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Posted 2/15/2015 3:44 PM (GMT 0)

Ultimately the major reason AS is so little adhered to, even with very low risk PCa (the Epstein criteria) let alone low risk (Gleason 6, PSA under 10) is that the urological community has not bought into to it. This is why the wider medical community has advised against the PSA test in general.

The first diagnosis of CANCER is a shock to most people, and given the choice of listening to your doctor who will save your life with surgery, or some anonymous know-it-alls who are pontificating on some internet message board, who are you going to choose? This is exacerbated by the published advice of people like Dr. Patrick Walsh, perhaps the most renowned prostate surgeon, who advises that if you plan to live more than 10 years, or are younger than 65, you should avoid AS, even if you have very low risk PCa.

Consequently, it is no surprise to me that only 10% of people with low risk PCa choose AS. Among the people who post here and on similar message boards, almost every one winds up choosing some active treatment.

In my case, I was diagnosed after a TURP with Gleason 7 PCa. I then contacted one of the rock star surgeons in NYC, who scheduled me for a surgery 2 months later. In the meantime I had my first PSA test done after the TURP, and my PSA score dropped from a high of 9.6 to 1.0. I then contacted my surgeon ,asking to postpone the surgery for at least 3 months to see if my PSA remained stable or not. The surgeon strongly advised against this, insisting that the surgery take place. I then went to another urologist for a second opinion, and he agreed with the first surgeon. I still resisted, and with the advice of a person I contacted on the internet, I sent my biopsy slides to Jonathan Epstein for a second opinion on the pathology. (It was at this time that my sister castigated me by saying that I was just looking for someone who will agree with me.) As it turned out, Epstein downgraded my Gleason score to GL6, and when I spoke to him directly, he advised me to "just watch it."

All this occurred almost three years ago (I was diagnosed in April, 2012). Since then, my PSA has remained stable, with my last PSA score of 0.9. I have been vigilantly keeping watch of my situation with semi-annual PSA tests and annual 3T mp-MRIs. I have decided to avoid any additional biopsies, unless the MRI warrants it.

It should also be noted that the first indication that I had a problem with my prostate was in 1998 (17 years ago) when my PSA score jumped from 1.0 the previous year to 3.4. The next PSA jumped to 4.2, leading to my first biopsy. There is no doubt in my mind that if that biopsy (or any of the next two biopsies) was positive, I would have undergone surgery since this is what everybody I knew did back then. The fact that the situation in terms of advice from your urologist hasn't changed that much since then is disheartening.

Posted 2/15/2015 4:08 PM (GMT 0)
@Dreamerboy - it's actually a very good analogy, and I'll add to it. What you've done regarding AS vs treatment, is exactly what a good investor would do - you've set up a decision making process that eliminates emotion.

@GOP - I have no doubt that the "Brachy Guys" promote less radical treatment than surgery, because they truly believe it's the right approach. Same for the proponents of AS. Like I said, natural bias, human behavior. But also, good intentions. We all want to help the next guy in line to go through what we've been through

@Michael_T, I've noticed that about you, that you def are sensitive to the fact that some are just not wired for AS. Regarding the Monte Carlo analogy, you are correct. It's an imperfect process, not just because it uses statistical likelihood, but because Fin Planning in general , it uses assumptions, many of which we know will not pan out . Unfortunately, like PC decisions, statistics are all we've got, to guide us. Along with our personalities.

@Baldeagle - you're right, not enough Drs promote AS because there is not a lot of cash in it. Which seriously sucks. It makes a good argument for going to the major teaching hospitals or National Comprehensive Cancer Centers, vs the local urologist . I believ that most of the DRs at these centers are above the fray. When I first was told I needed a biopsy, by my local URO, who worked in a one man office alone at the time, I immediately sought out a Uro at Columbia Prysbeterian , a top teaching hospital with a top rated urology department. That biopsy turned out to be negative, but before he even did the biopsy, we discussed the what ifs and he talked about his belief in AS in certain cases of what would appear to be less aggressive Cancer.

@Sheepguy - as always it comes down to a personal decision - for me, and I emphasize the ME, I wouldn't want to take a 30% risk. And as it turned out, it's good that I didn't because I was upgraded.

This thing is beaten to death, so I'm gonna bow out at this point, but just want to say, I agree that there is a big over treatment of Pc and its a problem. And some guys are good for AS. The medical profession should be held accountable for educating us, we shouldn't have to depend on each other for that (although thank God we are all here for each other). It's beyond me why the financial planning profession is more regulated than the medical profession in this regard. Last I looked, our health is more important than our money. But it's left to us, and we just need to be careful when talking to new guys about ANY treatment vs another, to not use extreme, or emotional words. We all have different experiences and naturally, we are each a product of those experiences.

Sorry for rambling

Post Edited (Pratoman) : 2/15/2015 9:13:23 AM (GMT-7)

Posted 2/15/2015 4:16 PM (GMT 0)

island time said...
Ziggy...

What I'm hearing you say is..."Being diagnosed makes no difference to me. If you could take it out with no side effects I'd just as soon leave it in." If this is not what you mean...then AS is, by my definition, no silver bullet.

But I agree that there are no physical side effects from AS. Save for the biopsies.


As to whether we may lead new men into believing AS is the way to ride with low risk disease, all one needs to do is to look at the signatures. As soon as the prostate healed most every person on here (who does much posting) received curative treatment. At least...that's one of the things that caught my attention in no small way.

Well since you can never say you can be guaranteed not to have side effects after surgery that is not what I said. It's always major surgery. Even with a few holes from a Davinci may make it appear less threatening it is still major frickn surgery. I never said AS is a silver bullet but time on AS may result in a new silver bullets in the future being available. Some here act like only surgery and brachytherapy are options forever. Back in 2007 most here felt radical surgery was the gold standard and everything else including brachytherapy was risky and foolish. People thought I had a death wish rejecting surgery and going with TFT. Those people, don't think that anymore.

I don't know what you mean by curative treatment. Not all side effects are overcome. For near all who undergo radical surgery right after most have their lives revolve around urinating be it just for a few weeks, months or worse case the rest of their lives. It happens. For there are those who never are continent again even using slings and other nightmares. There are many who remain impotent, and all who go through surgery never have a normal sex with wet orgasms again.

This disease is massively over treated. That's been the growing and more and more accepted opinion the last few years in the medical community. This insane over treating results with many many men suffering through lower quality of lives never needing to. For most low risk PCa victims who would adhere to AS would die with PCa and not of it. And those whose AS indicated a a worsening situation can still be treated with either present treatment options or future better ones. Plus additional months/years on AS before needing treatment leading normal lives can't be ignored as an AS result alone.

I agree with Tall Allen that for those with lower risk PCa ( I personally include some gleason 7s here for a friend of mine has that has been on AS for 4 years now). AS is the new "gold standard" The major problem here is PCa is just not one disease that progresses and acts the same in most men. I've read there are possibly 7 to 12+ strains of PCa and only a few are lethal. Obviously AS is not an option for the latter.

Tall Rick ( I am 6'3") aka Ziggy
Posted 2/15/2015 5:19 PM (GMT 0)
I had bookmarked a couple of articles on AS that seem relevant here:
prostatecancerinfolink.net/2015/02/15/when-should-therapeutic-intervention-take-place-for-men-on-active-surveillance/

prostatecancerinfolink.net/2014/11/24/active-surveillance-for-men-with-gleason-3-4-7-disease/

The most puzzling part of AS for me is how to determine if someone is a candidate for AS. In my case, my uro and a medical oncologist are both willing to supervise me on AS. But three RO's that I consulted with recommended treatment. Do I trust the RO's for treatment but not trust their judgement regarding AS? Who to believe? I guess the AS decision is one to be made entirely by the patient just like the choice of treatment is ultimately ours regardless of medical recommendations.
Posted 2/15/2015 5:30 PM (GMT 0)
I think Prat's last paragraph makes tons o' sense. I too will let things lie. I hope I didn't, but I apologize if I went over the top in any of my comments.
Posted 2/15/2015 5:42 PM (GMT 0)

halbert said...
I find this quote important (page 203 in Walsh)...If you're a healthy man under the age of 65 with many years still ahead, active surveillance is not for you" (Walsh again in his section on low volume T1c cancer). And his definition of significant is 3 or more positive cores, or >50% in any one core, or G7 and higher, or PSA density greater than .1-.15, or free PSA < 15%

Walsh is not the bible - he has his biases just like everyone else. While his opinions carry a lot of weight about his specialty, prostate surgery, I'm not sure he is the man to quote about active surveillance. Also, I'm not sure he still holds the opinion he expressed in that book - books get outdated very quickly. The man to quote about AS would be Laurence Klotz, who has the longest running study on it, over 20 years.

Johns Hopkins has the most restrictive criteria - the so called "Epstein criteria" - for AS of any major institution. Although they have said that they are studying the matter, to my knowledge, they have not yet changed their program to conform with the new data.

I find the argument about age to be ageist. I have argued elsewhere that decisions about treatment of any kind ought not be based on chronological age. What distinguishes "Active Surveillance" from "Watchful Waiting" is an intention to definitively treat. One may argue that because PC is usually more virulent when diagnosed at an older age, Active Surveillance is less attractive because it puts off definitive treatment still further. On the other end of the age spectrum, AS allows for more years to enjoy potency and continence.

It's true that younger men get better results from surgery, but that is not an argument against AS in younger men, it is only a statement about a lower risk of surgery. Once one no longer holds surgery as the "gold standard" against which other treatments ought to be judged, Walsh's arguments disappear. In my opinion, AS is the gold standard because it comes closest to the Hippocratic oath to "first, do no harm." All other treatments must be judged against that.

- Allen
Posted 2/15/2015 6:18 PM (GMT 0)
I want to reiterate my agreement with Tall Allen. Klotz, who has started to endorse AS for some patients with GL7, has shown conclusively that AS can be a safe choice, even in the long run. Incidentally most of the few people who have died from PCa under Klotz (as opposed to with it) did so at the beginning of his study. Also, it is not clear from his study whether those who died later did so under Klotz's advice (i.e. did those people progress in their cancer but refused more active treatment?).

However, I still want to make the point that most people will follow a leading authority such as Dr. Walsh as opposed to somebody on the internet like Tall Allen. This is especially so when one's life is on the line.

Posted 2/15/2015 7:37 PM (GMT 0)
This thread is very informative. I'll take my information into my uro in March when I have my first post DX PSA check. He did my biopsy and, when he gave me the results, told me, "I'm trying to keep you out of the operating room".

One other thing. When JH tells you about AS and then tells you "You've got time to decide" with a smile on their faces and a pat on the back it becomes very difficult to then say..."Nah...go ahead and pencil me in".

What I here them saying is..."Right now, it's elective surgery".



As with many things in life...One is forced to make judgement calls (decisions) which is based on incomplete information.
Posted 2/15/2015 8:48 PM (GMT 0)
I thought this was interesting. How about looking for PC in autopsies of men who died from other than PC, from countries where PSA screening is rare? I think the initial reason for this study was looking for difference among asian and caucasian men, but it can also be of interest as to what happens to men of whom very few are screened for PC? So, if they happen to have PC, they are kind of default in the wait and see group. I would call them active surveillance or maybe watchful waiting group, but they were not even being watched. They just died of the usual stuff and then were looked at post mortem.

http://www.ncbi.nlm.nih.gov/pubmed/23847245

study said...
Abstract
BACKGROUND:

Substantial geographical differences in prostate cancer (PCa) incidence and mortality exist, being lower among Asian (ASI) men compared with Caucasian (CAU) men. We prospectively compared PCa prevalence in CAU and ASI men from specific populations with low penetrance of prostate-specific antigen screening.
METHODS:

Prostate glands were prospectively obtained during autopsy from men who died from causes other than PCa in Moscow, Russia (CAU), and Tokyo, Japan (ASI). Prostates were removed en-block and analyzed in toto. We compared across the 2 populations PCa prevalence, number and Gleason score (GS) of tumour foci, pathological stage, spatial location, and tumor volume using χ(2), Mann-Whitney-Wilcoxon tests, and multiple logistic regression. All statistical tests were two-sided.
RESULTS:

Three hundred twenty prostates were collected, 220 from CAU men and 100 from ASI mean. The mean age was 62.5 in CAU men and 68.5 years in ASI men (P < .001). PCa prevalences of 37.3% in CAU men and 35.0% in ASI men were observed (P = .70). Average tumor volume was 0.303cm(3). In men aged greater than 60 years, PCa was observed in more than 40% of prostates, reaching nearly 60% in men aged greater than 80 years. GS 7 or greater cancers accounted for 23.1% and 51.4% of all PCa in CAU and ASI men, respectively, (P = .003). When adjusted for age and prostate weight, ASI men still had a greater probability of having GS 7 or greater PCa (P = .03).
CONCLUSIONS:

PCa is found on autopsy in a similar proportion of Russian and Japanese men. More than 50% of cancers in ASI and nearly 25% of cancers in CAU men have a GS of 7 or greater. Our results suggest that the definition of clinically insignificant PCa might be worth re-examining.

Wow, I thought that was pretty wild: not much difference in prevalence among Asians and Russians, despite what is probably vast difference in diet and other cultural norms, plus the Asians have double the rate of more aggressive PC!

But the real take away that makes me stop and ponder? 100% of these men died, and 100% did not die of PC, But, above age 60 a whopping 40% had PC, above age 80 60% had it, and 23% of these among Russians had the more aggressive forms and 51% of those Asians with PC had the more aggressive forms. And all died of something else before they could even be diagnosed with PC and treated for it.

Is there any conclusion to be drawn from this study? Sure makes me think! It's giving me a headache! smilewinkgrin
Bill

Post Edited (BillyBob@388) : 2/15/2015 2:03:52 PM (GMT-7)

Posted 2/15/2015 9:13 PM (GMT 0)
Well Bill, the 100% means nothing because none of them died from Pca since it was the selection criteria. For the rest of it, it looks like a diet with high concentrations of vodka might be helpful for PCA whereas fish and rice don't help much. Best I can do!

Cheers, Doug
Posted 2/15/2015 10:49 PM (GMT 0)
Walsh is not the bible - he has his biases just like everyone else. While his opinions carry a lot of weight about his specialty, prostate surgery, I'm not sure he is the man to quote about active surveillance.

Actually, his biases are far greater than most. He has made a very good living removing prostates surgically and selling books that tell you that while there are many ways to treat pc, there is only one right way...surgery.

As is often stated, it is what it is. I've tried for years to suggest to the newly dx'd that there are at least other options....just consider them. More often than not that advice falls on deaf ears. I hate reading posts like the original in this thread where guys are suffering when they probably didn't have to. But, I'm going to agree with Prato for the first time and also be done with it. Hey, Walsh is the expert...listen to him.
Posted 2/16/2015 1:21 AM (GMT 0)
Cap Huff..
Oh, how I wish my husband could have read your story way before ours. We go back to 2001. Seeds, external radiation, then salvage surgery, incontinence, fistula, implant for urination..still incontinence, and the final blow, radiation induced rectal cancer..and then exenteration surgery, and two permanent ostomies, urostomy and colostomy, rectum sewed shut, last March, and the darned PSA is now up to 38…lupron last month, and now feeling horrible and unable to even hobble around well. I believe all the treatments were way worse than the slow growing cancer.
I know there are many different kinds of PCA, but, I also know that this is a big business. I think a surgeon will cut, and a radiation doc will do radiation. These hospitals must perform their jobs. Just remember if you have surgery first, you can do the radiation after…not like my poor husband did. He had seeds and radiation, and then when the cancer came back, the surgery was devastating, even though our doctor at Sloan told us it would "debulk" the tumor. Well, he is still alive, but his QOL was debulked.
Cap Huff, today my husband said he wished he could go back to the incontinence. The bags are humiliating, and difficult for him, and for me to change. I love him dearly, and of course do anything for him, but, I do believe that Watchful Waiting may be a good option for those that can do it.
Posted 2/16/2015 4:58 AM (GMT 0)

Doug said...
Well Bill, the 100% means nothing because none of them died from Pca since it was the selection criteria. For the rest of it, it looks like a diet with high concentrations of vodka might be helpful for PCA whereas fish and rice don't help much. Best I can do!

Cheers, Doug

divo said...
Cap Huff..
Oh, how I wish my husband could have read your story way before ours. We go back to 2001. Seeds, external radiation, then salvage surgery, incontinence, fistula, implant for urination..still incontinence, and the final blow, radiation induced rectal cancer..and then exenteration surgery, and two permanent ostomies, urostomy and colostomy, rectum sewed shut, last March, and the darned PSA is now up to 38…lupron last month, and now feeling horrible and unable to even hobble around well. I believe all the treatments were way worse than the slow growing cancer.
I know there are many different kinds of PCA, but, I also know that this is a big business. I think a surgeon will cut, and a radiation doc will do radiation. These hospitals must perform their jobs. Just remember if you have surgery first, you can do the radiation after…not like my poor husband did. He had seeds and radiation, and then when the cancer came back, the surgery was devastating, even though our doctor at Sloan told us it would "debulk" the tumor. Well, he is still alive, but his QOL was debulked.
Cap Huff, today my husband said he wished he could go back to the incontinence. The bags are humiliating, and difficult for him, and for me to change. I love him dearly, and of course do anything for him, but, I do believe that Watchful Waiting may be a good option for those that can do it.

Wow, Divo, just wow. I'm so sorry to hear about all of that. Just out of curiosity, do you know what kind of Gleason and PSA he started with?(EDIT: never mind, I see it now in your sig)

Doug, especially as I read Divo's post, I'm thinking that just maybe the 100% does mean something? Maybe the 100% dieing before PC makes some kind of a point. True, they are pre-selecting for death from other than PC. So obviously, no one is going to die from PC with that kind of pre-selection.

Still, 40-60% had PC, and 23-51% of those had the more aggressive PCs. Yet none had any treatment for PC, and none died of PC before something else could kill them(pre-selection bias again). BUT, what if they had PSA testing and follow up treatment available to them? Would these men have been helped even a small amount?

In fact, couldn't it be said that, at least for these men, unless they had some treatment that had zero SEs, wouldn't 100% of these men have been harmed by Bxs and treatment? Wouldn't they all have had a decreased QOL during their remaining years without getting even 1 day of extra life? In fact, didn't they come out better not even knowing they had PC?

I realize that may not be fair, choosing a group in which all died of something besides PC. Because, how could we ever know we were going to be in that group? Although I had a friend who was in that very type of group and in my opinion he would have been better off never knowing about his PC. But who could have known he was going to die young from a stroke? Still, based on just that study, a lot of us would end up in the category of dead from other than PC regardless of what we do, 40-60% at least based on that group. And if limited to the G6s, maybe even the 3+4s, no doubt even larger % would have PC but die of something else.

Of course, age complicates things. These men were almost by definition older, old enough to start dying of other diseases. Men in their 40s or early 50s would have a lot more years, on average, for a PC to advance and do damage.

I don't know what to think sometimes. Sometimes it seems it's a real rock and a hard place we find ourselves between.
Posted 2/16/2015 1:25 PM (GMT 0)
Billy I see where you're coming from and agree. The first thing that popped into my head while reading was PSA screening. First, I AGREE with PSA screening, but I DO NOT AGREE with over treating.
One could argue that an individual may have an overall better QOL (longer) if he waited to be symptomatic (of something) before having his PSA checked. On the other hand, screening early allows you to make appropriate decisions but shortening your overall QOL.
Therein lies the conundrum.
I would like to see the responsibility put on the medical community to better educate patients before any life altering treatment. For example, before a biopsy, the patient should be given an information document explaining the reason for biopsy, the procedure, the side effects etc. This document should then be discussed with the patient with the Doctor, signed by both parties and placed on file. It would serve to properly inform the patient and slow things down. Doctors spend too much time on selling their trade rather than imparting knowledge so patients can make an informed decision. Too many doctors strike when the patient is in his most vulnerable state to "close the deal", in my opinion.
This forum for example, shouldn't have the responsibility to educate; that is the responsibility of the health care system, no matter what nationality.
Bit of a disjointed ramble but got it off my chest!

Cheers, Doug
Posted 2/16/2015 1:28 PM (GMT 0)
Billybob, exactly on the rock vs. hard place.

The one thing we don't know (yet) is how to distinguish on biopsy, or even on post surgery evaluation, which tumors are slow growing and which are not. From what I understand, the general belief is that age of the patient is part of it. A man in his 40's with G8 or G9 is understood to have a highly aggressive cancer, just because of when it showed up and how high the level is.

Beyond that, it's somewhat of a crap shoot.

In the end, we are all rolling the dice. We're putting our lives, and our futures, in the hands of strangers. The one thing that has not changed about cancer treatment in 3000 years is this: one way or another, all treatment comes down to (a) remove it in some way or (b) manage the symptoms. We still do not, and may never know how to turn the tumor cells off biochemically. The question I want to ask is, how do some people manage to live to be 100 or more without cancer? What do they have that the rest of us don't?
Posted 2/16/2015 1:51 PM (GMT 0)
Halbert,

You asked how do some people live to 100 without Cancer?

My answer.... think Darwin ... their ancestors are more fit then my ancestors when it came to Cancer. My ancestors were crap .... without modern medicine, I would have died at age 8. I survived and have passed on my (ancestors) bad genes ... We continue to weaken the gene pool with medical advances. Maybe bioengineering will reverse the trend.

Again, this is only my guess.

Maybe they lived to 100 because they injested Iowa corn or Vitamin D or Pom T or yellow snow?
Posted 2/16/2015 2:06 PM (GMT 0)
RCS, pretty good answer to a rhetorical question! Well done.

Cheers, Doug
Posted 2/16/2015 2:15 PM (GMT 0)
Doug, I guess I've been fortunate in my caregivers so far. From my PCP, who I've been going to now for nearly 25 years...and who never fails to ask how the kids are doing, to the local Uro who took as much time as I needed to explain and discuss the diagnosis and his view of the options. He even owned his own limitations: He is now in his late 60's, and has PC himself. He told me clearly that when the Davinci system came out, he studied it and went to the seminars, and decided ultimately to not put 200 patients at risk while he got good at it. (I also think he would have had a hard time selling the small local hospital on buying it).

What I'm saying is, that in my case, I haven't felt a speck of pressure from anyone to choose one treatment over another, at least from the medical profession. I had a biopsy because it was recommended..and because I wanted to know if something was there. I had the bone scan and cat scan and bladder ultrasounds also to learn what was going on.

My local Uro has clearly been on board with handling my postop care, and that made my decision of where to go for treatment easier.

Maybe I'm luckier than some.
Posted 2/16/2015 2:23 PM (GMT 0)
Shaba,

Spot on.

My vocation .... answering rhetorical questions!
Posted 2/16/2015 2:28 PM (GMT 0)
Well, how do some people live to 100 without cancer…Your DNA. My father in law died at 96 with alzheimers, (He had had the PCA treated with surgery when he was 67), so the cancer was taken out, but when he had the autopsy, it showed a small PCA, but the alzheimers took him.

My husband was dx with PCA at the same age, 67, but he had a completely different treatment. He is alive , but so debilitated. The two ostomies are so difficult to deal with. The lupron now has raised his sugar level, His shoulders are bone on bone from calcium lost from lupron, he is on oxycontin, oxycodone, blood thinner, medicine for sugar, because the lupron has raised the sugar level, and now they are talking about prednisone. but he will probably live to be 96 like his father, hopefully not with alzheimers…but it is a possibility.

I realize this is a difficult email to read . It is difficult for me to write, but something in Cap Huffs first post caused me to come forward. I used to post much more in the early years, but now just look in once in a while, and see men who are deciding. It is a difficult difficult decision, and you must realize going in that you may make the wrong one. We have no guarantees in this life. We are all dying the day we are born.

Peter and I have been married for fifty years. He was a wonderful lover, a wonderful father to our three children, and a great grandfather. He was a scientist, and a very strong outdoorsman, who loved swimming, hiking, fishing, and running. He never was sick in our entire marriage of almost 50 years, but now the last ten years have been filled with horrible side effects from the treatments of this PCA. The cancer itself is laughing at our human feeble attempts. It is the ISIS of disease.

My heart goes out to everyone who has to deal with making this decision. I still say that AS is a good choice.

Di
Posted 2/16/2015 2:33 PM (GMT 0)
Di,

So very sorry.

Thank you for your posts. They will help the new people.

Best wishes as you move forward.
Posted 2/16/2015 2:36 PM (GMT 0)
Halbert, my concern comes from the number of Newbies who arrive here with "basic" questions about treatment. These aren't so much clarifying questions but basic stuff which leads me to believe they have been not very well informed by the medical community. I know they're new to this and have a ton of questions and panicky, but reading between the lines I can't help but think they are not being properly informed or not listening or both.

As far as your PCP, Bravo! To me his age tells all, from the generation where customer service meant something and consideration of others before yourself, our generation.

Cheers, Doug
Posted 2/16/2015 2:50 PM (GMT 0)
Doug, my PCP is a great doc. He knows what he doesn't know. As far as the rest goes, well, a lot of it is in our training: we are taught to not argue with the experts, and maybe not even question them. That, I think, is the bottom line. We do a horrible job of teaching critical thinking, and it is discouraged at all turns. In some ways, I think, the internet makes it worse by treating all information as equally valid.

To Divo, when you posted yesterday, I did think back to my father. He sounds a lot like your husband. A professor of Organic Chemistry (did that fact contribute to his cancer?). Diagnosed around 1990, chose cryo in part because it was cutting edge and because the practitioner was a former student. Had 10 good years after that, then HT, radiation, and ultimately the mets got into his spine and ended his life in 2004.

I do draw some value from the fact he was willing to be a part of cutting (shall I say freezing) edge research that I'm sure helped us today. Would he have done better, lived longer, if he'd had more established treatment? No way to know.

And now it's my turn, in about 24 hours.
Posted 2/16/2015 3:04 PM (GMT 0)
Halbert, my best wishes to you. Interesting that you said your father was a chemist. My husband was a chemist also., working with nicad batteries, (nickel cadmium), he has patents for some of the first satellites that are still in the air. He has always thought it had something to do with the chemicals that he worked with. But then, his father, had cancer also. Di
Posted 2/16/2015 3:15 PM (GMT 0)
I will be on AS for 3 years in March. Over the 3 years I have seen AS become more accepted and the criteria has been widened a bit. I have seen age to be less of an issue and even a small amount of G7 (3+4) be accepted. Also over the 3 years I have seen the tools to diagnose have improved. More accurate 3T MRI's, MRI guided biopsies and gene testing are available. With these advancements deciding on AS isn't what it was in the past and will only improve over time. Do your research.
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