A Plea for AS

Tall A:

You said:

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I really don't worry about overstating the case for AS.
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Well, maybe you should be. One should not overstate the case for ANY tx.

What should be absolutely overstated is the need to do research and see more than one expert, knowing each expert has a bit of a vested interest in promoting his/her methodology.
You actually go on to say the same thing. But recommending due dilligence should NOT be the same as overstating AS. The former is fine; the latter has its own set of problems.

Mel

What compiler said. He said it better than me.

Compiler,

I don't agree that the case for AS can be overstated - with 98% 20-yr survival and half the men remaining on it for 20 years - the numbers speak for themselves. They are what they are, and they are excellent. What worries me is when people overstate the case for radical treatment. As I said, that, and not AS, is what is too often overstated. AS is only getting a fraction of the enrollment it ought to be getting, according to both urologists and radiation oncologists.

- Allen

island time said...
Micheal T said..."One pushback I see to AS is when someone is young and says that "well, it's likely that I'm going to need treatment eventually" so I'm not going to do AS. To me, that's actually an argument for AS--buying time that's free of side effects. Each year you get is a blessing."


This is true.

There is no silver bullet here. AS has side effects as well. The men on AS are not cured of cancer. (And they know it).

There may well be silver bullets for as one goes on AS time and research moves on. In time more advanced less invasive treatments will come online. I speak as one who has had one and still 6 years later remains the most successfully treated man here. I also back in 2007 was almost pressured into radical surgery but unlike some here I don't panic and could've lived with indolent PCa. Thus months of research and the absurd luck of finally through a local TV news special heard of the cutting edge PCa research at the University of Colorado which resulted in its director of research becoming my urologist. BTW what AS side effects are you talking about? No men are not "cured" of PCa with AS. But instead monitor what very likely is not a threatening strain. Those who have had radical treatments too are monitored with PSa tests, I for one don't see that being much different than AS monitoring. I've seen the same pretest anxiety as a result from both scenarios. The bottom line with low risk Pca remains constant. You're most likely to die with PCa and not of it. Also it just not coincidence that usually the most strident anti AS voices here often are from those who recently have had radical surgery. That's one thing I've noticed through the years.

Great comments CapHuff. You should voice them more frequently than semi-annually. Every six months tens of thousands of men are over treated for PC.

An interesting thing about this thread is what is not mentioned. A G7 being downgraded to a G6! In most cases this would be good news. Most of us surgical type guys would love to see a downgrade.LOL

Cheers, Doug

CapHuff,
I'm very new here, and like halbert, do appreciate the cautionary tale. Hopefully your condition improves. Nine days past my 52nd birthday, I was graded t1c and 3+3. More than one doctor has recommended surgery because I'm considered young, relatively healthy, and "will recover fast". The scary thing is what if "recover fast" isn't so fast. The side effects are enough to make one hide under the bed.

I was diagnosed at age 52 and I heard all the comments about being young and that meant I should have surgery. (For the record, the main reason I didn't have surgery was after further staging it was somewhat risky for my G9 diagnosis.) But assuming you have the personality to deal with AS, couldn't you make a case that's the best time for it? If it buys you 8 years, wouldn't there be incredible value in being SE-free through the rest of your 50s? And according to Allen's stats, it could even be 20 years. And think of how much treatments may have progressed by then.

I'm not saying that's what you should do, but I'd sure think about it.

I've seen comments from members here, referring to Men with G6 on biopsy like "for the life of me I can't understand why a ga6 would not choose AS", and other similar comments . That's what I'm referring to when I say the case for AS is sometimes overstated.

Of course you can't understand. Your not that guy. He's built different than you. In addition, that guy doesn't really know if he's going to be a G6 on surgical pathology. What about the guy who is G6 on biopsy and (7 (4+3) on surgical pathology? If he chose AS, it could potentially turn into a big problem.

Statistics a good as a guide, but they are statistics, and there are guys that end up,in the wrong side f those stats.

As far as the comment (don't remember from who) that it always seems like the guys who are most vocal about being anti AS are the ones who've had radical treatment, I think you could say the same thing about the Brachy guys when the conversation turns to brachy vs surgery. It's a just a natural bias being Voiced. Human nature.

The answer is that the medical profession should have some kind of write up or a conversation that is required to take place with every newly diagnosed man, the purpose of which is to offer an educated UNBIASED view of the pros and cons of each treatment, along with what ifs, and it should be a directive from the AUA! Or whatever organization would give a directive like that.

Somehow as soon as I saw the first couple of posts in the thread, I inew it would be the thread that keeps on giving lol

Good work CapHuff, As you can see you stimulated some good posts that will help others with decisions. Personally I would like to hear some more stories of success or failure, if those are the correct terms, from guys who have been on AS.
I suspect there are not a lot of Dr's out there devoting careers to AS. No cash in it. No glory. Whatever the reasons. I have found myself pretty much having to supervise my own treatment. I work with a surgeon who does the DRE's and orders tests.
I would like to see some more resources and support for new guys who want to try AS.
Without this current resource of HW I know I would be demented and would not have lasted this long on AS.
Thank you all.
A word in defense of the medical guys...we want them to believe in their modalities and they do...that's what makes some of them the great Dr's that many of them are.

I Just love the information/oppinions that has been generated by this thread. Thanks guys.

Some people get annoyed with this analogy,but I'm an active investor and I see some parallels with investing and cancer. One thing that investing has taught me is that a state of fear is the worst place to make a decision. This is what causes so many people to sell at the worst possible time. Unfortunately there are not many more frightening things than the "C" word.

Investing is all about allocating your funds to the most favorable risk/reward ratio and risk/reward ratio is what one must determine when considering between treatment and AS. I was extremely content to be on active surveillance but I also established predetermined parameters on when to take action. For me, at my age, that was:

- no Gleason 7 or higher
- PSA under 10%
- no more than 3 cores positive
- preferably no cores over 50% (not a big factor for me unless combined with other factors)
- preferably no perineural invasion (not a big factor for me unless combined with other factors)
- the disease should be T1c (clinically inapparant tumor, not palpable or visible by imaging - eg. only determined through need biopsy).

Unfortunately, a recent MRI scan picked up a nodule and a small amount of Gleason 7 was identified in the nodule (50% Gleason 6 and < 5% Gleason 7, in 2 cores targeting the nodule). To tell the truth, I question the Gleason 7 finding as less than 5% seems pretty vague and possibly there is a need to err on the side of caution when a nodule is identified.

However, even if I assume it is all Gleason 6, I still don't fit any of my other criteria except PSA - there is a nodule that appears on imaging, there are 5/10 cores positive (2 were done in the nodule), there is 50% in 2 separate sites, there is perineural invasion in 2 sites. So I'm booked for robotic surgery in March. I wish I could say that I had complete confidence in my decision but I don't know if that is possible when you have just crossed over your predetermined limits. However, it does appear that the risk/reward pendulum has moved in that direction.