#1 20 years ago there was little alternative to treating localized prostate cancer than surgery. There are plenty of options available today that are far less invasive.
#2 "...not only is AS a very viable option of any age, but it should be the only recommendation that doctors give to patient with <10 yrs L.E. (for “low risk” PC), or <20 yrs L.E. (for “very low risk” PC)."
I hope doctors apply more common sense and explanation than what is written here. There is certainly cases that should be AS but there is no way to determine indolent versus aggressive disease. According to this article MOST will exit the AS program as I have stated before. For some it was just a personal decision and for others the plan simply failed and diverse conditions existed. It is my belief that the above quoted line is simply an inadequate explanation of what the intent of the demarcation means from the NCCN.
See the link John posted again...
(Does anyone notice that more than half in this study eventually vacated the AS decision by year 10. I think I was pummeled here in the past when I suggested this would be the case for most that do AS)
Anyone can do AS. That I don't argue. And SOME outside the parameters of the group that would receive a "blanket" recommendation should absolutely NOT do it. I agree with you final comment that each case should be evaluated versus taking these guidelines and applying them rigidly. Not all men with 25% of 3 cores positive, a PSA of 4.5 and Gleason 3+3=6 should sit on their diagnosis, especially for example if they young such as a 38 year old.
To suggest it is acceptable because the NCCN leaves
open that door ~ and it is borderline ludicrous to apply the NCCN statement in recommending AS to such cases...The parameters are separate for a yet still unexplained reason on this thread. As my comments are in Mikes post in the link above, a doctor should need to explain the WHY
AS for longer LE isn't in the blanket recommendation as opposed to just saying "ah shucks you can still do it"...
We also know that men with more diverse risk factors can do AS if they have co-morbitity that will likely be their demise. At least they will get a better explanation than what we have defined today for those that are "optional".
Post Edited (TC-LasVegas) : 4/15/2011 10:55:53 AM (GMT-6)