "law suit" worries. However, where does this leave the patient?Out on his own!We do not want to sue...just want help in getting his problem under control to be out of pain!Summary of this whole email....For Patients with PC---DO YOUR RESEARCH...PRAY...and then choose wisely! And keep in mind you work with your doctor, and need to respect him or

her.For Urologist doing PC Surgery -- Keep ACCURATE Statistics -- and follow up with your patients!! Be humble when "complication" or "bad result" happen, and listen, believe, and help your patients as much as possible. Keeping record and stats of "Complications" from PC surgeries will only lead to doing better surgeries in the future, and helping your patients more! mkTo: ProstateCancerSupport Sent: Sat, October 23, 2010 8:20:39

AMSubject: Re: Active surveillance patient selection and management

Before my surgery, the Dr. placed me on a "cocktail" of antibiotics for some three days. He also insisted that a perform a colonoscopy prep-like bowel cleansing prior to surgery, and continued me on antibiotics for some two to three days afterwords. Because he was using the perineal access approach, he was most concerned of infection should the bowel be nicked during surgery and these precaution would prevent the need to perform a temporary colostomy should nicking happen. I was in the hospital for just a day and a half. Recovery time for the perineal approach, though considered to be old-fashioned by many Drs. has the advantage of recovery time comparable to that of robotic surgery. The hospital used was a non-profit hospital.Louis. . . To: ProstateCancerSupport Sent: Sat, October 23, 2010 2:32:14 AMSubject: Re: Active surveillance patient selection and management

You do not understand what has happened to American care in Hospitals. 1. After surgy they are out in one or two days. 2. There are no antibodies and test conducted-all are considered extra. 3. Dr.s are managed by Health care associations and insurance not need of care. 4. Minimal care and assembly line surgies with the cheapest methods-not the best or even what is good for your care and recovery.

I could go on but you get the idea. Health care under for profit has reduced care to the very minimal of anything to get the job done. They do not about comfort or recovery times etc.

Tom W.

To: ProstateCancerSupport ; newdx@...; ww@...Sent: Sat, October 23, 2010 6:47:10 AMSubject: Active surveillance patient selection and management

Active surveillance for prostate cancer: patient selection and management L. Klotz, MD is a paper published in last month’s Current Oncology. I think it gives a very useful overview of the current issues surrounding Active Surveillance and should be read by any newly diagnosed man or anyone contemplating Active Surveillance as their ‘therapy’ of choice.

Some of the key points are:

1. A diagnosis of cancer often results, at least initially, in “cancer hysteriaâ€â€”that is, a perfectly understandable reflexive fear of an aggressive life-threatening condition. For some cancers this fear is warranted, but for most men with favourable-risk prostate cancer, their condition is far removed from that of a rampaging, aggressive disease. Most men with favourable-risk prostate cancer are not destined to die of their disease, even in the absence of treatment. This view is echoed by luminaries such as Dr Logothetis who said many years ago

“One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.â€

And Dr Jonathon Oppenheimer who said

“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.â€

2. Some studies demonstrated that prostate cancer typically begins in the third or fourth decade of life yet the median age of death from prostate cancer is about 80 years. Dr Klotz says this implies a 50-year time course from inception to mortality and that most patients have a long window of curability, which is particularly true for patients with favourable-risk, low-volume disease. It also implies that young age at diagnosis should not preclude a surveillance approach. Of course there are tragic cases of young men dying from the disease, but as Dr Klotz says they generally have high-grade disease at the outset and represent a very small proportion of prostate cancer patients. According to the current SEER data less than 10% of cancer deaths (which account for about 3% of all male deaths) occur in men under the age of 54.

3. Although approximately 200 patients have been followed for between 10 and 15 years, it is acknowledged that most of the studies have immature data and it will be another 5-7 years before a median follow-up of fifteen years can be achieved. This will be a good deal longer than many of the published studies for other therapies which often have a median follow-up of five years or even less. In one study where 50% of the surveillance patients were eventually treated, absolutely no difference was observed in the mortality or the metastasis rate at a median follow up of about 8 years.

4. The paper sets out various criteria for the clinical follow-up for men who choose Active Surveillance and it is interesting to note the move away from the concept of frequent biopsy procedures once the basic diagnosis has been confirmed after 12 months. This will diminish what is sometimes referred to as a ‘side effect’ of Active Surveillance.

Choosing Active Surveillance is not without its risks, as are all options for the man diagnosed with prostate cancer. This paper does not deal with any potential loss of quality of life (QOL) that may come with the election of the AS option or make any comparison with QOL issues associated other therapy options.

The paper can be accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

[Guest guest]

Dear Louis,My husband had the same surgery this past Feb. Exactly!! However, he ended up with a hematoma after 5 days, that was not detected until the 7th day, as no one came to visit or check him out after he left the hospital after 1 day in the hospital. Then we went back to dr.s office, and had catheter out on day 8. They thought his urethra was healed, (no test) but when we got home, he urinated through the incision site, and not the penis. Back to the doctors office, where the catheter was re-inserted for another 3 weeks, (test done here)... then another 3 weeks with catheter and finally removed with no test at 8 weeks post surgery. The last week of catheter, husband had terrible bladder spasms...! This doctor did not work with insurance companies, in order to provide

the best care possible. We submitted all our own cost to our insurance company and they reimbursed us.Now today, my husband is still not healed, 8 months after surgery, he cannot sit, and has rectal pain internally and at the site of the perineal prostatectomy incision that is disabling so much, he has not been able to return to his medical profession! Basically may have to retire and collect disability at age 57. Results of the Perineal Prostatectomy is being called, Pudendal nerve damage...that we finally diagnosed through the internet by finding other patients with this very un-researched medical complication. No doctor has even hinted it could be due to his surgery, or post op problems. However, my husband had NO problems ever in this area before.The reason my husband had the surgery -- like you-- was because our very knowledgeable, and good doctor said it had less complications! We believed him totally, and were

reacting too emotionally to the "dealing with of cancer", that we did not do more investigation of the many different ways to treat PC, and get other second, third or even 4 opinions. Today, the POST OP COMPLICATIONS are reported to be so numerous and devistating to the people who have had PC surgery, that the ACTIVE WATCHING and MONITORING of the disease is becoming a way of the future! WISH WE WOULD have been told this too...but our doctor was truly in the belief, "take it out, and have no worry!" He was right! No worry...but instead...My husband lives with much pain, emotional turmoil and social complications!Living with "knowing cancer is in you" is something that is hard. But if you have to live the rest of your life in excruciating pain, or debilitating circumstances (incontinence, impotence, loss of employment and social life)...they can be just as "worrisome" and

debilitating! If you look at the statistics...my husbands post op complications are rare...but it is a possible complication that others should know about! When anyone decides to have PC surgery ...I think they should be made aware of ALL the complications that HAVE occured thus far from these surgeries...even if it is rare! Pudendal nerve damage usually results in a LIFE TIME of pain...and living with constant physical pain, for the rest of your life, is much worse than living with other PC post op problems. It is our own faults, and we should have gotten many other opinions on PC surgery before choosing what our home town EXPERT doctor said, was the BEST! We believed what we wanted to...and what the convincing doctor led us to believe. He said "check out the statistics"....however, there is not ONE PLACE that statistics are gathered that truly show the post op complications that each different PC surgery have resulted in! Each doctor keeps (and records) his own stats...and the post op complications are often "over looked" or made to look "less complicated" then they are! In our case...we can get NO ONE who will help with his condition now! We have to go out of state to find help. Our urologist and area doctors are very leary to get involved in the results of a doctors surgery complications, most likely because of "law suit" worries. However, where does this leave the patient?Out on his own!We do not want to sue...just want help in getting his problem under control to be out of pain!Summary of this whole email....For Patients with PC---DO YOUR RESEARCH...PRAY...and then choose wisely! And keep in mind you work with your doctor, and need to respect him or

her.For Urologist doing PC Surgery -- Keep ACCURATE Statistics -- and follow up with your patients!! Be humble when "complication" or "bad result" happen, and listen, believe, and help your patients as much as possible. Keeping record and stats of "Complications" from PC surgeries will only lead to doing better surgeries in the future, and helping your patients more! mkTo: ProstateCancerSupport Sent: Sat, October 23, 2010 8:20:39

AMSubject: Re: Active surveillance patient selection and management

Before my surgery, the Dr. placed me on a "cocktail" of antibiotics for some three days. He also insisted that a perform a colonoscopy prep-like bowel cleansing prior to surgery, and continued me on antibiotics for some two to three days afterwords. Because he was using the perineal access approach, he was most concerned of infection should the bowel be nicked during surgery and these precaution would prevent the need to perform a temporary colostomy should nicking happen. I was in the hospital for just a day and a half. Recovery time for the perineal approach, though considered to be old-fashioned by many Drs. has the advantage of recovery time comparable to that of robotic surgery. The hospital used was a non-profit hospital.Louis. . . To: ProstateCancerSupport Sent: Sat, October 23, 2010 2:32:14 AMSubject: Re: Active surveillance patient selection and management

You do not understand what has happened to American care in Hospitals. 1. After surgy they are out in one or two days. 2. There are no antibodies and test conducted-all are considered extra. 3. Dr.s are managed by Health care associations and insurance not need of care. 4. Minimal care and assembly line surgies with the cheapest methods-not the best or even what is good for your care and recovery.

I could go on but you get the idea. Health care under for profit has reduced care to the very minimal of anything to get the job done. They do not about comfort or recovery times etc.

Tom W.

To: ProstateCancerSupport ; newdx@...; ww@...Sent: Sat, October 23, 2010 6:47:10 AMSubject: Active surveillance patient selection and management

Active surveillance for prostate cancer: patient selection and management L. Klotz, MD is a paper published in last month’s Current Oncology. I think it gives a very useful overview of the current issues surrounding Active Surveillance and should be read by any newly diagnosed man or anyone contemplating Active Surveillance as their ‘therapy’ of choice.

Some of the key points are:

1. A diagnosis of cancer often results, at least initially, in “cancer hysteriaâ€â€”that is, a perfectly understandable reflexive fear of an aggressive life-threatening condition. For some cancers this fear is warranted, but for most men with favourable-risk prostate cancer, their condition is far removed from that of a rampaging, aggressive disease. Most men with favourable-risk prostate cancer are not destined to die of their disease, even in the absence of treatment. This view is echoed by luminaries such as Dr Logothetis who said many years ago

“One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.â€

And Dr Jonathon Oppenheimer who said

“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.â€

2. Some studies demonstrated that prostate cancer typically begins in the third or fourth decade of life yet the median age of death from prostate cancer is about 80 years. Dr Klotz says this implies a 50-year time course from inception to mortality and that most patients have a long window of curability, which is particularly true for patients with favourable-risk, low-volume disease. It also implies that young age at diagnosis should not preclude a surveillance approach. Of course there are tragic cases of young men dying from the disease, but as Dr Klotz says they generally have high-grade disease at the outset and represent a very small proportion of prostate cancer patients. According to the current SEER data less than 10% of cancer deaths (which account for about 3% of all male deaths) occur in men under the age of 54.

3. Although approximately 200 patients have been followed for between 10 and 15 years, it is acknowledged that most of the studies have immature data and it will be another 5-7 years before a median follow-up of fifteen years can be achieved. This will be a good deal longer than many of the published studies for other therapies which often have a median follow-up of five years or even less. In one study where 50% of the surveillance patients were eventually treated, absolutely no difference was observed in the mortality or the metastasis rate at a median follow up of about 8 years.

4. The paper sets out various criteria for the clinical follow-up for men who choose Active Surveillance and it is interesting to note the move away from the concept of frequent biopsy procedures once the basic diagnosis has been confirmed after 12 months. This will diminish what is sometimes referred to as a ‘side effect’ of Active Surveillance.

Choosing Active Surveillance is not without its risks, as are all options for the man diagnosed with prostate cancer. This paper does not deal with any potential loss of quality of life (QOL) that may come with the election of the AS option or make any comparison with QOL issues associated other therapy options.

The paper can be accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

[Guest guest]

Tom, I respectifully disagree.

In the past 15 years I have had triple-bypass surgery and prostate surgery, and I believe I got the best possible care from my doctors and the hospitals. In neither case was I rushed to make a decision on treatment, and I was given a full plate of choices, in the case of prostate cancer, that included active surveillance.

I would point out that more than half a million patients come from other countries, including the U.K., Germany, France, and Canada, to be treated by American doctors in American hospitals.

Further, most of the protocols for what will be covered by insurance are set by Medicare. That is, private insurance companies pay for what Medicare has agreed to pay for, only they pay more than Medicare does. Many doctors have stopped taking Medicare patients because Medicare payments are so low they can't cover their costs.

Mike C.

Subject: Re: Active surveillance patient selection and managementTo: ProstateCancerSupport Date: Saturday, October 23, 2010, 2:32 AM

You do not understand what has happened to American care in Hospitals. 1. After surgy they are out in one or two days. 2. There are no antibodies and test conducted-all are considered extra. 3. Dr.s are managed by Health care associations and insurance not need of care. 4. Minimal care and assembly line surgies with the cheapest methods-not the best or even what is good for your care and recovery.

I could go on but you get the idea. Health care under for profit has reduced care to the very minimal of anything to get the job done. They do not about comfort or recovery times etc.

Tom W.

To: ProstateCancerSupport ; newdx@...; ww@...Sent: Sat, October 23, 2010 6:47:10 AMSubject: Active surveillance patient selection and management

Active surveillance for prostate cancer: patient selection and management L. Klotz, MD is a paper published in last month’s Current Oncology. I think it gives a very useful overview of the current issues surrounding Active Surveillance and should be read by any newly diagnosed man or anyone contemplating Active Surveillance as their ‘therapy’ of choice.

Some of the key points are:

1. A diagnosis of cancer often results, at least initially, in “cancer hysteriaâ€â€”that is, a perfectly understandable reflexive fear of an aggressive life-threatening condition. For some cancers this fear is warranted, but for most men with favourable-risk prostate cancer, their condition is far removed from that of a rampaging, aggressive disease. Most men with favourable-risk prostate cancer are not destined to die of their disease, even in the absence of treatment. This view is echoed by luminaries such as Dr Logothetis who said many years ago

“One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.â€

And Dr Jonathon Oppenheimer who said

“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.â€

2. Some studies demonstrated that prostate cancer typically begins in the third or fourth decade of life yet the median age of death from prostate cancer is about 80 years. Dr Klotz says this implies a 50-year time course from inception to mortality and that most patients have a long window of curability, which is particularly true for patients with favourable-risk, low-volume disease. It also implies that young age at diagnosis should not preclude a surveillance approach. Of course there are tragic cases of young men dying from the disease, but as Dr Klotz says they generally have high-grade disease at the outset and represent a very small proportion of prostate cancer patients. According to the current SEER data less than 10% of cancer deaths (which account for about 3% of all male deaths) occur in men under the age of

54.

3. Although approximately 200 patients have been followed for between 10 and 15 years, it is acknowledged that most of the studies have immature data and it will be another 5-7 years before a median follow-up of fifteen years can be achieved. This will be a good deal longer than many of the published studies for other therapies which often have a median follow-up of five years or even less. In one study where 50% of the surveillance patients were eventually treated, absolutely no difference was observed in the mortality or the metastasis rate at a median follow up of about 8 years.

4. The paper sets out various criteria for the clinical follow-up for men who choose Active Surveillance and it is interesting to note the move away from the concept of frequent biopsy procedures once the basic diagnosis has been confirmed after 12 months. This will diminish what is sometimes referred to as a ‘side effect’ of Active Surveillance.

Choosing Active Surveillance is not without its risks, as are all options for the man diagnosed with prostate cancer. This paper does not deal with any potential loss of quality of life (QOL) that may come with the election of the AS option or make any comparison with QOL issues associated other therapy options.

The paper can be accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

[Guest guest]

Tom, I respectifully disagree.

In the past 15 years I have had triple-bypass surgery and prostate surgery, and I believe I got the best possible care from my doctors and the hospitals. In neither case was I rushed to make a decision on treatment, and I was given a full plate of choices, in the case of prostate cancer, that included active surveillance.

I would point out that more than half a million patients come from other countries, including the U.K., Germany, France, and Canada, to be treated by American doctors in American hospitals.

Further, most of the protocols for what will be covered by insurance are set by Medicare. That is, private insurance companies pay for what Medicare has agreed to pay for, only they pay more than Medicare does. Many doctors have stopped taking Medicare patients because Medicare payments are so low they can't cover their costs.

Mike C.

Subject: Re: Active surveillance patient selection and managementTo: ProstateCancerSupport Date: Saturday, October 23, 2010, 2:32 AM

You do not understand what has happened to American care in Hospitals. 1. After surgy they are out in one or two days. 2. There are no antibodies and test conducted-all are considered extra. 3. Dr.s are managed by Health care associations and insurance not need of care. 4. Minimal care and assembly line surgies with the cheapest methods-not the best or even what is good for your care and recovery.

I could go on but you get the idea. Health care under for profit has reduced care to the very minimal of anything to get the job done. They do not about comfort or recovery times etc.

Tom W.

To: ProstateCancerSupport ; newdx@...; ww@...Sent: Sat, October 23, 2010 6:47:10 AMSubject: Active surveillance patient selection and management

Active surveillance for prostate cancer: patient selection and management L. Klotz, MD is a paper published in last month’s Current Oncology. I think it gives a very useful overview of the current issues surrounding Active Surveillance and should be read by any newly diagnosed man or anyone contemplating Active Surveillance as their ‘therapy’ of choice.

Some of the key points are:

1. A diagnosis of cancer often results, at least initially, in “cancer hysteriaâ€â€”that is, a perfectly understandable reflexive fear of an aggressive life-threatening condition. For some cancers this fear is warranted, but for most men with favourable-risk prostate cancer, their condition is far removed from that of a rampaging, aggressive disease. Most men with favourable-risk prostate cancer are not destined to die of their disease, even in the absence of treatment. This view is echoed by luminaries such as Dr Logothetis who said many years ago

“One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.â€

And Dr Jonathon Oppenheimer who said

“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.â€

2. Some studies demonstrated that prostate cancer typically begins in the third or fourth decade of life yet the median age of death from prostate cancer is about 80 years. Dr Klotz says this implies a 50-year time course from inception to mortality and that most patients have a long window of curability, which is particularly true for patients with favourable-risk, low-volume disease. It also implies that young age at diagnosis should not preclude a surveillance approach. Of course there are tragic cases of young men dying from the disease, but as Dr Klotz says they generally have high-grade disease at the outset and represent a very small proportion of prostate cancer patients. According to the current SEER data less than 10% of cancer deaths (which account for about 3% of all male deaths) occur in men under the age of

54.

3. Although approximately 200 patients have been followed for between 10 and 15 years, it is acknowledged that most of the studies have immature data and it will be another 5-7 years before a median follow-up of fifteen years can be achieved. This will be a good deal longer than many of the published studies for other therapies which often have a median follow-up of five years or even less. In one study where 50% of the surveillance patients were eventually treated, absolutely no difference was observed in the mortality or the metastasis rate at a median follow up of about 8 years.

4. The paper sets out various criteria for the clinical follow-up for men who choose Active Surveillance and it is interesting to note the move away from the concept of frequent biopsy procedures once the basic diagnosis has been confirmed after 12 months. This will diminish what is sometimes referred to as a ‘side effect’ of Active Surveillance.

Choosing Active Surveillance is not without its risks, as are all options for the man diagnosed with prostate cancer. This paper does not deal with any potential loss of quality of life (QOL) that may come with the election of the AS option or make any comparison with QOL issues associated other therapy options.

The paper can be accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

[Guest guest]

I'm not going to start an elongated back and forth but this is a gross generalization.

 

You do not understand what has happened to American care in Hospitals. 1. After surgy they are out in one or two days. 2. There are no antibodies and test conducted-all are considered extra. 3. Dr.s are managed by Health care associations and insurance not need of care. 4. Minimal care and assembly line surgies with the cheapest methods-not the best or even what is good for your care and recovery.

 

I could go on but you get the idea. Health care under for profit has reduced care to the very minimal of anything to get the job done. They do not about comfort or recovery times etc.

 

Tom W. 

To: ProstateCancerSupport ; newdx@...; ww@...

Sent: Sat, October 23, 2010 6:47:10 AMSubject: Active surveillance patient selection and management

 

Active surveillance for prostate cancer: patient selection and management L. Klotz, MD is a paper published in last month’s Current Oncology. I think it gives a very useful overview of the current issues surrounding Active Surveillance and should be read by any newly diagnosed man or anyone contemplating Active Surveillance as their ‘therapy’ of choice.

 

Some of the key points are:

 

1. A diagnosis of cancer often results, at least initially, in “cancer hysteria”—that is, a perfectly understandable reflexive fear of an aggressive life-threatening condition. For some cancers this fear is warranted, but for most men with favourable-risk prostate cancer, their condition is far removed from that of a rampaging, aggressive disease. Most men with favourable-risk prostate cancer are not destined to die of their disease, even in the absence of treatment.  This view is echoed by luminaries such as Dr Logothetis who said many years ago

 

“One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.”

 

And Dr Jonathon Oppenheimer who said

 

“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.”

 

2. Some studies demonstrated that prostate cancer typically begins in the third or fourth decade of life yet the median age of death from prostate cancer is about 80 years. Dr Klotz says this implies a 50-year time course from inception to mortality and that most patients have a long window of curability, which is particularly true for patients with favourable-risk, low-volume disease. It also implies that young age at diagnosis should not preclude a surveillance approach. Of course there are tragic cases of young men dying from the disease, but as Dr Klotz says they generally have high-grade disease at the outset and represent a very small proportion of prostate cancer patients. According to the current SEER data less than 10% of cancer deaths (which account for about 3% of all male deaths) occur in men under the age of 54.

 

3. Although approximately 200 patients have been followed for between 10 and 15 years, it is acknowledged that most of the studies have immature data and it will be another 5-7 years before a median follow-up of fifteen years can be achieved. This will be a good deal longer than many of the published studies for other therapies which often have a median follow-up of five years or even less. In one study where 50% of the surveillance patients were eventually treated, absolutely no difference was observed in the mortality or the metastasis rate at a median follow up of about 8 years.

 

4. The paper sets out various criteria for the clinical follow-up for men who choose Active Surveillance and it is interesting to note the move away from the concept of frequent biopsy procedures once the basic diagnosis has been confirmed after 12 months. This will diminish what is sometimes referred to as a ‘side effect’ of Active Surveillance.

 

Choosing Active Surveillance is not without its risks, as are all options for the man diagnosed with prostate cancer. This paper does not deal with any potential loss of quality of life (QOL) that may come with the election of the AS option or make any comparison with QOL issues associated other therapy options.

 

The paper can be accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

 

 

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

 

-- Emersonwww.flhw.orgEvery 2.25 minutes a man is diagnosed with prostate cancer.

Every 16.5 minutes a man dies from the disease.

[Guest guest]

I'm not going to start an elongated back and forth but this is a gross generalization.

 

You do not understand what has happened to American care in Hospitals. 1. After surgy they are out in one or two days. 2. There are no antibodies and test conducted-all are considered extra. 3. Dr.s are managed by Health care associations and insurance not need of care. 4. Minimal care and assembly line surgies with the cheapest methods-not the best or even what is good for your care and recovery.

 

I could go on but you get the idea. Health care under for profit has reduced care to the very minimal of anything to get the job done. They do not about comfort or recovery times etc.

 

Tom W. 

To: ProstateCancerSupport ; newdx@...; ww@...

Sent: Sat, October 23, 2010 6:47:10 AMSubject: Active surveillance patient selection and management

 

Active surveillance for prostate cancer: patient selection and management L. Klotz, MD is a paper published in last month’s Current Oncology. I think it gives a very useful overview of the current issues surrounding Active Surveillance and should be read by any newly diagnosed man or anyone contemplating Active Surveillance as their ‘therapy’ of choice.

 

Some of the key points are:

 

1. A diagnosis of cancer often results, at least initially, in “cancer hysteria”—that is, a perfectly understandable reflexive fear of an aggressive life-threatening condition. For some cancers this fear is warranted, but for most men with favourable-risk prostate cancer, their condition is far removed from that of a rampaging, aggressive disease. Most men with favourable-risk prostate cancer are not destined to die of their disease, even in the absence of treatment.  This view is echoed by luminaries such as Dr Logothetis who said many years ago

 

“One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.”

 

And Dr Jonathon Oppenheimer who said

 

“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.”

 

2. Some studies demonstrated that prostate cancer typically begins in the third or fourth decade of life yet the median age of death from prostate cancer is about 80 years. Dr Klotz says this implies a 50-year time course from inception to mortality and that most patients have a long window of curability, which is particularly true for patients with favourable-risk, low-volume disease. It also implies that young age at diagnosis should not preclude a surveillance approach. Of course there are tragic cases of young men dying from the disease, but as Dr Klotz says they generally have high-grade disease at the outset and represent a very small proportion of prostate cancer patients. According to the current SEER data less than 10% of cancer deaths (which account for about 3% of all male deaths) occur in men under the age of 54.

 

3. Although approximately 200 patients have been followed for between 10 and 15 years, it is acknowledged that most of the studies have immature data and it will be another 5-7 years before a median follow-up of fifteen years can be achieved. This will be a good deal longer than many of the published studies for other therapies which often have a median follow-up of five years or even less. In one study where 50% of the surveillance patients were eventually treated, absolutely no difference was observed in the mortality or the metastasis rate at a median follow up of about 8 years.

 

4. The paper sets out various criteria for the clinical follow-up for men who choose Active Surveillance and it is interesting to note the move away from the concept of frequent biopsy procedures once the basic diagnosis has been confirmed after 12 months. This will diminish what is sometimes referred to as a ‘side effect’ of Active Surveillance.

 

Choosing Active Surveillance is not without its risks, as are all options for the man diagnosed with prostate cancer. This paper does not deal with any potential loss of quality of life (QOL) that may come with the election of the AS option or make any comparison with QOL issues associated other therapy options.

 

The paper can be accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

 

 

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

 

-- Emersonwww.flhw.orgEvery 2.25 minutes a man is diagnosed with prostate cancer.

Every 16.5 minutes a man dies from the disease.

[Guest guest]

Tom,

I would say all the more reason to be very actively involved in your case. That

is, to take this article and other resources and use those to track and manage

your own case, then compare notes with your urologist/oncologist/primary care

physician, depending upon where you are in the process from prediagnosis with

signs of potential cancer to diagnosed.

Rich L

Green Bay, WI

>

> You do not understand what has happened to American care in Hospitals. 1.

After

> surgy they are out in one or two days. 2. There are no antibodies and test

> conducted-all are considered extra. 3. Dr.s are managed by Health care

> associations and insurance not need of care. 4. Minimal care and assembly line

> surgies with the cheapest methods-not the best or even what is good for your

> care and recovery.

>

> I could go on but you get the idea. Health care under for profit has reduced

> care to the very minimal of anything to get the job done. They do not about

> comfort or recovery times etc.

>

> Tom W. 

>

>

>

>

> ________________________________

>

> To: ProstateCancerSupport ; newdx@...;

> ww@...

> Sent: Sat, October 23, 2010 6:47:10 AM

> Subject: Active surveillance patient selection and

> management

>

>  

> Active surveillance for prostate cancer: patient selection and management L.

> Klotz, MD is a paper published in last month’s Current Oncology. I think it

> gives a very useful overview of the current issues surrounding Active

> Surveillance and should be read by any newly diagnosed man or anyone

> contemplating Active Surveillance as their ‘therapy’ of choice.

>  

> Some of the key points are:

>  

> 1. A diagnosis of cancer often results, at least initially, in “cancer

> hysteriaâ€â€ " that is, a perfectly understandable reflexive fear of an

aggressive

> life-threatening condition. For some cancers this fear is warranted, but for

> most men with favourable-risk prostate cancer, their condition is far removed

> from that of a rampaging, aggressive disease. Most men with favourable-risk

> prostate cancer are not destined to die of their disease, even in the absence

of

> treatment.  This view is echoed by luminaries such as Dr

Logothetis

> who said many years ago

>

>  

> “One of the problems with prostate cancer is definition. They label it as a

> cancer, and they force us all to behave in a way that introduces us to a

cascade

> of events that sends us to very morbid therapy. It's sort of like once that

> cancer label is put on there we are obligated to behave in a certain way, and

> its driven by physician beliefs and patient beliefs and frequently they don't

> have anything to do with reality.â€

>  

> And Dr Jonathon Oppenheimer who said

>  

> “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.â€

>  

> 2. Some studies demonstrated that prostate cancer typically begins in the

third

> or fourth decade of life yet the median age of death from prostate cancer is

> about 80 years. Dr Klotz says this implies a 50-year time course from

inception

> to mortality and that most patients have a long window of curability, which is

> particularly true for patients with favourable-risk, low-volume disease. It

also

> implies that young age at diagnosis should not preclude a surveillance

approach.

> Of course there are tragic cases of young men dying from the disease, but as

Dr

> Klotz says they generally have high-grade disease at the outset and represent

a

> very small proportion of prostate cancer patients. According to the current

SEER

> data less than 10% of cancer deaths (which account for about 3% of all male

> deaths) occur in men under the age of 54.

>  

> 3. Although approximately 200 patients have been followed for between 10 and

15

> years, it is acknowledged that most of the studies have immature data and it

> will be another 5-7 years before a median follow-up of fifteen years can be

> achieved. This will be a good deal longer than many of the published studies

for

> other therapies which often have a median follow-up of five years or even

less.

> In one study where 50% of the surveillance patients were eventually treated,

> absolutely no difference was observed in the mortality or the metastasis rate

at

> a median follow up of about 8 years.

>  

> 4. The paper sets out various criteria for the clinical follow-up for men who

> choose Active Surveillance and it is interesting to note the move away from

the

> concept of frequent biopsy procedures once the basic diagnosis has been

> confirmed after 12 months. This will diminish what is sometimes referred to as

a

> ‘side effect’ of Active Surveillance.

>  

> Choosing Active Surveillance is not without its risks, as are all options for

> the man diagnosed with prostate cancer. This paper does not deal with any

> potential loss of quality of life (QOL) that may come with the election of the

> AS option or make any comparison with QOL issues associated other therapy

> options.

>  

> The paper can be accessed at

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

>

>  

>  

> All the best

> Prostate men need enlightening, not frightening

> Terry Herbert - diagnosed in 1996 and still going strong

> Read A Strange Placefor unbiased information at

> http://www.yananow.net/StrangePlace/index.html

>

>  

>

[Guest guest]

Tom,

I would say all the more reason to be very actively involved in your case. That

is, to take this article and other resources and use those to track and manage

your own case, then compare notes with your urologist/oncologist/primary care

physician, depending upon where you are in the process from prediagnosis with

signs of potential cancer to diagnosed.

Rich L

Green Bay, WI

>

> You do not understand what has happened to American care in Hospitals. 1.

After

> surgy they are out in one or two days. 2. There are no antibodies and test

> conducted-all are considered extra. 3. Dr.s are managed by Health care

> associations and insurance not need of care. 4. Minimal care and assembly line

> surgies with the cheapest methods-not the best or even what is good for your

> care and recovery.

>

> I could go on but you get the idea. Health care under for profit has reduced

> care to the very minimal of anything to get the job done. They do not about

> comfort or recovery times etc.

>

> Tom W. 

>

>

>

>

> ________________________________

>

> To: ProstateCancerSupport ; newdx@...;

> ww@...

> Sent: Sat, October 23, 2010 6:47:10 AM

> Subject: Active surveillance patient selection and

> management

>

>  

> Active surveillance for prostate cancer: patient selection and management L.

> Klotz, MD is a paper published in last month’s Current Oncology. I think it

> gives a very useful overview of the current issues surrounding Active

> Surveillance and should be read by any newly diagnosed man or anyone

> contemplating Active Surveillance as their ‘therapy’ of choice.

>  

> Some of the key points are:

>  

> 1. A diagnosis of cancer often results, at least initially, in “cancer

> hysteriaâ€â€ " that is, a perfectly understandable reflexive fear of an

aggressive

> life-threatening condition. For some cancers this fear is warranted, but for

> most men with favourable-risk prostate cancer, their condition is far removed

> from that of a rampaging, aggressive disease. Most men with favourable-risk

> prostate cancer are not destined to die of their disease, even in the absence

of

> treatment.  This view is echoed by luminaries such as Dr

Logothetis

> who said many years ago

>

>  

> “One of the problems with prostate cancer is definition. They label it as a

> cancer, and they force us all to behave in a way that introduces us to a

cascade

> of events that sends us to very morbid therapy. It's sort of like once that

> cancer label is put on there we are obligated to behave in a certain way, and

> its driven by physician beliefs and patient beliefs and frequently they don't

> have anything to do with reality.â€

>  

> And Dr Jonathon Oppenheimer who said

>  

> “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.â€

>  

> 2. Some studies demonstrated that prostate cancer typically begins in the

third

> or fourth decade of life yet the median age of death from prostate cancer is

> about 80 years. Dr Klotz says this implies a 50-year time course from

inception

> to mortality and that most patients have a long window of curability, which is

> particularly true for patients with favourable-risk, low-volume disease. It

also

> implies that young age at diagnosis should not preclude a surveillance

approach.

> Of course there are tragic cases of young men dying from the disease, but as

Dr

> Klotz says they generally have high-grade disease at the outset and represent

a

> very small proportion of prostate cancer patients. According to the current

SEER

> data less than 10% of cancer deaths (which account for about 3% of all male

> deaths) occur in men under the age of 54.

>  

> 3. Although approximately 200 patients have been followed for between 10 and

15

> years, it is acknowledged that most of the studies have immature data and it

> will be another 5-7 years before a median follow-up of fifteen years can be

> achieved. This will be a good deal longer than many of the published studies

for

> other therapies which often have a median follow-up of five years or even

less.

> In one study where 50% of the surveillance patients were eventually treated,

> absolutely no difference was observed in the mortality or the metastasis rate

at

> a median follow up of about 8 years.

>  

> 4. The paper sets out various criteria for the clinical follow-up for men who

> choose Active Surveillance and it is interesting to note the move away from

the

> concept of frequent biopsy procedures once the basic diagnosis has been

> confirmed after 12 months. This will diminish what is sometimes referred to as

a

> ‘side effect’ of Active Surveillance.

>  

> Choosing Active Surveillance is not without its risks, as are all options for

> the man diagnosed with prostate cancer. This paper does not deal with any

> potential loss of quality of life (QOL) that may come with the election of the

> AS option or make any comparison with QOL issues associated other therapy

> options.

>  

> The paper can be accessed at

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed

>

>  

>  

> All the best

> Prostate men need enlightening, not frightening

> Terry Herbert - diagnosed in 1996 and still going strong

> Read A Strange Placefor unbiased information at

> http://www.yananow.net/StrangePlace/index.html

>

>  

>

[Guest guest]

Yes I have learned that I have to be my own medical advocate and be more assertive about treatment-I do not have a medical degree so I am at a disadvantage. My masters degree is in what is between your two ears. I will not argue with the people here and I know what happened to me. I have lived outside the USA so I am familiar with at least S E Asia's medical care. I wish all of you well. This site helped me get some sanity and education about my disease.

Thanks Again,

Tom W.

To: ProstateCancerSupport Sent: Sat, October 23, 2010 11:26:24 PMSubject: Re: Active surveillance patient selection and management

Tom,I would say all the more reason to be very actively involved in your case. That is, to take this article and other resources and use those to track and manage your own case, then compare notes with your urologist/oncologist/primary care physician, depending upon where you are in the process from prediagnosis with signs of potential cancer to diagnosed.Rich LGreen Bay, WI>> You do not understand what has happened to American care in Hospitals. 1. After > surgy they are out in one or two days. 2. There are no antibodies and test > conducted-all are considered extra. 3. Dr.s are managed by Health care > associations and insurance not need of care. 4. Minimal

care and assembly line > surgies with the cheapest methods-not the best or even what is good for your > care and recovery.> > I could go on but you get the idea. Health care under for profit has reduced > care to the very minimal of anything to get the job done. They do not about > comfort or recovery times etc.> > Tom W. > > > > > ________________________________> > To: ProstateCancerSupport ; newdx@...; > ww@...> Sent: Sat, October 23, 2010 6:47:10 AM> Subject: Active surveillance patient selection and > management> >  > Active surveillance for prostate

cancer: patient selection and management L. > Klotz, MD is a paper published in last month’s Current Oncology. I think it > gives a very useful overview of the current issues surrounding Active > Surveillance and should be read by any newly diagnosed man or anyone > contemplating Active Surveillance as their ‘therapy’ of choice.>  > Some of the key points are:>  > 1. A diagnosis of cancer often results, at least initially, in “cancer > hysteriaâ€�â€"that is, a perfectly understandable reflexive fear of an aggressive > life-threatening condition. For some cancers this fear is warranted, but for > most men with favourable-risk prostate cancer, their condition is far removed > from that of a rampaging, aggressive disease. Most men with favourable-risk > prostate cancer are not destined to die of their disease, even in

the absence of > treatment.  This view is echoed by luminaries such as Dr Logothetis > who said many years ago > >  > “One of the problems with prostate cancer is definition. They label it as a > cancer, and they force us all to behave in a way that introduces us to a cascade > of events that sends us to very morbid therapy. It's sort of like once that > cancer label is put on there we are obligated to behave in a certain way, and > its driven by physician beliefs and patient beliefs and frequently they don't > have anything to do with reality.�>  > And Dr Jonathon Oppenheimer who said >  > “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.�>  > 2. Some studies demonstrated that prostate cancer typically begins in the third > or fourth decade of life yet the median age of death from prostate cancer is > about 80 years. Dr Klotz says this implies a 50-year time course from inception > to mortality and that most patients have a long window of curability, which is > particularly true for patients with favourable-risk, low-volume disease. It also > implies that young age at diagnosis should not preclude a surveillance approach. > Of course there are tragic cases of young men dying from the disease, but as Dr > Klotz says they generally have high-grade disease at the outset and represent a > very small proportion of prostate cancer patients. According to the current SEER > data less than 10% of cancer

deaths (which account for about 3% of all male > deaths) occur in men under the age of 54.> Â > 3. Although approximately 200 patients have been followed for between 10 and 15 > years, it is acknowledged that most of the studies have immature data and it > will be another 5-7 years before a median follow-up of fifteen years can be > achieved. This will be a good deal longer than many of the published studies for > other therapies which often have a median follow-up of five years or even less. > In one study where 50% of the surveillance patients were eventually treated, > absolutely no difference was observed in the mortality or the metastasis rate at > a median follow up of about 8 years.> Â > 4. The paper sets out various criteria for the clinical follow-up for men who > choose Active Surveillance and it is interesting to note the move away from the

> concept of frequent biopsy procedures once the basic diagnosis has been > confirmed after 12 months. This will diminish what is sometimes referred to as a > ‘side effect’ of Active Surveillance.>  > Choosing Active Surveillance is not without its risks, as are all options for > the man diagnosed with prostate cancer. This paper does not deal with any > potential loss of quality of life (QOL) that may come with the election of the > AS option or make any comparison with QOL issues associated other therapy > options.>  > The paper can be accessed at > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed > >  >  > All the best > Prostate men need enlightening, not frightening> Terry Herbert - diagnosed in 1996 and still going strong> Read A Strange Placefor unbiased

information at > http://www.yananow.net/StrangePlace/index.html > > Â >

[Guest guest]

Yes I have learned that I have to be my own medical advocate and be more assertive about treatment-I do not have a medical degree so I am at a disadvantage. My masters degree is in what is between your two ears. I will not argue with the people here and I know what happened to me. I have lived outside the USA so I am familiar with at least S E Asia's medical care. I wish all of you well. This site helped me get some sanity and education about my disease.

Thanks Again,

Tom W.

To: ProstateCancerSupport Sent: Sat, October 23, 2010 11:26:24 PMSubject: Re: Active surveillance patient selection and management

Tom,I would say all the more reason to be very actively involved in your case. That is, to take this article and other resources and use those to track and manage your own case, then compare notes with your urologist/oncologist/primary care physician, depending upon where you are in the process from prediagnosis with signs of potential cancer to diagnosed.Rich LGreen Bay, WI>> You do not understand what has happened to American care in Hospitals. 1. After > surgy they are out in one or two days. 2. There are no antibodies and test > conducted-all are considered extra. 3. Dr.s are managed by Health care > associations and insurance not need of care. 4. Minimal

care and assembly line > surgies with the cheapest methods-not the best or even what is good for your > care and recovery.> > I could go on but you get the idea. Health care under for profit has reduced > care to the very minimal of anything to get the job done. They do not about > comfort or recovery times etc.> > Tom W. > > > > > ________________________________> > To: ProstateCancerSupport ; newdx@...; > ww@...> Sent: Sat, October 23, 2010 6:47:10 AM> Subject: Active surveillance patient selection and > management> >  > Active surveillance for prostate

cancer: patient selection and management L. > Klotz, MD is a paper published in last month’s Current Oncology. I think it > gives a very useful overview of the current issues surrounding Active > Surveillance and should be read by any newly diagnosed man or anyone > contemplating Active Surveillance as their ‘therapy’ of choice.>  > Some of the key points are:>  > 1. A diagnosis of cancer often results, at least initially, in “cancer > hysteriaâ€�â€"that is, a perfectly understandable reflexive fear of an aggressive > life-threatening condition. For some cancers this fear is warranted, but for > most men with favourable-risk prostate cancer, their condition is far removed > from that of a rampaging, aggressive disease. Most men with favourable-risk > prostate cancer are not destined to die of their disease, even in

the absence of > treatment.  This view is echoed by luminaries such as Dr Logothetis > who said many years ago > >  > “One of the problems with prostate cancer is definition. They label it as a > cancer, and they force us all to behave in a way that introduces us to a cascade > of events that sends us to very morbid therapy. It's sort of like once that > cancer label is put on there we are obligated to behave in a certain way, and > its driven by physician beliefs and patient beliefs and frequently they don't > have anything to do with reality.�>  > And Dr Jonathon Oppenheimer who said >  > “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.�>  > 2. Some studies demonstrated that prostate cancer typically begins in the third > or fourth decade of life yet the median age of death from prostate cancer is > about 80 years. Dr Klotz says this implies a 50-year time course from inception > to mortality and that most patients have a long window of curability, which is > particularly true for patients with favourable-risk, low-volume disease. It also > implies that young age at diagnosis should not preclude a surveillance approach. > Of course there are tragic cases of young men dying from the disease, but as Dr > Klotz says they generally have high-grade disease at the outset and represent a > very small proportion of prostate cancer patients. According to the current SEER > data less than 10% of cancer

deaths (which account for about 3% of all male > deaths) occur in men under the age of 54.> Â > 3. Although approximately 200 patients have been followed for between 10 and 15 > years, it is acknowledged that most of the studies have immature data and it > will be another 5-7 years before a median follow-up of fifteen years can be > achieved. This will be a good deal longer than many of the published studies for > other therapies which often have a median follow-up of five years or even less. > In one study where 50% of the surveillance patients were eventually treated, > absolutely no difference was observed in the mortality or the metastasis rate at > a median follow up of about 8 years.> Â > 4. The paper sets out various criteria for the clinical follow-up for men who > choose Active Surveillance and it is interesting to note the move away from the

> concept of frequent biopsy procedures once the basic diagnosis has been > confirmed after 12 months. This will diminish what is sometimes referred to as a > ‘side effect’ of Active Surveillance.>  > Choosing Active Surveillance is not without its risks, as are all options for > the man diagnosed with prostate cancer. This paper does not deal with any > potential loss of quality of life (QOL) that may come with the election of the > AS option or make any comparison with QOL issues associated other therapy > options.>  > The paper can be accessed at > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935703/?tool=pubmed > >  >  > All the best > Prostate men need enlightening, not frightening> Terry Herbert - diagnosed in 1996 and still going strong> Read A Strange Placefor unbiased

information at > http://www.yananow.net/StrangePlace/index.html > > Â >