Re: Un=necessary Treatment?

March 12, 2007

Fred,

As I have said on many occasions previously,

read the two important files on the subject that are on this site – go to

Files at the bottom of this mail – and select Insights AS Article and European

Report.2 It would also be of some benefit for you to read this study published

in The Lancet and available at http://tinyurl.com/arc8s These three pieces explain in some detail why it is to the benefit

of some men to choose active surveillance over immediate treatment.

Logothetis, a

leading expert in advanced prostate cancer, summed up the position well when he

was asked a question at a US-TOO meeting in Texas. He had been commenting on the

relative inaccuracy of the diagnostic process. The question was: " Does

this mean that a lot of people who are diagnosed as having cancer really don't?

His answer was: " Yes, if one accepts the diagnosis that the cancer is a

disease that is potentially lethal……. One of the problems with

prostate cancer is definition. They label it as a cancer, and they force us all

to behave in a way that introduces us to a cascade of events that sends us to

very morbid therapy. It's sort of like once that cancer label is put on there

we are obligated to behave in a certain way, and its driven by physician

beliefs and patient beliefs and frequently they don't have anything to do with

reality. And they are only worrisome because the pathologist has decided to

call it a cancer.”

There is a high number of

men treated unnecessarily for the disease – estimates are between 25% and

80%. If these views, expressed by people who have more knowledge of the disease

than I do, are correct then in the USA that would mean that between 50,000 and

160,00 men EACH YEAR have a reduced quality of life for no benefit.

I have never advocated

that men should take the active surveillance or watchful waiting path merely

because that was my choice, but I do think they should all be awre of the fact

that if they have what is termed an insignificant tumour they should at least

be aware of the thinking on the subject which is often not disclosed to them

by their primary medical advisor.

All the best

Terry Herbert

in Melbourne

Australia

Diagnosed ‘96: Age

54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. June '04: TURP. Feb '07

PSA 30.4

My site is at www.prostatecancerwatchfulwaiting.co.za

It is a

tragedy of the world that no one knows what he doesn’t know, and the less

a man knows, the more sure he is that he knows everything. Joyce Carey

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of ncsailors

Sent: Tuesday, 13 March 2007 10:44

AM

To: ProstateCancerSupport

Subject:

Un=necessary Treatment?

I keep reading impressions about " watchful

waiting " may be a

better option, than active treatments? Rather surprising.

I'm a trained engineer - and always was rather pro-active. It can

be said that if one elects the " active waiting " treatment -

there is a good chance that sooner or later - one's early diagnosis,

and treatment advantage, will be gone - and they will naturally

enter the more serious " about to leave the prostrate " stage.

If this is true - why would anyone opt, for the " active waiting "

method? The European remark - that too many Pca patients choose

active treatment methods, unnecessarily. I don't understand

their reasoning.

Reading, and

reading ............ So many questions. I need

to find the treatment experts.

Fred

Spring Hill, FL

diagnosed 2/2007 - (1) .005% ca sample, out of 12. Negative

bone scan, and body xray scan. Pro = 81ccm Had 2 hormone

shot - 2 weeks ago. Scheduled for 2 more - May, August. Starting

Casodex in 1 week.

March 12, 2007

Fred - I'll put my two cents worth in on the " watchful waiting "

decision. I was dx with PCa in June 1998 at the age of 58 - only 1

of the 6 biopsy specimens was positive for carcinoma, and my PSA was

only 4.2 I did all the research I could, talked to an ex-brother-in-

law who is a urologist and who, as he said, had probably treated " a

couple of thousand " men with PCa.

I was undecided about which treatment option would be best,

but " watchful waiting " was not one of them for me. I just could not

see not doing anything if I knew that cancer was in my body. (I

know, " not doing anything " is not entirely accurate as there are some

steps one can take even if no active treatment is undertaken.)

A big influence for me were the words my ex brother-in-law (he is

still in practice) said to me: " Have the surgery. That is the best

chance you have of getting rid of the cancer. If you choose

radiation, then the chances are great that the cancer will eventually

return, and it will be more difficult to treat then, than now. "

I took his advice and had the surgery. Being a urologist, he may

have been biased toward surgery, but I respected his years of

experience and his direct involvement in treating many of his

patients who had prostate cancer.

It's been almost 9 years for me and I'm still kickin'. I had one

course of casodex (18 months) which got the PSA way down south again,

and my last PSA in January 07 was 0.3. That was a slight increase

from the 0.1 in June of last year, but my doctor did not believe that

any additional treatment necessary at this time.

Making a decision about treatment, or " watchful waiting " is

difficult. But I kept asking myself the question: " If I know cancer

is in my body, why would I want to just see what it will do? " My

decision was not to watch and wait. Had I been 78 instead of 58, my

decision might have been different. That I will never know.

Good luck to you, and keep us posted, please.

March 12, 2007

Whilst respecting your decision, I have to

say that the information I suggest Fred read was simply not available to you

when you were diagnosed in 1998. Perhaps if it was you may have made a

different decision. It is also a fact that the majority of urologists are surgeons

and the majority of surgeons will always recommend surgery, as you’d

expect in the same way as the majority of radiologists will recommend

radiation.

It seems from what you say that your

surgery may not have been successful – is that the case? The fact that

you had a course of Casodex implies a rising PSA in a situation where, since

the prostate was removed, there should be no PSA measurable, absent disease.

If you have what is termed biomechanical

failure then you have my sympathies, but I do think that you should make the

position quite clear when giving advice to others.

All the best,

Terry

Herbert in Melbourne, Australia

Diagnosed ‘96: Age

54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. February '07 PSA 30.4

My site is at www.yananow.net

As a

physician, I am painfully aware that most of the decisions we make with regard

to prostate cancer are made with inadequate data: Dr

“Snuffy” Myers.

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of willxxssi