Nice post. Thought I would take a stab at some of my initial, uneducated, unreserched gut reactions. Nit sure there are right or wrong answers on many of these .
1. Belief: Active Survielance is dangerous. Challange: AS is the safest option for those meeting the criteria.
I think the word safest is probably a stretch . Perhaps the least invasive with the fewest side effects may be truer. There is a risk associated with AS. Some of that risk is making sure the patient has correct data. Accurate biopsy, accurate pathology, accurate staging, appropriate follow up tests. If the patient does not get the proper diagnosis, it could be the higher risk option.
2. Belief: Diet has no affect on PC prevention or progression. Challange: Diet has a significant affect on slowling PC growth.
Hard to argue or prove either side of the coin, but most likely there is more truth than untruth. The question is, how much does slowing it down help ?
3. Belief: Surgery is the gold standard and has cure rates above other treatmets, especially in higher gleason grades. Challange: All treatment options have similar cure rates in low risk PC and other options indicate better cure rates with higher Gleason grades.
Hard to prove, because each case can be so different, particularly with higher Gleasons.
4. Belief: With failed surgery you get a 2nd chance, and with radiation there are no viable salvage treatments: Challange: There is only a 6% probability in this outcome (20% reoccurrance X 30% success rate). There are secondary treatment for failed radiation that have the same success rate as SRT for failed surgery.
The actual number of cases for this would be a question. Few doctors attempt post radiation treatment other than hormones.
5. Belief: Side affects are not important; 1st thought should be to get the cancer out. Challange: The side affects of surgery are underestimated by doctors and patients and other options have similar cure rates with much less side affects.
I don’t think the belief is stated accurately. I think the belief that curing the cancer is more important than side effects is more correct. I also think side effects of alternative treatments are understated.
6. Belief: Hormone therapy should be a last option and used only when PSA rises significantly after local treatment: Challange: HT should be used in conjunction with local treatments in high risk cases and is more effective when psa is at a very low level.
Still hard to prove.
7. Belief: CT and bone scans should be given to every PC patient. Challange: Bone and CT scans in anything under 40 psa are as good as a coin flip, and just waste money and give a false sense of security.
Don’t disagree with the waste of money part, particularly if patient is paying cash. But, if it finds 1 in 100 cases of lymphatic involvement, and I was the 1, I think I would be glad I had it, and the doctor’s insurance carrier would be glad he ordered it.
8. Belief: Biopsies and psa provide sufficient data on which to base a decision. Challange: Biopsies are inaccurate and more data is needed for a proper clinical staging. PAP, MRIS, Color Doppler, ploidy analysis and the use of Artificial Neural Nets provide significant additional data for a proper clinical staging before treatment.
Don’t disagree in some cases, but I maintain they are adequate in a high percentage of cases. Much like the CT and MRI challenge, it will tell us what we already knew in many cases. Availability and medical education are two other huge issues on this one.
9. Belief: Universal PSA screening saves many lives. Challange: Screening should take place only for those patients with high risk factors as overtreatment and QOL issues overshadow the small amount of additional lives saved.
I must disagree with this one as one who was “saved” by early diagnosis. What we do with the PSA screenings data may be a better challenge.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic 4/14/09 Nerves spared, but carved up a little.
0/23 lymph nodes involved pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free 6 week PSA <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED. Trimix injection
No pads, 1/1/10, 9 month PSA < .01