Casey's thread #2

Simple question, is stage 0 still cancer? Or is it a cancer some dream of renaming in an effort to manipulate patients and an industry away from treatment and towards AS?

link not working (for me)

I think the issue, as many experts have stated, is that there is no way for practitioners to tell patients with absolute certainty which CANCERS will not progress and which will kill them.

I agree that a better understanding of the cancer is critical so that both the doc and the patient can make an informed decision. But renaming it for the sake of manipulating people and the way they think as a result of a conviction that there is OD which leads to OT which leads to maiming of patients is not the best way to approach these potential problems in my opinion.

There is also a mixed message because while there are "some" experts and some activists looking to curb treatment in certain cancers (PCa, breast, thyroid), there are new industry standards for other cancers like lung cancer which are calling for more screening and by consequence more diagnosis. The rationale for these is that doing so will have a benefit in lives saved. Well, we know, as has repeatedly been pointed out here, often by Ralph, that screening in PCa saves lives. So renaming something in order to change and curb diagnosis and treatment should be as tough a sell with men as it was with women.

A man walks into an office, his doc tells him that he has cancer, but that it's a form/stage of cancer that is potentially IDLE and that monitoring that it doesn't progress to the next stage is a realistic approach and perhaps even the prudent course. Another man walks into an office and his doc tells him that he has pre-cancer and that it potentially will not turn into cancer although he cannot say with certainty, and that he advises monitoring that it doesn't evolve into cancer. What is the true difference here other than playing with words in an attempt to manipulate the thoughts of that grown man?

As some other experts have stated, the drive to re-brand some forms of cancer is merely a platitude at this point.

I think that is the issue that upsets so many women and men about some in the industry trying to manipulate personal decisions through the re-branding of cancer.

I don't know anything about your friend, but she probably made a personal decision based on her family history, her age, and her psychological makeup vis-avis living with this disease.

Changing the name of something in order to change her thinking is trite when all you need is for the doctor to plainly explain what her personal situation is and what he roptions are.

read it, good article.. If these advances in imaging were readily available to everyone and covered it would certainly add to our option, but they're not yet.

Also, if the man had called me and I had told him about my SEs and recovery he might have had yet another picture. Had he called many here about their positive outcomes with BT same thing. Same with the live group he went to, guys who do great/well tend to move on, not go to these groups. There are so many factors to consider including age, practitioner skill etc. These are all individual decisions based on individual factors. In fact, at 40, with the same opportunities and information Jim had at 60, I would ahve still chosen treatment and not surveillance.

Post Edited (davidg) : 8/24/2013 8:50:15 AM (GMT-6)

A false argument? That's a bit of an excessive statement,isn't it? It certainly wasn't false to me when i considered my options. I suspect it isn't false to the vast majority of those 90% of men who also think through and opt for treatment.

When all factors were considered, my age (40), the trust in the skill of the surgeon I chose, I opted for treatment of cancer.

the tests reduce the risk of having aggressive cancer?

All those tests are not readily available to every man. When they are, men will be able to discuss their individual options with their doctors and decide what is best for them. The uncertainty you are willing to live with, perhaps resulting fromt he uncertainties you were forced to adapt to while in service are frankly not uncertainties that at this point in time most men and cancer patients are willing to live with. I certainly wouldn't be.

"However, Dr. Larry Norton, the medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center, who was not part of the group, said the larger problem is that doctors cannot tell patients with certainty which cancers will not progress and which cancers will kill them.

"Which cases of D.C.I.S. -- ductal carcinoma in situ -- will turn into an aggressive cancer and which ones won't?" he asked. "I wish we knew that. We don't have very accurate ways of looking at tissue and looking at tumors under the microscope and knowing with great certainty that it is a slow-growing cancer."

Read more: http://www.upi.com/Health_News/2013/07/31/US-experts-propose-renaming-cancers-not-likely-to-kill/UPI-77231375243507/#ixzz2cu89O0AF"

I think Angelina had an 85% chance. Courageous or not, I understand her choice.

The man you mention in London went overboard in my opinion. I certainly have not heard of more than this example as a preemptive attempt to beat PCa solely based on family history. Not sure it's a good example.

I think there are many issues being discussed here. Renaming cancer, renaming it with a goal in mind (ODOT). Options and personal choice.

I think that we often ignore nuances in these discussions. What works for a 70 year old might not work on many levels for a 40 year old, what works for a white man might not work for an African American. What tools one man has access too may not be available to another.

In further response to what John is saying above, see this:

www.sciencedaily.com/releases/2013/06/130625150745.htm

"This study offers the most conclusive evidence to date that broad application of active surveillance recommendations may not be suitable for African-Americans," says urologist Edward M. Schaeffer, M.D., Ph.D., a co-author of the study. "This is critical information because if African-American men do have more aggressive cancers, as statistics would suggest, then simply monitoring even small cancers that are very low risk would not be a good idea because aggressive cancers are less likely to be cured," he says. "We think we are following a small, nonaggressive cancer, but in reality, this study highlights that in black men, these tumors are sometimes more aggressive than previously thought. It turns out that black men have a much higher chance of having a more aggressive tumor developing in a location that is not easily sampled by a standard prostate biopsy."

Now, change the name of cancer to something else and ask yourself how the men mentioned above would do.

John, that's fantastic. I'm sure AS is a wonderful option for many many men but certainly not all men.

However, not sure I see the relevance of that post to the previous ones we exchanged or to the what I think is the point of this thread (missed Casey's original thread), which I believe is the rebranding of cancer into something else

Look at the last link I provided and tell me what such rebranding would do to those men as an example.

www.sciencedaily.com/releases/2013/06/130625150745.htm

The Gleason grade is a continuous spectrum of cell changes divided into lines across that spectrum from 1 to 5. 2 and above were considered cancer when Gleason developed the scale 40 years ago.
Since then we have learned a lot moe about prostate cancer and grade 2 is no longer considered a cancer and not reported. The scale was developed so that 90% of pathologists would agree when they viewed a cell structure.
Knowing this we can see that Gleason grades are not exact science, but lines drawn by one pathologist years ago. So who is to say that a g2.5 is not a cancer, but G 3 is. It is simply a scale developed by one man that has proved useful in stratifying cell structure. Why should we be chained to a definition created years ago, as we learn more should not we change definition to better reflect that knowledge or are we permanently wedded to a definition that is 40 years old.

We're also glued to a TNM that has many years to it. There have been minor regrading changes ~ until 2002 there were T3C cases. AJCC decided to regrade the T3C cases to T3B (Seminal invasion) because they saw no oncological differences between T3A and what was T3B. To rename the disease is one way but it's a bit risky for some of the reasons stated above. Restaging can be a viable option to define disease that does not appear to be aggressive. Again this is only for LL T1 that has been monitored a short while and shown no aggressive tendency. All T2's remain T2's and above remain unchanged. Other Stage 0 cancers are many. For the same reasons.

Tony

Post Edited (TC-LasVegas) : 8/24/2013 8:59:49 PM (GMT-6)

I don't like the Stage 0 either, but its a lesser of evils than an out and out re-naming scheme.

david

Unfortunately not all urologists are created the same. I just spoke with a 70 year old neighbor yesterday. He just had a 16 core biopsy with 2 cores positive, less than 5%, G6. His PSA is 4.5. His urologist advised that immediate surgery was his best option. Needless to say he is getting other options.

Anecdotal stories that each of us have do not make policy but they certainly add interesting perspective.

JIm

Tudpock18 said...
Unfortunately not all urologists are created the same. I just spoke with a 70 year old neighbor yesterday. He just had a 16 core biopsy with 2 cores positive, less than 5%, G6. His PSA is 4.5. His urologist advised that immediate surgery was his best option. Needless to say he is getting other options.

Anecdotal stories that each of us have do not make policy but they certainly add interesting perspective.

JIm

Hey Jim. I ran into an ex-boss 74 who had radical surgery 1 year ago and is still in many pads a day. I sure wish I ran into him 13 months ago. He's not in the best of health to begin with, but his urologist talked him into surgery anyway. Without mentioning most men aren't operated on after age 70. On top of that his wasn't all that bad he was a g-7 with about a 6 PSA. I think he had 4 cores out 12 but he wasn't sure of the percentage. He was told he'd be continent in a month post surgery.