Active Surveillance Update - 99.9 Percent Will not Die from Prostate Cancer

JackH said...

Pratoman said...
But as you note, that cannot happen until there is a really definitive way, not with 95% surety but with 100% or 99.5% , to ackmpnowledge the fact that there are never absolute guarantees, to determine which PCs are truly indolent.

Did I say that?

You'd have to show me, because I don't think I would have said that.

I wouldn't have said that because I don't believe that.

Actually, the sentence fragments you wrote are a little confusing (it's a little late; that can be forgiven), but I don't think I would have said what I think you meant to write.

I don't think I would have said that because that sounds like someone who doesn't understand AS.

AS doesn't guarantee you will have an indolent tumor forever. That's not what AS is all about.

AS means validating the stability of one's low grade tumor over time, and eventually moving safely to deferred treatment for the subset of men who show indications that treatment is appropriate.

Understanding AS means understanding that the cancer outcomes for those with similar low risk characteristics who undergo immediate treatment is no better or worse than those who follow AS. Possible future upgrades notwithstanding.

Sorry if I somehow, somewhere left a different impression. Where/when did I do that? Please let me know, and I'll try to go back and correct it. Thanks!

This may have been, in part, me misinterpreting your statement, and in part, as you said, saying what i meant to say, using fragments....

You said ..
"You have highlighted EXACTLY the reason, Pratoman, why many of the PC thought leaders are searching for the right way to redefine favorable-risk prostate cancers."

I took that to mean that PC thought leaders are looking for ways to classify pc as low risk and suitable for AS USING METHODS SUCH AS MRI and Genetic tests. Perhaps that is not what you meant. THE 95% /99.5% comment was my own, didnt mean to say that you said that.

Pratoman,

Gotcha.

I think my message might have been different. The key to mine is in the sentences that followed:

JackH said...

You have highlighted EXACTLY the reason, Pratoman, why many of the PC thought leaders are searching for the right way to redefine favorable-risk prostate cancers. People hear the word "cancer" and they just simply shut down all reasonable thought processes. The doctor's know that. Some say call it "pre-cancer," other say call it "IDLE tumor" (that stands for something, I forget what).

Personally, I think telling someone they are Gleason 6 sounds like it could be bad. Six out of ten sound like it's a long way from THE LOWEST POSSIBLE RATING, and one that does no harm. It should be a "1" not a "6."

Some of the possible ways that favorable-risk PC may be redefined which are all intended to reduce the unnecessary fear, terror, panic, etc that too many men experience when they are first diagnosed, which experts recognize is one of the key contributors to men rushing into unnecessary aggressive treatments:

1) call it pre-cancer instead of cancer
2) call it IDLE tumor
3) throw out the Gleason scale; replace with "1" being the lowest possible (roughly equal to 3+3)

Note that these all relate only to the favorable-risk PC, which is what most men are diagnosed with. PC is a full spectrum of diseases...many people think it should be broken out into different diseases. They are not treated the same, and they have very different outlooks...may they should be called something different by literally redefining the low-end of PC by taking out the unnecessary scary word.


Hopefully this clarifies the statement for you, Pratoman. Now, go enjoy the weekend...which is exactly what I'm going to do, starting now by cracking a session IPA and cruising the lake. I'll check back in later (few days?) and pursue finalization of the AS FUNDAMENTALS sticky contribution...if anyone wants to add ideas for that, please post here. Otherwise, if this thread goes off the rails and gets goofy, someone please pull it back....

Post Edited (JackH) : 9/4/2015 1:01:41 PM (GMT-6)

I hope all of us with pca can last as long at this thread.
I don't quite understand why some people are jumping on this study. Isn't this good news? Shouldn't we be happy with any good news no matter what degree of pca it relates to. As having chosen AS, I'm extremely happy to hear these stats. Let me tell you, you can become a bit of a hypochondriac when you're an AS member so anything that will help put your mind at ease is great.

After 3 1/2 years I did have to get treatment and I went the Da Vinci route. Would Brachytherapy have been a better choice? I don't know. I hope one day a study proves that it is. My point is, let's not get caught up on the choices we've made. Good news is good news and it will help all of those who come after us.

Oh, one last point. One of the earlier comments was that AS wasn't a good choice for those that are young. What? Why wouldn't it be? I was 49 when AS was presented as an option to me. I was told "you never know, you may not have to get treatment for 5, 10, 15 years and you'll still be young enough for surgery". Isn't that a good choice. The only thing you know for sure when you choose AS at a younger age is that you are going to live long enough that you will eventually need treatment.

Pratoman said...
In my mind it all boils down to the question..."is G6 really always indicative of cancer?"

Respectfully, I DO NOT think that is a burning question of 2015.


Think about it, Pratoman...that WAS the question that Johns Hopkins medical researchers sought to find the answer to 20 years ago—back in 1995 when this study was first launched. Today, after 20-years of results, we have that answer.

Post Edited (NKinney) : 9/8/2015 12:21:29 PM (GMT-6)