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Posted 10/25/2021 3:01 AM (GMT 0)
James Michael Tyler , played Gunther, on Friends, passed from PCa at 59.
May he Rest In Peace

https://www.today.com/popculture/james-michael-tyler-actor-who-played-gunther-friends-dies-59-t235790
Posted 10/25/2021 12:22 PM (GMT 0)
Very unfortunate. First PSA test at Age 56, “extraordinarily high” PSA, Stage 4 and is gone in three years. If only he had started screening a decade or so ago he may have been cured. The current screening guidelines have not been good, in my opinion. My Uro says in the last five years nearly every man referred to him is at least locally advanced. Very few low risk dx that he sees any more. A big change in the last decade.
Posted 10/25/2021 12:53 PM (GMT 0)
Well when the PSTF under the prior regime 13 yrs ago makes bonehead recommendations, these are the results. I read that decision in 2008 to change the guidelines to discontinue PSA screening resulted in more than 20K additonal deaths per year.

My PCP didnt want to do a PSA test on myself in 2017, siting the PSTF and standard of car non-sense. Fortunately I insisted. Too many men I talk to have no clue what a PSA test is and the PCP are at fault for not coaching them up when they have their yearly exams, and damm those doctors on the PSTF back in 2008! Not one was a URO, RO or MO who treated Prostate Cancer.
Posted 10/25/2021 3:55 PM (GMT 0)
Sad. His you tube video serves as a good reminder for us all to get tested regularly.
Posted 10/25/2021 4:09 PM (GMT 0)
A PSA test is like $40. darn the PSTF idiots.
Posted 10/25/2021 5:22 PM (GMT 0)
Yeah, the guidelines are a problem. Didn't they change them more recently to make them more encouraging of screening?

The real point is--and it was discussed in here, quite energetically as I recall, that the vast majority of men get the tests, and do the medical things their doctor tells them to do. That is, if they ever go to a doctor at all for an annual physical.

It was predicted, in this forum, that the 2016 (I think it was) recommendations would lead to more, younger men getting diagnosed after it was too late, all in the name of preventing overdiagnosis and over treatment.
Posted 10/25/2021 5:48 PM (GMT 0)
I posted about Mr. Tyler's death on my Facebook page today, with a comment about the wisdom of having a PSA test included with the annual physical after age 45 or so. I'll always feel that my family doctor saved my life by insisting on the annual PSA test, and then convincing me to see a urologist when the number started climbing. I very nearly waited too long.
As for the USPSTF recommendation, I've never understood why anyone would recommend against a simple blood test that might be helpful in dealing with a potentially deadly cancer. Are we men such babies that we need to be shielded from possible distress if the number comes back high or if follow-on test shows the number wasn't really indicating cancer?
Posted 10/25/2021 5:49 PM (GMT 0)
I think the recommendations were closer to 2012. After throwing PCa and BCa patients under the bus, I think the Task Force is now focusing on the safety of things like baby aspirin. Maybe they should have stayed with that in the first place. 😐
Posted 10/25/2021 6:47 PM (GMT 0)

clocknut said...
I posted about Mr. Tyler's death on my Facebook page today, with a comment about the wisdom of having a PSA test included with the annual physical after age 45 or so. I'll always feel that my family doctor saved my life by insisting on the annual PSA test, and then convincing me to see a urologist when the number started climbing. I very nearly waited too long.
As for the USPSTF recommendation, I've never understood why anyone would recommend against a simple blood test that might be helpful in dealing with a potentially deadly cancer. Are we men such babies that we need to be shielded from possible distress if the number comes back high or if follow-on test shows the number wasn't really indicating cancer?

Good idea to post on Facebook, using Tyler as an example. He was big on outreach so i think he wouldn't mind. Its a way to reach lots of people, and maybe save one person from a lot of heartache.

And yes, i feel the same way you do about my PCP
Posted 10/25/2021 9:38 PM (GMT 0)
I don't want to rake up old fights, but remember you guys Stateside had a - what? - 20y epidemic of overtreatment, much of it substandard. The incidence of depression and suicide on PCa diagnosis and treatment is enormous, with its own morbidity and mortality, never mind lost QALY among overtreated men, so can we all agree that this is not a black and white issue? In an ideal world of course knowledge is power but in the real world we are oscillating to a correct equilibrium and the word "cancer" still sends rationality out the window. With MRI etc the overtreatment is receding and the treatment is improving. Personally I would screen in an ideal medical environment but we don't have one either side of the Atlantic. We "aggressive" patients are in the minority. We would be screened: should everyone? Not black and white: may it become clear if the environment improves as treatment advocacy gets outed as being unethical (etc.) but we are not there yet: look how hard the posters on here work to create our own little corners of proper treatment, fighting off over-eager surgeons etc.

Back to the original spirit of the thread, we have a high-profile case in the UK too, a broadcaster called Bill Turnbull, who seems to be seriously ill following Dx in 2017.
Posted 10/25/2021 10:08 PM (GMT 0)
Michael was a friend and he was a very sweet man. I just finished texting with his widow and although she knew this was coming, it is still so tragic. I don't feel it's right for me to post any of his specifics, but I will say that if his story doesn't reinforce the need for PSA screening, then nothing does. I know he would want me to spread the Gospel of early and annual screenings.

RIP JMT. So sad to see you go.
Posted 10/26/2021 7:03 AM (GMT 0)
Shaws...you are right on your assessment...but it won' carry water here....nice try...this is not a black and white forum...it tries... but just cant seem to see both sides of any side of any issue...regardless of the aisle...er....carry on tho
Posted 10/26/2021 7:28 AM (GMT 0)
SUM, you're right. It's finding that balance point, and who the heck knows what it is. I like to look at the longer history.

Prior to the development of PSA, and it's widespread use in the early 1990's--yes, it's only been 30 years or so--diagnosis and treatment of PC was chancy at best, and brutal at worst. Many men had TURP (or as we call it not-so affectionately the "Roto-Rooter" procedure) for prostate "trouble", and from time to time the removed cells would indicate the presence of cancer. Otherwise, PC was not generally diagnosed until there were visible symptoms, and treatment was generally palliative only.

Then PSA appeared on the scene, and as happens frequently in medicine as well as in many other areas, it was seen as the best diagnostic tool there was, and there was an assumption that all high PSA readings meant there was cancer. I'm not sure when TRUS biopsies came into play. Still, at the time, the modern drug and radiation therapies were not around. There were some centers who were trying things like whole gland cryotherapy instead of surgery (my dad was one of the men who opted for that treatment), and hormone therapy consisted of monthly injections of synthetic estrogen.

I think, when we take a rational look at the history, we have to take a deep breath, and look at the overall state of the art at the time, not just at PSA and overtreatment. Many of the treatments and therapies that are available today simply did not exist 30 years ago, or if they did, they were still in the highly experimental stages.

So, we had a situation, that yes, led to overtreatment and misery for many men, but also undoubtedly saved many lives. Then we flipped on the pendulum swing to avoiding overtreatment and missing the opportunity to save the lives of many younger men. Now, hopefully, it is swinging towards some middle ground--maybe.

We have all these great new therapies, and more all the time for treating the highly aggressive cancers in younger men. We just have to find a way to diagnose them when they can be helped--without throwing too much emotional turmoil at the men who are screened, and who have indolent cancers. That, to me, is the aim of future research: How do we identify, from a biopsy or other relatively non-invasive procedures, which cancers are aggressive and need immediate, hard treatment, and which are not.
Posted 10/26/2021 7:43 AM (GMT 0)
@Geetarman: sorry for your loss. @logoslidat: I think I get it but there might be a stray negative in there?!

@halpert: 100% and finding the dividing line between what is essentially 2 diseases, and the mystery as to whether and when *****cats become tigers (or, ever, vice-versa?).

This is why I stand in awe of the Protect trial (which must be just about to disgorge 15y data.) Just the most amazing piece of science, propelled by 1800-odd brave men.

<ADD>Hahaha: when I say ***** I mean kitty, not ****</ADD>
Posted 10/26/2021 12:57 PM (GMT 0)
Actually my GP at the VA saved my life... It was 2013. The VA when you have a blood test, which I had every six months for heart issues they also track your PSA. My PSA came back 4.5. He showed me the chart on the screen showing how it had climbed. He set me up to see the Urologist. We all called him the rear admiral. He didn't like what he felt and set my up for a biopsy. I had the biopsy in Jan 2014 and came back 4-3. The rest is history.. RP March 2014
Posted 10/26/2021 5:35 PM (GMT 0)
I just watched the interview and tribute that was linked. His first PSA was 654 and cancer had spread to his bones. Despite ADT treatment it mutated and worsened causing fractures and spinal compressions which ended up crippling him.

I will be sharing it with my friends on Facebook and Instagram.

SUM, over-treatment of a condition is not due to finding the condition. It is due to the doctors deciding to treat the condition with little regard to the variations in the condition from indolent to life threatening. Millions of dollars were made by surgeons that “saved the lives” of thousands of men who had one positive core of G6 and slightly elevated PSA. Over-treatment is not the fault of the test, rather the fault of those that miss-use the test results.
Posted 10/27/2021 3:33 PM (GMT 0)
"Stray negatives"...Yes as stray as the the cancer in your body.( i won't quibble with %(tages)..but that would be reasonable giving the circumstances...what would be unreasonable...and in keeping with your shaw "shtick"...is to ask 'us to reason together' over black and white...that alone...plus the obvious fear you display which is quite reasonable ends this for myself...(u can only have it both ways in Quantum Physics)...I do wish you well in your journey...Shawspeed and good luck as well...regards...
Posted 10/29/2021 12:11 PM (GMT 0)
That over treatment issue is the primary driver for the revised Grade Group system. Instead of telling guys they have a Gleason 6 on a scale of 10, which sounds pretty scary, they have a Grade Group 1 that can be readily monitored, and not likely to ever be a real problem for them.

We all, I'm sure, know of people with a 5% of 1 core G6 that freak and want their prostate GONE, "get that cancer out of there!", and live a long time with bothersome side effects after surgery. The cost and burden of treatment for such people drove the USPSTF recommendation to just avoid even testing people. "You can't diagnose a fever if you don't take a temperature".

That is so disrespectful and lazy on the part of the medical community. Do the tests, but then HELP patients really understand their options. And I'm cynical enough to believe some doctors do the surgeries because it pays very well and boosts utilization of the expensive robots hospitals purchase for such things.

Instead, they stop screening, and write off those of us with rarer but truly life-threatening cases.
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