PC myths and partial truths

I had a thought the last few days, seeing some of the persistent things that newcomers post about, and what they heard from doctors and well-meaning friends, and I am amazed, again, at the myths and partial truths that about in the PC world. In a peculiar way, the thread about movie quotes got mixed in here, particularly Jack Nicholson's famous, "You want the truth? You can't handle the truth!". The truth is, most people don't want the truth. They want their beliefs confirmed by facts, not the other way around.

So, a few myths I've seen and heard over my history with PC:

"Nobody dies of PCa anymore". Yes, this is actually still out there. The headlines and first sentences and soundbites that accompany the latest screening guidelines feed this, I think. I always remember that our general attention span is measured in seconds, so the lead statement is the critical one when this sort of thing hits the streets.

"High PSA equals Cancer". Its shocking how many doctors either still think this--or if they know better, don't tell their patients that this isn't true. As we know, there are a lot of reasons for PSA to spike that have nothing to do with cancer. The definition of "high" is also pretty flexible.

"Every diagnosed PCa needs treatment immediately". Again, it's shocking how many Urologists keep saying this. And they should know better. And it's shocking how few of them seem to be willing to refer patients for different treatment options.

"Treatment X (usually the one the doctor specializes in--or the one a particular patient had) is the best treatment for everyone". Stated with all the energy of Truth, when in fact, it is opinion. This is the kind of almost-truth that is really risky to state, because there isn't a one-size fits all treatment.

What other ones do you guys think are still out there?

You are right, halbert. There are many misleading "myths" about prostate cancer that continue to exist. I'm glad you started a thread to help draw attention to them because at a site like this "we" do a strong dis-service to our fellow men by allowing them to perpetuate without squashing them.

I have several to contribute, but I'll lay them out one at a time. I will also circle back and comment on some of what you have initially posted. You listed four myths, and InTheShop added a fifth one. You didn't start out by numbering them, but that's going to be helpful going forward to promote clearer discussion, and discussion seems to be what you are asking for (perhaps you could go back and edit your opening post to add enumeration). Allow me to start with a new one, the sixth myth:




(6) The popular belief is that it's better to catch cancer—any cancer—early and treat it until it's gone.


This is not necessarily true for prostate cancer, and many prostate care specialists go further to stress that this is just plain wrong for most cases. The roots of this myth are easily understood and known, but far too often the simple facts get overcome by the waves of emotion.

This fear is based on a personal-historical belief that most of us have—remembering our grandmother's (or some other close family member; and if it was grandpa's death from PC, all that much moreso) cancer death—that a diagnosis of cancer was a death sentence. In Western society at large, the cancer "zeitgeist" is that this disease is dreadful and must be caught early and treated aggressively to avoid what would otherwise be a painful and premature death. This widely shared preconception often leads the patient to make a quick and early decision for treatment, regardless of the risks and benefits.

For some cancers this fear is warranted, but for most men with favorable-risk prostate cancer, their condition is far removed from that of a rampaging, aggressive, killing disease. Most men with favorable-risk PC are NOT destined to die of their disease, even in the absence of treatment.

As you said, halbert, people's "beliefs" can be strong...even when the facts don't add up in support of their beliefs. It is difficult to engage in conversations on this topic at HW/PC with favorable-risk men who have already had an RP because I don't want to hurt anyone's sensitive feelings. A RP can't be undone. The men that are post-RP, that geared up for their major surgery, and are gung ho—you can't tell them that they might have done the wrong thing, not after what it has cost them financially, emotionally, and physically. THAT is why doctors, and the well-educated (school of hard knocks) patient support sites like HW, need to communicate more effectively with new patients up front, and strongly resist any encouragement to rush into an aggressive treatment. While men are unwittingly rushed into a drastic operation without a full understanding of the consequences, they often defend their surgeon (the one who did the rushing) with the notion that he "saved their lives," when in fact for low-risk patients the surgery probably had no impact on their longevity.

The majority of PC cases fall into the favorable-risk category and so the popular belief is that it's better to catch prostate cancer early and treat it until it's gone is largely a myth.

Post Edited (JackH) : 4/20/2017 7:44:17 AM (GMT-6)

raypaul said...
From what I can see it doesnt appear that the profession that treats prostate cancer is doing much to clarify these and the many other myths that exist out there. From a patient point of views its very confusing, discouraging and anxiety promoting.

Too true, and equally concerning to me, is my observation that one of the other major PCa web sites seems to be so "gung-ho" over surgery that literally every man who goes there is advised to prepare for surgery as "it is the only way to be sure you remove it" or "it is the gold standard" or some such biased commentary. The people there seem more biased toward surgery than Dr. Walsh's book which, in my opinion, unfairly describes many of the now-standard radiation therapies as "experimental."

I have chosen not to join that site, as I don't like to participate in flame wars, and nobody who goes there seems to ever be advised to look into AS or RT. . . just surgery.

26 K sounds huge and it needs to be 0 but I think what is helpful is perspective because most of the time when people hear the word cancer they jump to painful, premature death. Also the perspective of the degree and grade of PCa is helpful. It is still cancer but the degree and grade of cancer often influences the behavior of the disease and then of course outcome. Having this information widely available may help slow the treatment process down for many men.

7. Younger prostate cancer patients should choose surgery over radiation since longer life expectancies predispose patients to the secondary cancers produced by radiation.
Secondary radiation cancers in patients treated for prostate cancer are extremely rare. Men having iatrogenic impotence from prostate surgery is over 50%. I know radiation has some effect on sexual functions as time passes, but less.

If anything, younger men that are very sexually active should not allow a urologist to talk them out of SBRT, LDR brachytherapy or HDR brachytherapy.

Paul

The song of the times..."Tell Me Lies...Tell Me Lies...Tell Me...Sweet...Sweet...Lies."...

Radiation can be administered so it's equivalent or better than surgery + SRT and with fewer side effects. this is something you wont hear from many urologists, but that's exactly what mine told me when he recommended combined treatment.

instead you'll hear "with surgery you will have radiation as a back-up"

ed

As a newer member to the forum and to PC I've heard a lot of these "myths" already. Some from doctors and some from forums and websites. Each individuals cancer is unique and dynamic as the indidual. Each person must make their own choice in their own time.
Facts change with new discovery..That's why they call it "practicing" medicine

Reading the "myths" posted by TallAllen has made me realize this: there is some basis for pretty much ALL of these myths.

This struck me particularly when reading his Myth #2 and Myth #3 (#1 is largely a repeat of #3). It's true that these so-called myths are not ALWAYS the case; nor are they NEVER the case. I was especially looking skeptically at Myth #2. There certainly is a basis for each of them to be true some of the time, and maybe often. So rather than calling these "myths" or not, they are all really "partial truths."

So then I went back and read all the others posted by him and others (including myself), and pretty much the same is true of all of them. There is some truth to how and why they became considered "myths." It's simply that they are NOT "universal truths."


Great thread, halbert, but as is so often the case in issues of life, the simple, universal answer-in-a-nutshell just can't be given to so many of these questions. Takes a little 'splainin'.

Post Edited (JackH) : 4/21/2017 1:10:49 PM (GMT-6)

Agreed. That 'splainin' should be coming from the doctors (as per USPSTF), but we're here to help...