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Worse prostatectomy outcomes? …or are they really better? Or the same? Look at the big picture.

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Posted 5/21/2016 3:00 PM (GMT 0)
Bottom line: AS is NOT the only viable option for all low risk patients, regardless of what you believe.
Posted 5/21/2016 7:25 PM (GMT 0)

compiler said...

In my case: blah, blah
In your case: blah, blah

Darn it…I took your bait, Mel. I went back and re-read what I had written…

Indeed there is NO reference WHATSOEVER to anything you have ascribed to me. Can I have those 3 minutes back, please? For a mathematician, your application of logic fails miserably.



Here’s what a good mathematician would have done: base your theorem on some something established, or something on the record. The “quote” feature here at HW is useful for that. Otherwise, you are just making s**t up. As far as we can tell, your comments are of “a meager and unsatisfactory kind”…which brilliant physicist/mathematician/engineer does that quote come from? (hint: it wasn't me)

Here’s your chance to redeem, or to bail. If there’s something you can quote of mine in this thread aligns with what you’ve ascribed to me, then quote it. If not, then simply don’t respond again to this thread...we'll understand.
Posted 5/21/2016 9:59 PM (GMT 0)
JackH,
You are commenting on someone's comment ..... something you have told me is bad form. Are you being a hypocrite?
Posted 5/21/2016 10:30 PM (GMT 0)
RCS, you are right. Posts about posts...bad form. Thank you. I don't take kindly to others putting words into my mouth, if they aren't my words. I got suckered.
Posted 5/22/2016 12:35 AM (GMT 0)
Jack:

You didn't say:
>>>>>>>>>>>>>>>
"You can lead a horse to water, but you can't make him drink."
>>>>>>>>>>>>>>>>>>>>>>>>>
????

I'm done with this thread as we have beaten the above horse to death

But, don't worry -- you will post the same thing on another 50 threads

Mel
Posted 5/22/2016 5:05 PM (GMT 0)
Mel, thanks for affirming...I was already quite sure there was nothing you could quote of mine that was like what you said; now it's clear to all.


Sadly, it probably won't take long for another 50 newcomers to pass through here...so yes, unless all online devices somehow break, you will likely see me helping to lead them (to the water) through the valuable process of peer-to-peer information sharing/patient education...especially the favorable-risk guys which I have most intimate personal experience with. This info may not be valuable to you; but I believe it will be to them.




halbert said...
Bottom line: AS is NOT the only viable option for all low risk patients, regardless of what you believe.

halbert, I would agree with a PART of your statement. I do believe that this is true: "AS is NOT the only viable option for all low risk patients."

The dangling participle phrase at the end--"regardless of what you believe"--doesn't really make sense here or add any value.

But the first part of your sentence is correct. I can think of a few, a very few, instances when AS for a low-risk case might NOT be the most sound initial approach. I think it is often tied to your earlier suggestion that some will probably want to pursue an aggressive (albeit unnecessary) treatment not matter what, I'd say probably just because of the word "cancer." Some people will have a mental block putting "unnecessary" and "cancer" together in the same sentence.
Posted 5/23/2016 1:05 PM (GMT 0)
There's a tremendous balancing act with today's capabilities to assess the details of high-risk cases.

On the one hand, the article "The Role of Surgery in High-risk Localized Prostate Cancer" highlights that the main arguments for radical prostatectomy in high-risk and locally advanced prostate cancer are, first, the clinical overgrading and overstaging in about 25% of patients for whom surgery alone can cure the disease without any need for second treatments using radiotherapy or hormones. Quite simply, with today's broad characterization of the "high-risk" category, surgery is all that some men need.


But highly-respected Dr Mark Scholz has made the counter-point to the notion that more high-risk patients should seek first-line surgery. His comment at a recent AUA meeting in Chicago was unequivocal:

    "Men with high-risk disease who elect to undergo surgery all too often have positive margins and need radiation anyway. Why should the poor souls be subjected to both surgery and radiation?"




We've broken intermediate-risk cases down into two groups now...favorable and unfavorable...each with different recommended treatment paths. We need a further taxonomy classifications for high-risk cases.

Post Edited (NKinney) : 5/23/2016 7:08:26 AM (GMT-6)

Posted 5/23/2016 7:18 PM (GMT 0)
Jack, Mel, NK, Halbert
Coming in here a little late, congrats on the number of views already Jack, good topic. But before you all get "locked" out like Bucs tangling antlers in a standoff, I want to say I appreciate all you guy's posts, and links, and the back and forth debate and differences of opinion. (that's what makes a horse race, right?) Not that we are racing here, but another sense I am just trying to 'run the race' as best I can, navigating this course of constant 'entanglements' and decisions beyond my understanding. So.. every viewpoint helps me out. Thanks again, my advice for what it's worth is just try to scale back some of the one up-manship that doesn't really do you justice, only more divergence. As Rodney said..Can we all get along? Love you Brothers, take care, take it easy, or even toke it easy.
Dan in So Cal -"actively surveying" the battleground
Posted 5/23/2016 9:15 PM (GMT 0)
You are very welcomed, Wings of Eagles. I think there has been some good information in this thread, too, and frankly the back-and-forth generally tends to be beneficial from two perspectives: it both a) draws out the finer points of agreement (and disagreement) in clearer terms, and b) separates more clearly the wheat from the chaff...you can be the judge of which is which, as you said, every viewpoint adds some value. You've had enduring favorable results after extended Lupron; I think I recall you were considering a vacation?
Posted 5/23/2016 10:51 PM (GMT 0)
Jack, Yes good points. I'm suppose to have more wheat in my diet!! Thanks for remembering my story, yes I am currently on Zytiga ,with a Lupron vacation after 3 1/2 years. We will see what the ol PSA and T levels are at on June 17th, I'm, not too worried about it.
Dan
Posted 5/25/2016 5:53 PM (GMT 0)

halbert said...
... regardless of what you believe.



Hey halbert, I saw this...

www.cafepress.com/+science_doesnt_care_what_you_believe_in_drinking,1281343102

...and thought of you! When's your birthday?
Posted 5/25/2016 7:42 PM (GMT 0)
Jack,

Cool. I see it comes on t-shirts as well.

H
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