Prostate Cancer “Quote-of-the-Day”

#101

 

Dr. Mark Moyad, serving as forum moderator, asked Dr Laurance Klotz if men on AS suffered from high anxiety by deferring treatment. Dr. Klotz responded that:

 

...their anxiety in the early years was about the same as anxiety for patients undergoing treatment, but that men on AS frequently were "ebullient" after being on AS for a few years: they looked at the side effects their friends were enduring who had had active treatment, and they were delighted they had not gone that route.

Casey:

Just heard Dr. Klotz speak at one of our forums. Perfect quote.

Skate

#105   Quoted from the AUA’s   Journal of Urology report titled, “ A Multi-Institutional Evaluation of Active Surveillance for Low Risk Prostate Cancer .”   The multi-institutional study authors included well-known PC surgeons such as Dr James Eastham (Sloan-Kettering), Dr Eric Klein (Cleveland Clinic), Dr Bertrand Guillonneau (Sloan-Kettering), Dr Scott Eggener (recipient of NIH National Research Service Award), Dr Peter Scardino (Sloan-Kettering), and several others [ a fairly respectable bunch of surgeons considered by many to be the thought-leaders in low-risk/intermediate-risk PC management ].   The study’s cohort of men were based on the following low-risk criteria (typical for AS programs):   PSA 10ng/mL or less, T1-T2a, Gleason sum less than 7, 3 or less positive cores at diagnostic biopsy, and a repeat biopsy before starting AS.   This quote emphasizes (a) that outcomes of groups of low-risk men on AS are not worse than outcomes of similar low-risk men who pursue immediate treatment, and (b) that many of the men on AS will not be subjected to the unnecessary rigors & consequences of an aggressive treatment:     AS is … a strategy for low-risk men that encourages initial observation, frequent monitoring based on serial prostate biopsies and, if needed, the implementation of active therapy while disease is still at a highly curable stage.   [The] findings [of the multi-institutional evaluation of AS for low-risk PC] highlight many of the hallmark features and purported benefits of AS in that most men will not require an intervention, and those who do will have benefited from a period when quality of life and cancer related outcomes do not appear to be compromised . edit :   fixed typo Post Edited (Casey59) : 4/13/2012 3:09:09 PM (GMT-6)

#107   Every major oncologist treating PC has diet as a part of their program; this alone should tell us something.        -- JohnT           Post Edited (Casey59) : 5/14/2012 2:57:06 PM (GMT-6)

#109 Interesting historical perspective.   In the pre PSA-era, most men presented with advanced PC.   In fact, the PSA test was originally introduced not for screening, but to test whether the early forms of HT were effective treatments for these advanced cases.   Companies promoting therapies discovered that they could generate more patients (revenue) if more men were tested, and thus PSA as a “screening test” was marketed.   It is interesting to look at how low-risk PC was viewed in the period just before the sharp increase in PC incidence which was driven by the PSA test, in the 1970s, and compare that to contemporary perspectives.   “We didn’t go looking for the incidental cancers that were of no clinical significance.  And if we found them, we did nothing about them.”    [ Dr Anthony Horan explaining the conventional wisdom of a non-treatment approach which was common in 1970's (pre PSA-era) as a result of an early Mayo Clinic study which showed that most men diagnosed with incidental (low-risk) PC had a survival curve identical the general population of men (similar, but not identical, to findings of the contempory PLCO trial).]

#111

 

 

"The great enemy of the truth is very often not the lie — deliberate, contrived, and dishonest — but the myth — persistent, persuasive, and unrealistic."

 

     -John F. Kennedy

"Feeling rather mortal are we?"

My brother's response when I told him I had prostate cancer.

He stayed up nights with me after surgery.

Lowandslow

#115 "A perfect storm of clinical evidence and economic reality has arisen in which urologists and radiation oncologists need to examine the evidence, examine their souls, and start to carefully look at every new patient asking, before anything else— is treatment really needed at all ?   If it is not, and that will frequently be the answer, then they must be prepared to lead the patient along the less financially rewarding and decidedly unglamorous path of active surveillance .   The training of resident doctors has to date been so focused on cure, and the culture of early detection/early treatment so deeply in-grained, that it is little wonder that this shift in thinking is yet to reflect itself in everyday practice." Dr Anthony Zeitman is an endowed professor of radiation oncology at Harvard Medical School, and as of January 1, 2012 is the editor of the Internal Journal of Radiation Oncology, Biology and Physics (the American Society for Radiation Oncology's primary research journal). In 2009, he published an editorial with this quote in the Journal of the American Society of Clinical Oncology (ASCO):   http://jco.ascopubs.org/content/27/30/4935.full.pdf+html  

#116

I was diagnosed with brain cancer about 16 years ago. I received chemotherapy and went into remission, but the cancer came back and I endured two surgeries and 13 months of chemotherapy. I asked my oncologist if I ought to change my diet to avoid another recurrence. His answer was perfectly stereotypical: "Eat what you like. It won't make much difference."

 

He was wrong.

 

The extensive research published in the last decade alone proves that what you eat can have a profound effect on your protection against cancer. But my doctor's answer was hardly surprising. It's a little-known fact that nutrition is barely taught in med schools, where the solution to most problems is a drug. And doctors don't trust patients to make lifestyle changes. I recall a conversation with a fellow physician at a conference after I spoke on the importance of a healthy diet in fighting disease. "You may be right, David, but people don't want to change," he said. "They just want to take a pill and forget about it." I don't know whether he's right, but after all the study I've done, I know it isn't true for me.

 

 

         -- Passage from the book, "Anticancer, A New Way of Life" by Dr David Servan-Schreiber

#119

 

 

"Lifestyle choices are the best course of action in preventing prostate cancer or other disease."

 

     -- Dr David Samadi

#121

 

 

"We need a new cancer lexicon — one in which the language reflects the knowledge of the 21st century, not the fears of 400 BC" (when Hippocrates gave "cancer" it's name).

 

We do ourselves a disservice when  conditions as wildly different as a grade 4 glioblastoma multiforme (a brain tumour that is virtually 100-per-cent fatal) and prostatic intraepithelial neoplasia (a condition more likely to make you pee often than kill you) are both described as cancer.

 

Should we be telling folks with abnormalities or weird-looking cells that they have cancer?  This is a question that health professionals, activists and patients themselves are increasingly struggling with.  Given evolving scientific knowledge, it may well be time to start making that distinction for some forms of prostate “cancer.”

 

A cancer diagnosis will pack a punch. When you hear the words “you have cancer,” the assumption is that you’re going to suffer and you’re going to die prematurely.  For many, many “cancers,” that simply isn’t true any more.  Language matters because it influences behavior.  When you use the dreaded C-word the reaction of patients is to want to rid their body of a deadly passenger.  But cutting and burning and poisoning — surgery, radiation, and chemotherapy if you prefer the more technical terms — are not always the best reponse to wierd-looking cells.

 

     --Andre Picard, Dec 2011

"Just as no one can be forced into belief, so no one can be forced into unbelief."

Sigmund Freud