Life extectancy with no treatment

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Date Joined Jun 2009
Total Posts : 35
   Posted 9/24/2010 8:15 AM (GMT -6)   
After 18 months on AS my disease has progressed and I am now scheduled for a radical prostatectomy on November 3rd. Prior to booking the surgery, and thinking what treatment to go for, it passed my mind what would be the life expectancy if I just did nothing and let it run it's natural course. Any thoughts on this for a person with Gleason 7? I am not considering it but am just curious.
Jan/09: PSA 3.48 / Free PSA 10%
Feb/09 - Biopsy - cancer diagnosed - age 55
PSA at time of Biopsy - 3.48
DRE: Nornal
Trus volume: 34cc
3 out of 10 cores positive

Gleeson 3+3
Now on Active Surveillance
Sept 1/10 - biopsy - 3 cores positive 2 @ G6 7 1 @ G7 - seeking treatment - likely surgerry

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Date Joined May 2009
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   Posted 9/24/2010 8:26 AM (GMT -6)   
Of course, no one knows the real answer to this, but my uneducated guess would be at least 10 years with good QOL.
On the other hand, we hear guys like Sonny who after a fairly uncomplicated surgery with decent pathology, followed by SRT, is already encountering a met all in the space of a year or a year and a half.
We hear that many men will die never knowing they had PC.
The nomograms can kind of be used to guess at this I think, but there are so many variables, pathways the PC can take, and the big question, did the biopsy find the highest grade PC, or is there some Gleason 8 or 9 lurking in there somewhere ?
Obviously, it is a poor gamble, but to some, I suppose they have chosen to take it by not having PSA checks, and not following up as they should.

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   Posted 9/24/2010 8:38 AM (GMT -6)   
The velocity and doubling time would be a bigger factor than Gleason by itself
You are beating back cancer, so hold your head up with dignity


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   Posted 9/24/2010 9:29 AM (GMT -6)   
Optimistically? Longer than you might guess
Pessimistically? All to soon
Glass half full, is there a glass?, do we know it is a glass?, glass empty or an illusion?
Hand me Budweiser I need no glass! (lol)
Or I don't drink anyway

I suppose you could try to compare some abstracts on patients with no treatments (Sweden or abroad studies). Still comparisons are not totally worthy because PCa is an individualized scenario, too many parameters that are unmeasureable or unknown and has exceptions and rarities within this jungle. (ploidy of the PCa cells DNA, unfound biopsies could harbor even different Gleason scores, micro mets that are undetectable and where they might be and more). Les mentioned some other variables that are factors, too.

Probably a generality would be like Goodlife suggests, but then are you a generality or an exception or in between those...who the heck can assess that the best is the question. You have seen patient scenarios herein....assessments and findings even in the same general stats turn out to be less than apples to apples. There are examples of men whom decided no treatment, I remember one of them long was his free did come to an end but it was on his terms which was his own free choice. Might have been 8+ yrs., he did have worse stats, that I remember.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

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Date Joined Jan 2010
Total Posts : 7084
   Posted 9/24/2010 9:45 AM (GMT -6)   
Goodlife reminded me of a good point in a running discussion on HT - if PCa is totally untreated, and you don't die of something else first, it will be very ugly. You might read the first chapter of Michael Korda's "Man to Man". I think it is on the Phoenix5 site. He tells of being driven to write his book after PCa surgery by his contact with Cornelius Ryan (The Longest Day), who died with mets (Ryan wrote a book about his fight - I've not found a copy yet). He says:
"As a result, ironically, cancer of the prostate was one of my nightmare fears, the disease I knew best and feared most."
Now, please excuse a temporary thread diversion -
You made a comment:
"Obviously, it is a poor gamble, but to some, I suppose they have chosen to take it by not having PSA checks, and not following up as they should."
If that were prefaced with "if they have been diagnosed" or "if they were told and refused diagnosis" I would be in 110% agreement.
I have the concern that the HW community expects that men know. I did not. My first introduction to a PSA test was the first (and by the way last) one I had before surgery. I didn't find this site until the week after my surgery. Until awareness is dramatically raised, we will be seeing this again and again.
Once someone has landed on HW, there is a lot of information. But if I were in the position I was in the morning before I got the first PSA, I would have not ever thought of coming here. I was a great example of "no problems - no trip to the doc". My insurance in that time period did not pay for any preventive care, so I didn't go racking up tests so I could give away money I had to spend on other immediate health care needs. Right or wrong philosophy? Too late now, regardless, so not relevant.
What can we do here that changes that? Not much. We only touch those who come to us after the fact. What can the ones of us who visit here do? Get behind Tony's USToo and similar programs, for a start.

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Date Joined Feb 2010
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   Posted 9/24/2010 9:57 AM (GMT -6)   

i posed the same question to one of my doctors and he smiled but would not answer the question. he did say that if i had been diagnosed  a year later we might be having a different conversation.


age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10

Regular Member

Date Joined Feb 2010
Total Posts : 308
   Posted 9/24/2010 10:09 AM (GMT -6)   
142, sorry this isn't keeping totally on the subject of the thread, but i'm not enough of a prognosticator to try to answer the other complex question.  however, you mentioned Cornelius Ryan's book, which is called "A PRIVATE BATTLE" .  i wasn't familiar with it, but you can find more info on AMAZON.  sounds like the wife combined His journaling with Hers, and published this after his gets good AMAZON book ratings, for whatever that's worth...anyway, you got me interested in it: thanks for the offhand comment!
Age@dx: 55
5/05 PSA: 1.8 ;12/07 PSA: 3.7 ;7/08 PSA:4.7
8/08 Biopsy1: 3 of 6 irreg
11/08 PSA: 6.5; 12/08 Biopsy 2: of 12, 3 cancer, other 9 irreg; Gl:3+3=6.
1/22/09 RRP; 1/25/09 Released; 1/28/09 Pathology: Cancer on 10% of gland, lymph & SV were benign, Gl re-typed 3+4=7, stage T2c
2/13/09 PSA:0.1
3/9/09 back to work
6/09 PSA:0.1; 10/09 PSA:0.1; 2/10 PSA:0.3 ; 4/10 PSA:0.4 Referred to RO
5/4/10 First RT.;6/25/10 Final RT. ended up 36 treatments, 64.8 Gy.
8/10 PSA:0.2

Regular Member

Date Joined Sep 2010
Total Posts : 71
   Posted 9/24/2010 10:29 AM (GMT -6)   
I am in the same boat as you, I did AS for one year, but I actually put off biopsies for 7 years. If you decide to continue with AS you will probably have to do two biopsies a year. I hate biopsies and their after effects. It takes me about 3 months to get back to normal function after a biopsy. So I decided to get it over with, have surgery and pray that it will work out.
History: 2 brothers with prostate cancer
Age 56
PSA at age 40: 2.5
PSA at age 45: 4.7. DRE normal. Advice, biopsy (I waited)
PSA at age 52: 8.0. DRE normal. 1st biopsy 12 cores, negative
PSA at age 55: 9.5. DRE normal. 2nd biopsy positive 2 of 14, gleason 3+3. both cores <5%
PSA at age 56: 9.2. DRE normal. 3rd biopsy positive 4 of 14, 3 cores <5%, 1 core 7% Gleason 3+4 in 1 core, prostate 81cc

Veteran Member

Date Joined Jul 2010
Total Posts : 3892
   Posted 9/24/2010 11:13 AM (GMT -6)   
Gleason 7 is always tricky (and dangerous) because one of the components is always Grade 4 cancer...

When I was first diagnosed, 4+5=9, I asked a top Radiation Oncologist the exact same question. Without any hesitation he answered: "Bob, if you don't treat this, you will be gone in 3 years, 4 at the most..." In Walsh's book, 2007 edition, page 474, fig 12-2, is a chart that predicts survival for those with advanced disease..

Gleason 7 is probably not as aggressive but lets face it..PSA doubling time tends to get shorter and shorter, not longer, without treatment..

With PC, you never know FOR SURE where you stand until a pathologist has the entire organ on his workbench...JMHO...

Post Edited (Fairwind) : 9/24/2010 10:32:04 AM (GMT-6)

John T
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Date Joined Nov 2008
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   Posted 9/24/2010 11:14 AM (GMT -6)   
It depends on a lot of factors, the most critical is how fast the tumor is growing. I had a G4+3 and a large 2.5cm tumor. I asked my doctor the same question and he said 10 years before it started to bother me and 5 to 10 more years before death. My psa doubling time was about 3.
You probably have 20 years

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


Regular Member

Date Joined Feb 2010
Total Posts : 385
   Posted 9/24/2010 11:41 AM (GMT -6)   
If you haven't already, look at the stories on Yananow:

The experience of these men may not be at all representative, but it can give you a feeling for what you could experience. The issues with quality of life with early progressive PCa seem to boil down to 1) can't pee unless get some kind of treatment, 2) side effects of treatments, particularly hormonal treatment (effects on libido, bone and muscle mass, and mood, especially). When these issues hit, depends on the person. Seems like a lot of people hang around for many years with progressive PCa, but many struggle with some of these things.

Regular Member

Date Joined Jun 2010
Total Posts : 416
   Posted 9/24/2010 4:05 PM (GMT -6)   
Opt, somewhere in a prior thread I made note of this.. I'm G7 4+3 per pathology. Prior to RRP I was considered G 3+4. After my RRP, I asked My Urologist and two different Rad Oncologists how long I would have lived, as a guestimate of course, had I not had surgery and just did nothing. All 3 said "10 years". Must be the standard answer.

Best of success to you personally, and everybody here as well.
First ever PSA test Jan 2010 @ 51 years old. 4.0.
Digital exam in March 2010 showed 1 side hard, other soft.
Biopsy, positive in 3 of 12.
Davinci @ Boston Medical Center, May 17, 2010.
Was suggested prior to it was likely contained.
June 1 advised 3+-4 was really 4+3 per pathology. Pos margins.
Listed on patholgy as PT3, but with extraprostatic extension,
microscopic invasion of the bladder neck, PT3A is perhaps the case.
Catheter removed June 1.. 1 pad/day, doing ok. ED, but not in rush.
Sore as heck down there, but doing much walking with my wife.
To meet with my Uri (1st meeting since) June 17 - 1 mo point, to discuss.
BMC already has me setup to meet with radiology.
Felling a little better each day. Cant tell if my expectancy just went from 10-15 down to 5-7, the information out there appears to be all over the place. I WILL NOT radiate my insides to the point of being a veg for the sake of a few years. QOL is primary to me. Selfish I guess. I pray for all of you as I do for myself, but must remember that i've had a pretty good 50+ years, and know others who have lost their children to disease.. so I dont have the nerve to complain! Update 7/14/2010: When I tried changing this sig a few days after creating it, system was broken. My new rad oncologist are discussing IMRT.. though he says he can see why waiting a bit and watching the PSA on super sensitive basis might make sense. I am leaning towards IMRT.. thinking is my body is pretty strong now, i'm 51, and if I can rid my body of this while trying to minimize the side effects.. I dunno. No really Good answers. When I said I didnt want radiation to the point of being a veg.. I really meant there is a limit as to where I wish to go in order to realize only a small increase in life expectancy.. and not that I am an unreasonable person. I do, after all, have an obligation to my wife and kids.

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Date Joined Jan 2010
Total Posts : 7084
   Posted 9/24/2010 4:13 PM (GMT -6)   
As to QOL / life expectancy - my uro said 3-5 years before symptoms would have gotten significant after the biopsy, but after surgery and the G 4+5 upgrade, he said he was wrong - it would have been more like 1 year.
He did not go into what life "once symptoms set in" would have been like, but I've read enough to know it would not have been pleasant.
I had similar comments from several doctors. They look at my path report - you can see the dark cloud set in. That's why I went straight off to IGRT.

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 9/24/2010 4:24 PM (GMT -6)   
There is no way of telling. It could be two years and as John suggest it could be 20. I am inclined to believe neither case is correct and it's somewhere in the middle. I have seen a Gleason 7 man die in just 6 years after a clean biopsy at age 45. He took his biopsy early as he had family history with multiple deaths in the family to PCa. At age 50 he was rechecked, it was positive in all cores, mets in the bones, and he died at age 51. He was positively diagnosed too late. This might be the extreme case, but that's what we have, a totally unpredictable disease. Each case will be different than the other.

Here is another example case that chose to not treat his 2002 he was G7, PSA was 2.2 at Dx. Watchful Waiting and holistic therapy. Passed last July...

Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog :

Veteran Member

Date Joined Jul 2008
Total Posts : 981
   Posted 9/24/2010 5:40 PM (GMT -6)   
When I had my first biopsy I asked the urologist (Sorensen btw Fairwind) the same question, he was really surprised. He told me after diagnosis I was the first ever to ask that. That surprised me and he really had to grasp for an answer. Finally he guess 7-8 years and you could tell and he admitted to just guessing. Maybe I really was the first guy to ever ask him that.

Regular Member

Date Joined Aug 2010
Total Posts : 487
   Posted 9/24/2010 7:46 PM (GMT -6)   
It's interesting how our minds often work alike. When I sat with my doc after the biopsy, I asked that question; "How long if I do nothing?" His immediate response; "If you did nothing, you'll be dead in 3 to 4 years." He predicts 4 to 5 times that now. Assuming I don't get run over by a bread truck, or have a heart attack prior. I plan to give those other options every possibility before letting the pca back in......<as if I had that choice huh?>

Age 57 at Diagnosis
May, 09 PSA 2.26
June, 10 PSA 3.07 Free PSA 18%
Met with Uro, DRE +
June, 10 Biopsy, 7 of 12 cores, up to 60%, 4+5=9
July 21, 2010 - RRP
Nodes negative
Vesicles negative
tumor contained in capsule, still 4+5=9
perineural invasion extensive
Aug 5, 10 catheter out
Sept 3, 10 PSA - 0.00 (great big whew)
As of 9/3/2010, I'm 99% continent - only occasional stress incontinence !

Post Edited (kbota) : 9/24/2010 6:52:46 PM (GMT-6)

Regular Member

Date Joined Jul 2006
Total Posts : 202
   Posted 9/24/2010 7:49 PM (GMT -6)   
Read Ron Hard's story on the link Tony posted.
Sobering stuff.

Regular Member

Date Joined Sep 2010
Total Posts : 148
   Posted 9/24/2010 11:09 PM (GMT -6)   
Any family history? My Dad fought Pc for years after his first radiation treatment. Dx. My Brother-In-Law lasted a year after his Dx. I am sure you will come to your best decision. Good luck
Age 48 w/diagnosed
10/25/06 PSA 3.0
11/13/06 PSA 3.8
11/13/06 PSA FREE 0.5
11/13/06 PSA % FREE 13.2
10/25/07 PSA 3.4
12/18/07 Biopsy-neg
6/2008 PSA 3.5
1/7/09 PSA 4.6
6/18/09 psa 5.8
2/9/10 psa 8.7
5/13/10 psa 10.5
7/19/10 PSA 10.8
8/19/2010 3rd Needle core biopsy- single focus of prostatic adenocarcinoma, Gleason Grade 3+3=6, Tumor involves one of eight cores -2%, Prostate 78 (big)

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Date Joined Dec 2008
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   Posted 9/25/2010 7:57 AM (GMT -6)   
Ron Hard's story is really interesting and the useage of 'T' gel later on his leg, which swelled and became cancerous is an eye opener. I kind of admire this mans quest and determination and earlier years he did pretty well. He ended up with aggressive PCa, so who knows how long surgery or radiations and such would have worked for his scenario? We don't fight other patients battles only our own, so you get to decide how you fight it or hand it over to whatever doctor you have chosen.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 9/25/2010 12:32 PM (GMT -6)   
My thoughts almost exactly, zufus. This is a very eyeopening story...

Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog :

Red Nighthawk
Regular Member

Date Joined Oct 2009
Total Posts : 289
   Posted 9/25/2010 7:50 PM (GMT -6)   
Ron Hard's fight, using AS and holistic methods apparently were working for him. Notice, it was after he stopped those methods that problems started, in addition to him starting rubbing T on his leg. We'll never know how long he would have survived if he had stuck with the program. Another point I noticed in Ron Hard's story is that he admitted to cheating on his diet once per week. Personally, once the decision to do AS is made, there should be no cheating whatsoever, IMHO.
Age: 63
Gleason grade: 3+4=7, present in both lobes, pT2c NX MX
Robotic RP: Sept. 15th, 2009
PSA's: .04, .03, .02, .05, .02
ED: Improvement slow but there are positive signs. No incontinent issues.
Surgery: Dr. Jim Hu. Dana-Farber/Brigham and Women's, Boston

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 9/25/2010 7:59 PM (GMT -6)   
To say he was "cheating" is true, but to assume that his approach had any affect on prostate cancer at all, is unverifiable. what is known is that prostate cancer can be unaggressive for years. And also what is known is that it can take a sudden catastrophic turn as well.

We really can only look at this case and we shouldn't make any assumptions. Last year his PSA was 5.7 and one year later the disease had run a fatal course in spite of returning to his dietary/holistic regimen.

Optimist asked what life expectancy would be without treatment. In Ron Hard's case he survived 8 years, if what he did in alternative therapy was working in some way, then the time line would have been even less, I would assume...


Post Edited (TC-LasVegas) : 9/25/2010 7:07:49 PM (GMT-6)

Regular Member

Date Joined Feb 2010
Total Posts : 385
   Posted 9/25/2010 11:41 PM (GMT -6)   
I know that this is pretty controversial. I think there are three ways of looking at this:

1. Choice. We always need to respect each others choices, and I'm sure we all have the highest respect for the choice that Ron Hurt made. He staked his life on it, and he followed the treatment he chose for year after year. He showed both courage and conviction.

2. Opinion. We all have our own opinion about what treatments are best. I have to be honest with my opinion, that the only thing that I agree with in this story posted on Yananow is the original comment by the doctor that he saw at the beginning that without conventional treatment this man would live about 8 years. I also agree with Tony that there is no way to verify that lapses in using the diet, or even the use of testosterone changed the course of the disease. Just my opinion.

Think of PCa as starting with a single malignant cell that doubles at intervals. If someone had 5 grams of PCa in their prostate, and it doubled in size every years, in 8 years there would be 1280 grams, almost 3 pounds, which would probably be fatal. On the other hand 50 or 100 grams probably wouldn't cause a lot of symptoms. So you'd expect few symptoms, except maybe obstruction of urine flow, until the very end. Doing very well for a number of years, then wham! seems like what you'd expect to happen.

If you say that cancer begins with a single cell that doubles every year, it would take 40 years for the cancer to get over a kilogram (100, 000, 000, 000 cells). Who knows if that's true. It could be that PCa arises from multiple cells, or that as it grows, more malignant clones of cells arise and the doubling time increases. In any case, when you find out you have cancer, it's been there a long long time. It's only at the very end that most cancers cause a lot of symptoms. Probably all of us over 50's types have several of these cancers brewing somewhere in our bodies.

3. Evidence. While everyone has the right to chose their own treatment, it's not appropriate to advocate that other people chose a particular treatment unless it has been tested and there is some kind of proof that it works. This means clinical trials that show that people with PCa live longer or do better if they get that treatment. It's true that some conventional treatments don't have great evidences, but they all have some kind of evidence. Where's the evidence that special diets, nutritional suppliments, etc, actually results in people with PCa living longer? Perhaps there are clues that people growing up in cultures that don't eat red meat or dairy, for life, are less likely to get PCa, but where's the evidence that such a diet actually helps once you've actually gotten PCa? If anyone knows the results of clinical trials, I'd like to see it, please tell us.

I'm not trying to stir things up, although I probably have. It's just that it's important to point out the differences among choice--opinion--evidence. People who are reading this board to make up their mind about their treatment choices, should be looking for evidence.
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