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Posted 6/12/2011 4:00 PM (GMT 0)
I can't help but notice that up until davidg's post on this thread that the subject matter was handled in an intelligent, rational manner with a speck or two of passion thrown in for good measure.  Exactly the kind of discourse that is valuable, IMHO.

Davidg, I must honestly wonder why you feel the need to constantly show up in attack mode.  Perhaps you should consider heeding the advice of our mods and take a deep breath or a walk around the block before posting such cra*.

Tudpock (Jim)

Posted 6/12/2011 4:03 PM (GMT 0)
...furthermore to the mods... this was a good thread with good information and good interaction...even though people disagreed.  Please don't let the rantings of one member cause another locked thread.  Why not just remove the offending posts and move on...

Tudpock (Jim)

Posted 6/12/2011 6:25 PM (GMT 0)
Pretty wild discussion.  It seems that most of what is going on here has little value for helping a newly diagnosed man to make a rational treatment decision.  There are three main treatment options, Active Surveillence, Surgery, Radiation.  Each of these treatments have a place for some people.  However, there are also many other people where it isn't crystal clear what treatment is best. Even if there were better comparative studies, for the individual patient, it would still be a matter of judging the odds and rolling the dice, as there is always some risk that one's cancer might evolve in a different way than most men with similar stats.

This discussion hasn't been very useful.  Mostly what you read in this thread consists of advocates for a certain treatment overstating the case for their favorite treatment and arguing with (or sometimes ranting at) those with other views.  It's understandable that when you've picked a treatment, you are emotionally invested in it, and need to think it's the best treatment out there.  You don't want to think you made a mistake, do you?  However, that doesn't mean you have to say that your favorite treatment is the right treatment for EVERYONE.

The other theme I've tried to inject into the discussion is skepticism.  The information on chosing among these three treatment options is inadequate, because it's very hard to get men to enroll in comparitive clinical trials where their treatment is chosen randomly for them, and because it may take 20 or more years to really answer the questions, because prostate cancer grows so slowly.  Throw in on top of this that medicine is a business, and there are a lot of MDs and clinical practices that use "education" and "studies" to promote their favorite treatment, and their own medical practices.  The result is a lot of contradictory messages based on flawed information.

The moral of the story is, live with uncertainty.  The medical information on chosing treatment is not adequate.  Be suspicious that at least some of the MDs you talk to may be biased, and nearly everyone who posts on this website has biases, too.  Buyer beware.

Posted 6/12/2011 7:40 PM (GMT 0)

Postop said...

The moral of the story is, live with uncertainty. The medical information on chosing treatment is not adequate. Be suspicious that at least some of the MDs you talk to may be biased, and nearly everyone who posts on this website has biases, too. Buyer beware.

I would not argue with any of that.

But the time for a person to be skeptical is when they receive the diagnosis and recommendation for treatment from their urologist. That is the time to get into action and do some research on the disease, and/or get a second or third opinion on treatment, and hopefully one from a medical oncologist rather than urologist or radiation oncologist. Being uncertain should not be a state of being, but a call to become better informed.

I see little bias on this forum in terms of the information given to newly diagnosed persons seeking treatment advise. The advise is nearly always the same: 1) get a second opinion on the biopsy pathology, 2) become as informed as possible about the disease, and 3) seek another opinion as to diagnosis.

Finally, it is important to understand that while all studies may contain some bias, some are inherently more credible and have greater usefulness than others. I believe the study is question has a lot more credibility than you give it, though it should certainly be reviewed with a skeptical mind.

Sancarlos

Post Edited (Sancarlos) : 6/12/2011 2:25:15 PM (GMT-6)

Posted 6/12/2011 8:26 PM (GMT 0)
Tony has written how medical studies are classed by level of evidence. There are different systems to rank these, but at the top there are randomized controlled studies, often called Class I evidence. At the bottom is expert opinion. Next to the bottom are uncontrolled observational studies.

This study was organized by a radiation oncologist in Seattle. It is a metanalysis where they collected data from uncontrolled observational studies and reanalyzed the pooled data. As best I can tell, the results haven't been published, but were posted on this radiation oncology group's website, and then discussed in the newsletter that is cited at the beginning of this thread.

This study should be ranked either as expert opinion, or uncontrolled observational studies, that is, at the lowest level of evidence. Further, the re-analysis has not been subject to peer review, that is, no anonymous reviewers not preselected by the author, has looked at this metanalysis to see that the methods were valid.

I think skepticism is justified.
Posted 6/12/2011 9:37 PM (GMT 0)

compiler said...
Davidg:


Wow. You don't post for awhile and then return with a bunch of ridiculous assertions. Hey, I'm a pro-surgery guy (despite the fact that mine didn't work, I know it works for the majority if PC patients).



What I do notice very much so is to be expected: we tend to, in a subtle or not so subtle manner, support whatever choices we made. There are certain posters that all I have to do is note their names and I know they will be pro-radiation. So what. That's the value of this board. We all have different experiences.



When I first got dx. (and even before) I did a lot of reading on HW. We did have the strident few who were clearly in left field with their own axes to grind. But, overall, when looking at the totality of posts, I learned more than I did from any other medium.



In short, I just have not seen any kind of animosity towards those who had surgery. Of course, for those who appear to be spamming for a particular surgeon, well maybe they were greeted a tad ...vigorously.



Mel

It's an opinion I have. One that is easy to verify btw.

You were operated on by a celebrity surgeon. One that is considered among the best. Everytime someone comes here asking for advice I don't see you or any of the other surgery guys post " give Menon a call" or "read Menon's blog".

On the other hand, you can see Scholz or that controversial book he wrote being recommended almost every time in those same threads.

Also, if the people who do not recommend surgery, and constantly point out the possible negative side effects don't also point out the extremely frequent great stories coming out of the surgery guys one could argue that their bias is dubious at best.

This site is extremely helpful, it's great. But it's a peer to peer group and I think it's best for folks to learn by actually talking to their doctors and other medical professionals, not random guys who like to play doctor.

There are some who have an inherent abundant amount of animosity towards doctors and their motives and this sometimes comes across very strongly. I personally don't believe this is a great thing for a "newbie" to hear.

Not sure what you mean by coming back with a "bang". I posted an opinion. I got back a few days ago from apt hunting in Rome and read 3-4 threads total. In two of them a veteren member here got attacked for no reason whatsoever and the other two also had what i call "pissing contests". I didn't even have the Internet at the time those threads were posted.

enjoy.
Posted 6/12/2011 9:54 PM (GMT 0)
It's a crying shame, that another good, well intended thread, ends up being trashed. Seems to me, that its becoming a trend here. Not the way HW use to be.

davidg - i can't believe what you posted. yes, it was your opinion, and everyone has one, but what you posted isn't going to be received, or believed, by the rank and file here. and i agree with ziggy above, at the least, you owe the board an apology for your accusations and rudeness. you came to hw with some kind of mission of your own, and you end up being in constant controversey. do you really think only you are right, and everyone else here is wrong? its sad actually.

david in sc
Posted 6/12/2011 9:59 PM (GMT 0)
what's rank and file?

I certainly never had a mission. i came to defend real people who were being attacked. Curiously by the same people that I consider organized anti surgery activists ( in my opinion).

I believe what I posted, why would apologize? and what's an apology anyway in cyberworld?

Where did I say I'm right and anyone else is wrong? Are we talking treatments here? I think everyone should pick their own treatment as it suits them after consultation with a real medical professional or two.
Posted 6/12/2011 10:09 PM (GMT 0)

Postop said...
Tony has written how medical studies are classed by level of evidence. There are different systems to rank these, but at the top there are randomized controlled studies, often called Class I evidence. At the bottom is expert opinion.
clip, clip, clip

I think skepticism is justified.

First, I am aware of Tony's classification of medical studies. And I am also quite aware of how the study was organized and published because this information was made available with the publication and one could read for themselves. Skepticism is certainly justified, said so already.

I am not a medical doctor and don't give advice about treatment but I have a good understanding of the methodology of how to determine what constitutes a good publication. This ensues from a background in academia, which includes an earned PhD, and many years of peer evaluation of both personnel and of research.

Important studies usually have several characteristics. One is that the head researcher is notably distinguished in his/her field. Second, the publication has the endorsement, implicit or explicit, of a significant number of other distinguished professionals in the field. And third, the publication takes into consideration most of the important studies by other professionals in this field. IMHO the study in question is important because it meets these criteria.

Also, because of the fact that so much money is involved in the treatment of prostate cancer one can be assure that this study will receive a great deal of "peer review" by those who practice other treatment modalities. So the conclusions formulated by the chief researcher are certain to be challenged, as they should be in the market place of ideas

Sancarlos

Post Edited (Sancarlos) : 6/12/2011 5:51:00 PM (GMT-6)

Posted 6/12/2011 10:57 PM (GMT 0)
San Carlos,
You nailed it. You forgot to mention the Grimm first presented this to the Annual Prostate Cancer Symposium which is attended by many professionals who present their findings to their peers. To even consider that this was not peer reviewed is nonsense.
JT
Posted 6/13/2011 12:04 AM (GMT 0)
Peer review doesn't mean presenting to your peers. It means the work doesn't get in print before it's scrutinized and approved:

en.wikipedia.org/wiki/Peer_review

"Scholarly peer review (also known as refereeing) is the process of subjecting an author's scholarly work, research, or ideas to the scrutiny of others who are experts in the same field, before a paper describing this work is published in a journal. The work may be accepted, considered acceptable with revisions, or rejected.

Pragmatically, peer review refers to the work done during the screening of submitted manuscripts and funding applications. This process encourages authors to meet the accepted standards of their discipline and prevents the dissemination of irrelevant findings, unwarranted claims, unacceptable interpretations, and personal views. Publications that have not undergone peer review are likely to be regarded with suspicion by scholars and professionals."
Posted 6/13/2011 12:36 AM (GMT 0)
Davidg:

Well, let me succinct for once. You keep declaring that it is so obvious surgery proponents get attacked, ridiculed, whatever.

I am a surgery proponent. I've never felt attacked.

Other responders don't seem to see that.

So, maybe it's not true. It certainly isn't obvious.

Incidentally, you keep mentioning that Dr. Scholz keeps getting high praise here. I don't see that at all. I've mentioned his name quite a bit because I am going to see him and I fully intend to report back here. Frankly, I hope I get a chance to praise him. But I assure you I will be very honest. I may very well conclude that he is arrogant and didn't give me the time of day (what a waste that would be!!).

The only praise I saw was when I specifically asked if anyone was familiar with Dr. Scholz and John T expressed his personal experience. Maybe there was another positive response to that specific request.

In fact, you said "On the other hand, you can see Scholz or that controversial book he wrote being recommended almost every time in those same threads."

OK -- BACK UP YOUR CLAIM. Show me a bunch of threads where his book is recommended. I seem to recall a few where the book was panned (Purg., I think, was critical of the book).

Welcome back

Mel

Posted 6/13/2011 12:38 AM (GMT 0)
search "scholz" and/or invasion of the prostate snatchers on the search function here.
Posted 6/13/2011 12:51 AM (GMT 0)
Davidg:

I just did as you suggested and put Scholz in the Search Box.

I see a ton of my posts, indicating that I am going to see him, requesting input, and also indicating a list of questions that I would like to ask Scholz.

The ball remains in your court to prove your assertion, showing us all of these many many many posts extolling his virtues.

Show me all these "recommendations" (your words, not mine) of Scholz and his book.

Mel 

Posted 6/13/2011 1:09 AM (GMT 0)
Mel -That's exactly what the search function is for. You'll see exactly 330 posts. Enjoy reading them, I'm watching the game.
Posted 6/13/2011 1:15 AM (GMT 0)
Enjoy your total lack of credibility

Mel

Posted 6/13/2011 1:33 AM (GMT 0)
Mel, Davidg,

Guys, I'll say that I have seen so many references to "invasion of the prostate snatchers" as a first read before you make a decision that it has arrived at the annoyance factor of a wart on the tip of the nose. But I don't suggest anyone avoid reading it because of my opinion. I always try to point at the local library before putting out hard-earned cash for any book.

I've also seen valid praise for Scholz.

Also the article mentioned by Dattoli - I think he is biased, but the points were good to consider.

They can't all be completely wrong.

Mind you that I read virtually every post, so I've seen a few.

Posted 6/13/2011 1:41 AM (GMT 0)
I got 131 hits on Davidg Samadi
Posted 6/13/2011 1:43 AM (GMT 0)

Postop said...
Peer review doesn't mean presenting to your peers. It means the work doesn't get in print before it's scrutinized and approved:

en.wikipedia.org/wiki/Peer_review

Peer review means external review. When discussing scholarly journals "peer review" means that a manuscript is submitted to other experts (peers) in the field for review and comment. Peer review is an important quality control, especially for young scholars.

However, many articles published in scholarly journals are by invitation. This might happen for a number of reasons, for example, where the scholar already has an established reputation. Also, many book publications by eminent scholars are prepared by contract with the publisher and not peer reviewed, though they will be edited. Peer review also has a broader and more general in academia, and I suspect elsewhere as well.

None of this matters much in the case of the article in question. It is an important article for the reasons I mentioned in an earlier message, and IMHO it will be cited and referenced often by doctors. Some will agree with the article, others will disagree. And the outcome will play out in the real world of the prostate cancer marketplace, not in a scholarly journal.

BTW, if anyone really wants to explore the complex world of peer review here is a link to some 20+ articles on the subject. http://www.nature.com/nature/peerreview/debate/index.html

Sancarlos

Post Edited (Sancarlos) : 6/12/2011 8:38:59 PM (GMT-6)

Posted 6/13/2011 1:56 AM (GMT 0)
mel, please stop putting words in my mouth, i think i am capable of my own opinions.

on the "snatcher" book, i wasn't any more critical of it then most of the readers here, the part by the doctor was excellent, and i thought the part by the "patient" was hokey. quite a few here felt the same way. didn't care for the implications of the title either, but then it's not my book

david in sc
Posted 6/13/2011 2:16 AM (GMT 0)
Fine David-- you were critical of the patient part

Mel

Posted 6/13/2011 2:18 AM (GMT 0)
I'd guess not using the search engine that The prostate snatchers book is usually listed along with the Walsh book for those newly diagnosed recommended reading.

I never read the former so all I ever say is that Walsh's book is becoming dated. I did read that one.

As far as I'm concerned the immature man falsely charging many here with lying never did have any credibility to lose and his actions are no surprise to me.

He owes this board an apology.

BTW where do I fit in his PCa world? I'm neither a radical surgery guy nor have I received radiation. I may have well chose AS now but in late 2007 few spoke of it's validity. My targeted focal treatment was done through cryosurgery done by a urologist/surgeon. So am I a surgery guy or what? All I recommend for all is not to rush into radical surgery like 6 weeks after ones biopsy. I do admit to believing PCa is being over treated and feel radical surgery has been abused but as long as one educates themselves with all available options and possible side effects I say good luck with whatever is chosen. Just as long as it's not done in an ignorant panic.
Posted 6/13/2011 2:23 AM (GMT 0)
Postop,
If I understand you correctly: if a study of all surgeries done at John Hopkins and at MSK were published and everyone agrees that the data is accurrate. If you take the two studies and average the results, then present this to 25 of the top surgeons in the US and they agree that the averages are correct and accurrately reflect the probable outcome of surgery performed at a major institution, that this data is not valid? That these surgeons are biased and the study is worthless? This is basically what you are saying.
This study has been out for about a year and outside of this forum I have never heard of anyone questioning the data. I would imagine that if there were issues with the data you would have seen many rebutals, but it seems that there are none. How do you explain this? Why do you only question radiation studies? There are many studies on Surgery that have been on this forum and I have never seen you question the validity of them. You seem to be very selective in which studies you challange.
Posted 6/13/2011 2:24 AM (GMT 0)
ziggy,

i would love to see a revised edition of the walsh book, as much as i loved in the early days of my pc journey (2008), some sections are becoming dated. still a real good reference book.

on the party in dire need of apologizing, he doesn't seem to realize that whether it is an on-line or real life situation, it shows character to admit one is wrong, and even more character to apologize. i don't expect that to happen.

if i may ask, what is your current psa? looks like your signature is getting dated too, lol.

david in sc, not to be confused with other davids in the vincinity
Posted 6/13/2011 2:26 AM (GMT 0)
so mel, instead of guessing at my opinion of the book in question, and i think i answered that in the past, and to you now, what was your opinion? or have you even read it?

like many books, there is good and bad in most, so like many people, you glean the good and don't worry as much about the rest.

david
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