an excellent article on a hot topic

It seems that those against AS believe that just because their are no garantees of 100% that it is a crap shoot. Well getting treated for low risk PC is also a crap shoot with a 15% failure rate and a much higher failure rate for more advance disease. There are many things one can do in determining the safety of AS in any individual situation. Get another biopsy within 6 months to a year to eliminate sampling errors; get scans such as color doppler or an MRIS, get a saturation biopsy. Of course monitoring psa and PCA3 at a regular basis using psa derivatives such a psa doubling time and psa density. If all of these are done and low risk or very low risk cancer is still indicated the odds of not getting treatment and surviving are far better than the odds of being treated for PC just based on a biopsy and psa reading.
AS is a very safe alternative if it is monitored properly. All of the above are available and will give a very high probability of identifying an agresssive disease as opposed to an indolant disease. Both getting treated or going on AS are crap shoots, but there are currently ways to greatly reduce the odds greatly in your favor.
We should treat agressively all PC that shows signs of progression and hold off treating and carefully monitor those that appear to be indolant.
JohnT

Let me put this another way because I don't seem to be getting my point across well.

Using the NCCN guidelines for AS the range of patients that qualify for AS range in a debate that 15% on the low end, and 25% on the high end would qualify for AS.

Using simple math that means that 75% to 85% of patients were NOT over treated.

I get a different impression from some here...

Tony

Casey, I am amazed at the extent that you will avoid a direct question at times. For the sake of many here, show your signature, so we can see what you were facing, and what choices you made. It shouldn't bother you to do that, and it is pertinent, considering that you give some rigid opinions most of the time.

I grow weary of this entire "over-treatment" debate. Not you in particular, but the subject in general. Who get's to make that call? And I do not believe for a second, that, as you stated, "there are a million overtreated men alive today". Where in the world did you come up with that number? Is that some conjecture based on your opinions, or is there a hard source to verify such a claim.

I have found some (not saying you by name), that harp endlessly about over treatment, but conviently, have already had treatment themselves. Cancer is not just something for academic discussion, its a real life situation for every one that is diagnosed and dealing with it. Percentages, graphs, studies, and all the "what if's" in the world are of little use and effect for those fighting cancer.

So what was your diagnosis, and what where your treatments, if you were treated. Or did you decide that any treatment for yourself, would be overtreatment? I think these are very fair questions, and you might be surprised at how many people here would love to know the answer.

David in SC

Tony,

I am Co-Chairman of the UsToo Group at Hackensack University Medical Center in NJ.
As a point of information, the following is read to our Group before each Meeting:
"The primary mission objective of the UsToo Group is to disseminate information about the diagnosis and treatment of Prostate Cancer in order to help members make an informed decision on the treatment modality which is best for them. The UsToo Group does not endorse any particular treatment modality".
It is always sad and frustrating to meet men who present with
Metastatic Prostate Cancer because they were not diagnosed and treated in a timely manner.
I pray that someone will be able to convince the 40 year old man you refer to with Gleason 8 to start treatment and realize he is playing
Russian Roulette with AS at this stage.
I only recently joined HW and think it provides an outstanding service to men combatting Prostate Cancer and treatment side-effects.

Bob

Recommended reading...

An editorial (written by a doctor, for other doctors) in the Journal of Clinical Oncology, written by Dr

Anthony Zeitman, Board Certified in the Dept of Radiation Oncology at Mass General specializing in Prostate Cancer:

"Evidence-Based Medicine, Conscience-Based Medicine, and the Management of Low-Risk Prostate Cancer"

 

 

Probably more interesting than the 5-minute anecdotal chat in the examination room.

 

For anyone who now actually reads the editorial---I shouldn't have to re-state the key point, but it is abundantly clear that some here make comments on posts like this without even reading the attachment---this editorial is written about  the percentage of low risk PC cases, which might range anywhere between 15% and 40% of PC cases diagnosed today.  In other words, it is not everyone, but clearly a lot.

Post Edited (Casey59) : 2/2/2012 6:16:17 AM (GMT-7)

I would equate AS as being Clint Eastwood in his infamous Dirty Harry movie. The patient is saying to the cancer "Make My Day" and then he will decide to take action if the PC makes its move. The big problem is did you make your move in time. I pray we as patients can continue to make those decision ourselves and not some bureaucrat. This is the most troubling quote from Anthony Zietman's article: "The evidence is mounting, the advocates of surveillance are finding their voice, and the economic incentives are changing." What are the economic incentives driving future treatment strategies of the future; and more importantly, who gets to make those decisions. I hope it is us, the patient, empowered with better unbiased studies.

TC-LasVegas in regards to your reply: "You can't use costs alone for solving these issues. The costs for similar treatments in other countries are a fraction of what they are here. We can blame greed, but we have to add regulation and litigation to these costs. We are a litigious society and if we are going to fix anything that we have direct control over it would have to be a level of acceptance of risks to treatments. ... For example administering tylenol in a hospital here can exceed 100.00 per dose. It's 3 euros in France...Ugh..."

I would like to add to your reply some personal information/experience. My sister spent approximately 25 years of her adult life in Europe. She lived in Germany for the first 4 years and the last 21 years in Switzerland. I have gone over to Europe twice in my life to vacation and to visit her. While spending time over there, I was always amazed with how much everything cost so much more over there whether is food, fuel, hotel rooms, transportation, etc. She moved back to Arizona 7 years ago. A while back, she didn't have US health insurance but she had coverage through her insurance plan back in Switzerland. about a year ago, she needed and emergency appendectomy. Her Swiss insurance would only pay the usual and customary fee that prevails in Switzerland. She was stuck with a huge out of pocket expense because of the difference in cost between US fees and Swiss fees. I was amazed that health care was cheaper in Switzerland given almost everything else is so much more expensive. I asked her why this was so and her response was Doctors are not deep in debt when they graduate from med school and the people over there would never even think of suing their doctors. I doubt these are the only two reasons, but addressing these two issues would make for a good start to contain costs.

Casey I want to continue this thread but we have to clip the direct impolite comments. I will reach out to you via Email...

Post Edited By Moderator (TC-LasVegas) : 2/2/2012 3:09:58 PM (GMT-7)

Enough.

Edits will follow.

Unlocked by consensus of the mods. Edits still pending, so lets not go off the rails again, please. Remember - respect for other members.

Glad you think this thread is worthwhile.

Let me shift the focus only slightly. PSA tests were mentioned.

I don't understand why the PCA-3 test is the new standard. It is much more accurate and is not influenced by prostatitis and all that stuff. When I went to Umich after a PSA test and PSA test in a grey area, they suggested this test. At the time, it was not FDA approved but they considered it ready for prime time. I'm not sure if that status has changed.

Unfortunately, for me the PCA-3 test told the story, confirmed by biopsy.

So, my question is why isn't this test THE test used?

Mel

Mel,
PCA-3 is more accurate in only some ways. It has it's own error margins. Some insurance carriers still consider the test as experimental and I believe that's mostly due to procedural issues and not science. The PCA-3 is not fool proof and can indicate a worse cancer than actually present.

Utlimately, we need better tests to quell this disagreement. If we had a fool proof test that distinguishes the difference between indolent and aggressive cancer then the USPSTF draft recommendation becomes a moot discussion. Until then, our differences of opinion and thoughts about over treatment and over diagnosis will remain highly controversial.

For that reason it will lead to some heated debate.

The article in this thread talks about the differences between brachytherapy, surgery, and external beam radiation. It was also posted on the InfoLink today and here is the article:

prostatecancerinfolink.net/2012/02/02/brachytherapy-is-it-really-better-as-a-first-line-treatment-for-low-and-intermediate-risk-prostate-cancer/

Mike makes some interesting comments about the data being presented...I encourage you all to read it.

Tony

David,
I had the same discussion with a friend while we were ATVing in the mountains Sunday. He's an RO. He said clearly there is the patient that should have surgery. There is the patient that should have radiation, and there is the patient that should not treat their disease. We desperately need better information in the discovery phase for prostate cancer.

It would be awesome to get that test soon. LOL at least for a discussion forum moderator...

Tony