We have a lot of collective wisdom at this site. Let’s make a value-added list of posts with wisdom that newcomers might not be initially aware of, and help get them off to a great start on their “patient education” journey. When we see a newcomer joining HW/PC, we can say, "Welcome! Be sure to visit the thread called, 'Newly diagnosed with PC? — read this thread first.'"
Let’s please avoid the goofy “posts about other posts” that don’t add value but consume space…let’s add to this thread only with information valuable to the PC newcomers in mind. Also, let’s please avoid the posts that begin with “Well, in my case…” which becomes a post "all about you," because this thread is not intended to be about what you did or what your case was. It’s intended to be a general reference thread of information for the PC newcomers. There are plenty of other threads to tell everyone all about you.
Further to this same point, my message to the newcomers who will benefit from this thread in the future is that you can save your “thank you” replies for other threads because these types of messages will, similarly, clog the space in the thread. Let’s keep the all the thread entries focused on the points newcomers may not be initially know about prostate cancer.
Added later as an edit: I’ll say “you are welcome” here to all those who have emailed me an offline “thank you” for having created this thread...
Added later as an edit: I’ll say “you are welcome” here to all those who have emailed me an offline “thank you” for having created this thread...
This thread has the potential to live on for a long time, and be referenced by many people in the future. Let’s put our best foot forward. Let’s see if we can turn this into some good…
IMPORTANT (although perhaps obvious) NOTE: this is not "medical advice," and should not be a substitute for medical advice; it is merely a collection of learnings and information about PC which often takes a while to be educated about
I’ll get this started with a post which will help to guide future posts, and then you guys can help to carry this legacy forward. Here we go...best foot forward...
Some of the tidbits of lessons learned/wisdom which may be added to this thread following this post will be intended for only one of these risk categories, others will be generic. If it is going to be valuable for only one of the risk categories, it will be helpful to indicate which one. For example, just say something like, “This input is for HIGH RISK men…”
SUMMARY: Know your “risk category”
Prostate cancer is really like two, or perhaps three, very different diseases. The recommended treatments (or non-treatment recommendations) are based largely on the NCCN Clinical Guidelines. Step #1 for all PC newcomers is to be able to answer the question, “What is your risk category?”
The NCCN “risk categories” are listed below:
· HIGH RECURRENCE RISK
o PSA > 20 ng/mL
o and/or Gleason 8-10
o and/or cT3 tumor
· INTERMEDIATE RECURRENCE RISK
o PSA between 10-20 ng/mL
o and/or Gleason = 7
o and/or cT2b-c tumor
· LOW RECURRENCE RISK
o PSA < 10 ng/mL
o and Gleason < 7
o and cT1-T2a tumor
· VERY LOW RECURRENCE RISK
o and cT1c tumor
o and PSA density <0.15
o and <3 biopsy cores positive, <=50% cancer in any core
Newly diagnosed? What's your risk category?
Post Edited (Casey59) : 7/12/2013 2:57:26 PM (GMT-6)
SUMMARY: When is a bone scan or CT scan appropriate (or not) for newly diagnosed men?
This bullet is intended to describe why your urologist may NOT prescribe a routine bone scan or CT scan immediately following your diagnosis…even though he/she may have prescribed a scan for another patient with a different case.
In the era when a large number of today’s urologists were being trained (figure about 15-20 years ago as typical), the initial staging of patients at the time of diagnosis of PC was frequently HIGH-RISK or INTERMEDIATE-RISK. Many men of this era were diagnosed following a visit to their urologist to investigate symptoms which ended up being rooted in advanced PC...by the time symptoms appeared, the case was clearly “advanced.” Bone scans and/or CT scan were, therefore, appropriately prescribed on a routine basis by urologists of that era to check the extent of metastasis, which most patients had at the time of initial presentation (checking for “mets” is the purpose of the bone/CT scans, and men diagnosed with advanced PC will be reoccurringly scheduled for scans to track & measure “met” progression).
Today, the prevalence of PSA testing has resulted in a “stage migration” downward, and the typical newly diagnosed PC patient is VERY LOW-RISK, LOW-RISK or INTERMEDIATE-RISK, and instances of mets in these cases is remote. The habits of urologists to routinely prescribe scans has, however, lingered into the new era.
The standard-setting body of the practicing urologists in the US, the AUA, has observed that scans were still generally prescribed for all new PC patients, but that a smaller and smaller percentage of the newly diagnosed population were actually found to have mets. Researchers at the Univ of Chicago Medical Center and Dana-Farber Cancer Institute estimated that the total annual cost of over-prescribed but unneeded testing is about $35 million every year in prostate cancer alone. As a result, the AUA updated its “Best Practices” Guideline for urologists to follow, and divided the population of newly diagnosed PC patients into two groups—those for whom a routine scan is appropriate to prescribe, and those for whom a routine scan is not appropriate to prescribe because they are almost certain to be negative.
Summarizing the “Best Practices” Guideline:
o Routine use of a bone scan is not required for staging asymptomatic men (no symptoms) with clinically localized PC when their PSA level is equal to or less than 20 ng/mL.
o CT scans may be considered for the staging of men with high-risk clinically localized PC when the PSA is greater than 20 ng/mL or when locally advanced or when the Gleason score is greater or equal to 8.
For additional clarity, there are some individuals with case exceptions for whom staging scans may be appropriate even though they appear to not meet the descriptions above, and it is important that the urologist treat each case individually.
The “Best Practices” Guideline is available as a free PDF download from the AUA website (HERE), and is an excellent source if information for PC newcomers of all risk levels.
Added as an edit in July 2013…
The AUA feels so strongly about the over-prescription of bone scans and CT scans by practicing clinicians for LOW-RISK patients that it is listed as the #1 item in their new publication, “Choose Wisely—Five Things Physicians and Patients Should Question.”
Post Edited (Casey59) : 7/25/2013 9:03:34 AM (GMT-6)
Post Edited By Moderator (Tudpock18) : 2/10/2017 10:06:10 AM (GMT-7)
SUMMARY: Considering surgery? Be aware that there is a well-known “learning curve” for the complicated radical prostatectomy (RP) procedure.
How many radical prostatectomies has your surgeon performed? Ask him (or her). This post addresses the importance of finding a highly experienced surgeon for treatment.
This posting is primarily for INTERMEDIATE-RISK cases, although it might be applicable to some LOW-RISK cases, and also some HIGH-RISK cases, for different reasons. Generalizing, HIGH-RISK cases are most frequently recommended to follow a multimodal RT/HT (radiation therapy/hormone therapy) treatment plan (although some cases include surgical “de-bulking” of tumors), and LOW-RISK cases are the best candidates for pursuing an Active Surveillance plan (also see Dr Walsh’s quote on surgery for LOW-RISK patients, below). INTERMEDIATE-RISK cases, today, are typically treated with either surgery or radiation therapy.
Surgery is the most common treatment mode today for INTERMEDIATE-RISK PC patients, with nearly 100,000 procedures (radical prostatectomy, or RP) performed each year in the US; approximately 75% of those RPs are minimally invasive and “robotically assisted” using the da Vinci surgical system robot.
In the last decade, there has been a dramatic growth in the availability of robotic surgery. The robotic systems were initially only available at high-volume major medical centers which attracted patients from a wide geographical radius, but today many local low-volume Community Hospitals have funded a robotic system and they are scheduling a broad range of procedures (from RPs, to heart surgery, kidney surgery, and many others).
The issue presented in this post, which may not be immediately or intuitively obvious to the newly diagnosed patient, is that multiple “learning curve” studies have been conducted with surgeons performing robotically-assisted RPs which demonstrated that a higher level of surgical proficiency and skill which is achieved over time and after performing many procedures. Naturally, no two studies have the exact same outcome, but the lowest typically reported “learning curve” (that point at which the rate of improvement slows dramatically) is 250 procedures. Other studies have reported higher minimums.
A relatively small number of surgeons perform a large number of procedures (only 1.8% of urologists perform 50 cases or more per year). The typical major treatment centers in larger metropolitan areas of the US will typically have mulitple surgeons with more than 1,000 surgeries experience. Conversely, a relatively large number of surgeons perform a small number of annual procedures (82% of urologists perform less than 10 cases per year). At that low rate, many will never reach the plateau of learning in their surgical career.
Examining outcomes of large populations of men, operations performed by surgeons during their learning process result in longer operating room time (it took longer to try to “get it right”) and less optimal outcomes (didn’t “get it right” as often, for both cancer-control and side effects).
This post is NOT a promotion or recommendation for any particular method of treatment or for any particular practicitioner; but the discussion focuses on the recognition that robotic surgery is the most commonly selected treatment mode for INTERMEDIATE-RISK patients in the US. More robotic RP surgeries were performed in the US than all modes of radiation therapy for PC combined.
While the discussion has focused primarily on robotically assisted RP, which has been most widely studied, but it is acknowledged that the “open surgery” technique has a similar learning curve. For example, Dr Patrick Walsh, who perfected nerve-sparing open surgery techniques widely used today was quoted at the AUA 2010 Panel Discussion on LOW-RISK PC as saying, “If you are going to have an unnecessary operation, it is important that you do it well.”
Regarding RT, many have commented about the similar importance of having an experienced radiation oncologist, if radiation is the chosen treatment plan…although I am not familiar with any similar “learning curve” studies for RT. Anecdotally, we have seen plenty of issues reported here at HW caused by something going awry with RT.
All the discussion in this post is from the big picture perspective, studying large populations of outcomes. This does not mean that any individual who selects a less experienced surgeon will always have a less optimal outcome; nor does it mean that someone who selects a more experienced surgeon will always have a more optimal outcome. It simply means that the risk (the probability) of a more favorable outcome is better with an experienced surgeon. There will always be anecdotal situations on both sides of the coin…but with this knowledge you can help to “stack the odds in your favor.”
Newly diagnosed and considering surgery? Choose an experienced practicitioner for PC treatment. Before signing-up for surgery, ask them how many procedures they have performed.
Data taken from this interesting article from the Journal of Urology: “Low annual caseloads of US surgeons conducting radical prostatectomy.” LINK
Post Edited (Casey59) : 3/1/2013 2:54:52 PM (GMT-7)
SUMMARY: Clinical Trials—what are they?
If you are a PC newcomer and have never previously dealt with a major medical issue, then you probably have no idea what a Clinical Trial is. This posting will give you plenty of info to get you started. Before you start any treatment, it might be worth looking into whether you are eligible to receive a higher level of care through a Clinical Trial…
This posting is appropriate for all newly diagnosed men, regardless of which risk category you are in (HIGH-RISK, INTERMEDIATE-RISK or LOW-RISK).
What is a Clinical Trial? A clinical study involves research using human volunteers (also called participants) that is intended to add to medical knowledge. Participants receive specific interventions according to the research plan created by the investigators. These interventions may be medical products, such as drugs or devices; procedures; or changes to participants' behavior, for example, diet. Clinical trials may compare a new medical approach to a standard one that is already available or to a placebo that contains no active ingredients or to no intervention. The investigators try to determine the safety and efficacy of the intervention by measuring certain outcomes in the participants — their disease or condition, how they react to the treatment, and potential side effects, which will be monitored.
Who conducts Clinical Trials? Every clinical study is led by a principal investigator, who is often a medical doctor. Clinical studies also have a research team that may include doctors, nurses, social workers, and other health care professionals. Clinical studies can be sponsored, or funded, by pharmaceutical companies, academic medical centers, voluntary groups, and other organizations, in addition to Federal agencies such as the National Institutes of Health, U.S. Department of Defense, and U.S. Department of Veterans Affairs. Physicians, health care providers, and other individuals can also sponsor clinical research.
Are Clinical Trials only for advanced cases? No, definitely not, although it is true that most trials for new drugs are for advanced, HIGH-RISK cases. A sampling of Clinical Trials which are currently recruiting for INTERMEDIATE-RISK or LOW-RISK men with PC include (but not limited to) these Trial titles (from clinicaltrials.gov):
· Diet in Altering Disease Progression in patients with PC on ACTIVE SURVEILLANCE (AS)
· AS for cancer of the Prostate (ASCaP)
· AS in PC
· Shared decision making in LOW-RISK PC
· Study of Antioxidants on prostate tumors in men undergoing RP for PC
· Quality of Life Study for PC patients
· Guided biopsy for mapping PC
· MRI in Diagnosing PC
· Impact of F-18 PTE/CT and MR Imaging in Management of Primary PC
· Anxiety in men with PC
· Efficacy and safety study of TOOKAD Soluble for localized PC compared to AS
· HIFU in treating patients with localized PC
· Stereotactic Hypofractionated Radiosurgery for Early Stage PC
What are the benefits of participating in a Clinical Trial? The key benefit is the opportunity to receive the latest and best treatment available. Patients receive either the best standard treatment (control group) or an additional treatment (test group) that may be more effective (and not generally available to others). People who enroll in these studies often get more frequent oversight & follow-up from doctors.
Tell me more about the use of placebos. A placebo-controlled trial compares a new treatment with a placebo; people who receive a placebo are in the control group. The use of placebos in cancer clinical trials is generally rare, but is an important component of the new “targeted” drugs being developed for prostate cancer so that researchers can tell whether stabilization of the tumor growth is an effect of the treatment or just reflects the natural behavior of the tumor.
Is it easy or difficult to enter a Clinical Trial? “Both” is probably the best answer. 80% of clinical trials fail to enroll the required number of patients on time, so many are looking for patients. On the other hand, the medical criteria is usually very strict because a valid scientific conclusion can only be reached if all the patients have similar medical conditions/requirements.
Where can I find more information on Clinical Trials?
· ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world.
· American Society of Clinical Oncology (ASCO) article “ASCO Expert Corner: Placebos in Cancer Clinical Trials”
Post Edited (Casey59) : 3/8/2013 8:56:16 AM (GMT-7)
This post is most appropriate for men diagnosed with LOW-RISK prostate cancer. (The RISK categorization is addressed in the very first posting in this thread.) This topic is not necessarily applicable to INTERMEDIATE- or HIGH-RISK cases, but probably of interest.
SUMMARY: Overtreatment of LOW-RISK prostate cancer is a reality you should be aware of. Be informed.
Discussions of treatment often follow closely on the heels of actual PC diagnosis; in fact, initial treatment discussions are often a part of the same appointment as when biopsy results are presented to the patient. The extension of the physician’s treatment discussion may or may not have been extended to included PC overtreatment; clearly, most physicians will have an opinion and a natural bias on the topic.
The mere mention of the topic of prostate cancer overtreatment has, in the past, led to some emotionally-charged flame-outs of threads here at HW/PC…so this posting is issued with very carefully selected minimalist wording to adhere to the mission of providing important information which may be valuable to newcomers who may not be intuitively obvious immediately after you actual PC diagnosis. The reality that PC overtreatment exists has not been the primary cause of the flame-outs; rather, the ensuing dialogue on opinions about why overtreatment exists, or what might be done to address it.
The men and women of this HW/PC site felt strongly* that newcomers should be aware of the fact that PC overtreatment exists. That knowledge is probably best presented here in this unamgibuous statement, without biases, discussion or opinions about why PC overtreatment exists, or what might be done to address overtreatment.
Read more on this topic yourself. If you Google these three words (prostate cancer overtreatment), you will find a plethora of information (I just did and got >80,000 related Google results). Among the results, one will find media/news articles, medical editorials, professional society presentations/abstracts, as well as many other sources. As always, one should appropriately gauge the legitimacy of each source of information on the internet…but many reliable and well-informed sources have published widely on this topic.
If you are a LOW-RISK patient, your patient education should include at least a basic awareness of prostate cancer overtreatment.
*NOTE: Before posting this information, an online poll was conducted among the experienced HW/PC “vets” to gauge whether this information is, or is not, important for a newcomer to learn soon after diagnosis. With 25 responses within the first 24-hours, the results were overwhelmingly (>90%) clear that it is important to know. HERE is the link to the poll, which may have updated results since the time this post was written.
Post Edited (Casey59) : 3/15/2013 8:15:33 AM (GMT-6)
Many newly diagnosed men come to HealingWell looking for information. This thread contains information from solid resources which helps men get off to a great start on their “patient education” journey.
Back in Dec 2011 (HERE), an outstanding list of links (with an accompanying brief, helpful explanation of each) was published here at HW/PC and was very well received by forum members. Site limitations prevented all the links from being added to the HW Welcome Page, so they have been updated and pasted here.
The links provided here range from some being relevant only to high-risk men, to others being relevant only to low-risk men, and to others being relevant to all newly diagnosed men with PC…let the brief, helpful explanation be your guide.
Important PC resources:
1. National Cancer Institute (NCI)-designated Cancer Centers – Best-in-class cancer care. List of the 67 leading US cancer treatment facilities which demonstrate depth of scientific leadership, resources and capabilities in laboratory and clinical sciences, with a transdisciplinary research approach. Of the 67 NCI-designated cancer centers, 41 are “Comprehensive Cancer Centers” which also carry out professional and public education programs…the CCC’s are where the experts went to learn.
2. NCCN Prostate Cancer Clinical Practice Guidelines in Oncology – consensus comprehensive “roadmap” of currently accepted approaches to PC treatment, published by the National Comprehensive Cancer Network, in free downloadable pdf format; updated 2010. Also, see the patient-centric NCCN Guidelines for (Prostate Cancer) Patients, free, downloadable in a reader, and printable; updated 2013.
3. AUA’s Prostate-Specific Antigen Best Practice Statement – resource for physicians & patients describing PSA and PSA test results published by American Urological Association, in free downloadable pdf format; now available in the 2013 Revision.
4. PCRI’s “Diet, Vitamins & Exercise for Prostate Cancer” – high-level brochure published by the Prostate Cancer Research Institute promoting lifestyle changes for PC patients which “don’t feed the cancer,” in free downloadable pdf format.
5. “Nutrition & Prostate Cancer” – detailed treatise by nutritionist specializing in PC addressing the scientific evidence, and resultant recommendations, that differences in diet and lifestyle may account in large part for the variability in PC, published by Helen Diller Family Comprehensive Cancer Center at UCSF, in free downloadable pdf format; revised 2009.
6. PCF’s “Nutrition, Exercise and Prostate Cancer” – information for men based on studies that lifestyle (especially nutrition & exercise) has a significant influence on PC prevention & treatment published by the Prostate Cancer Foundation, in free downloadable pdf format; published 2009.
7. Free online patient education material on Active Surveillance from several leading institutions:
a. “Active Surveillance for Prostate Cancer,” published by Univ of California at San Francisco
b. “Active Surveillance for Prostate Cancer: What a man needs to know before deciding on treatment,” published by the James Buchanan Brady Urological Institute at Johns Hopkins
8. PubMed – millions of searchable citations for biomedical literature available free, online and provided at taxpayer expense by the US National Library of Medicine, National Institutes of Health.
9. clinicaltrials.gov – searchable free, online registry and results database of federally and privately supported clinical trials conducted in the US and around the world, administered as a service of the US National Institutes of Health.
10. Nomograms – free online outcome prediction of risk based on individually variable case characteristics:
a. Memorial Sloan-Kettering Cancer Center Prostate Cancer Nomograms (includes PSADT calculator)
b. Cleveland Clinic Risk Calculators
11. Hormone-Refractory Prostate Cancer Association, Inc. patient web site – www.hrpca.org
12. AUA’s “The Management of Localized Prostate Cancer Patient Guide” – overview and recommendations from the Prostate Cancer Clinical Guideline Panel of the American Urological Association about how to make a treatment decision, includes four individual factors (my cancer’s characteristics, my overall health, my life expectancy/age, my personal values), in free downloadable pdf format.
13. PCI's "I Have Prostate Cancer, Now What?" — Prostate Cancer Institute website article with actionable first "next steps" for newly diagnosed men with PC. Includes recommendations on 2nd opinion, maintaining medical records, making immediate lifestyle changes to maximize protection and other suggestions on how to be an informed patient.
14. National Proactive Surveillance Network website. Site created in collaboration with the Prostate Cancer Foundation for the active management of Prostate Cancer in patients who qualify for this non-intervening management program. Launched 2011.
15. “Ask Dr. Myers” video library — Dr Charles “Snuffy” Myers is one of the world’s leading medical oncologists, specializing in treating advanced prostate cancer. On a nearly weekly basis, Dr Myers publishes a free online video segment of interest to men with PC titled “Ask Dr. Myers.”
16. The “NEW” Prostate Cancer InfoLink — An almost-daily posting of the latest-and-greatest (and not so great) news across the spectrum of PC issues. Outstanding layperson’s review and analysis of important journal postings. Fantastic “Search” function.
Note: links come-and-go...best efforts will be made to keep these links current
Post Edited (Casey59) : 8/30/2013 7:47:11 AM (GMT-6)
Post Edited (Tudpock18) : 7/24/2013 10:55:53 AM (GMT-6)
SUMMARY: PC newcomer's new vocabulary/terms
This entry is of potential interest to ALL newly diagnosed men with prostate cancer...for very different reasons. As a newcomer, you are embarking on a journey in a foreign land, with a foreign language…you will learn lots of new terms and acronyms along the way. Here is a pair of terms which you should add to your vocabulary.
Although frequently (mis-)used as interchangeable, the two terms “WATCHFUL WAITING” and “ACTIVE SURVEILLANCE” have some similarities, but have very different meanings. The term “Watchful Waiting” has been around a long time, whereas “Active Surveillance” is a relatively newer term created as a variant of “Watchful Waiting.” Read this to understand the important differences:
What is “WATCHFUL WAITING?”
Watchful Waiting (WW) is a strategy of using less intensive follow-up (fewer monitoring tests) and relying on changes in a man’s symptoms to decide if a treatment is needed. If symptoms appear, whether it is a lower urinary tract obstruction or bone pain from metastatic disease, treatment is introduced to relieve symptoms…so it is a palliative (not curative) therapy. This strategy is usually applied when the doctor & patient agree that he has fewer years of life expectancy and/or has other concomitant health problems, or because the patient believes strongly that he would prefer the risk of disease progression to the risks associated with aggressive treatments.
WW has been around a long time, but the fundamental basis for modern forms of this strategy is that one is trying to avoid receiving treatment of any type for as long as possible so that the patient may optimize his quality of life, while recognizing that it may be necessary in the long term to intervene so that he has minimal impact from the potential morbidity and mortality associated with prostate cancer.
WW may also be appropriate for a man who is suspected of having PC but for whom a biopsy is perhaps an unnecessary intrusion because of age or health. In such cases, even if a biopsy proved to be positive, curative therapy would not be recommended, which makes the biopsy somewhat futile.
WW in these, or similar, scenarios may apply to men of any PC RISK category.
What is “ACTIVE SURVEILLANCE?”
Active Surveillance (AS) is a very different strategy of proactive, prospective therapy for carefully selected LOW-RISK men to measure the pace of disease progression (or lack thereof) by regular monitoring AND instituting deferred treatment with curative intent based on pre-defined change in the monitoring test results. Close observation over time is the best way to distinguish men who can be safely watched from the men who genuinely need treatment.
This important element of “time” is unavailable at the moment of initial diagnosis…which has led to the mantra consistently provided to newly diagnosed LOW RISK men not to “rush” any aggressive treatment decision without understanding the likely “benefits” of aggressive treatment (many men are unaware of the uncertainty/controversies that aggressive treatment may not improve their survival, especially LOW RISK PC) versus the potential “costs” (many men are surprised post-op because they didn’t quite understand the gravity of the side effects).
AS is a relatively new term as more-and-more of the PC clinicians have realized that not all cases of PC need aggressive treatment…and as a result prostate cancer is now frequently referred to as a spectrum of different diseases, rather than a single disease. It should be noted, however, that there currently is no universally accepted formal protocol for AS entry, monitoring, or exit; rather, attending clinicians tailor a program of care unique to each individual case but based on common foundations. While age is a consideration in some programs, Dr Laurence Klotz, considered a foremost authority on AS, has expressed that "the longer the patient’s life expectancy, the more stringent should be the AS criteria, but youth alone is not a contraindication for AS." Also worthy of note is the recognition that Klotz's program, and others, are now evaluating limited inclusion of men on the low-side of INTERMEDIATE-RISK PC (small amounts of Gleason pattern 4, and otherwise low-risk case characteristics).
Those who may pursue AS may never need an aggressive treatment at all, or they may not need treatment for years, or they may need treatment after their next 6-month check-up. Most AS programs are holistic & integrative in their structure, and include supplemental patient education on lifestyle choices (diet, exercise and stress reduction) which has been demonstrated to slow or reverse PC progression in low-risk patients.
Related to the efficacy & safety of AS, the Univ of California-Davis conducted a study several years ago which compared pathological outcomes of men who sought deferred surgery after a period of AS with those from a similar risk group undergoing immediate surgery, and concluded with these important points:
The study’s conclusion statement: “The present analysis did not show an association between RP after a period of AS and adverse pathological features for men with low-risk disease.” In other words, in a sample study population deferred treatment after AS did not have different outcomes from those who sought immediate treatment.
The term “EXPECTANT MANAGEMENT” broadly encompasses both active surveillance and watchful waiting strategies.
Post Edited (Casey59) : 7/25/2013 11:39:37 AM (GMT-6)
Post Edited (Dreamerboy) : 8/1/2013 4:27:34 PM (GMT-6)
Welcome to all those newly diagnosed with prostate cancer.A new diagnosis of "cancer" may stimulate initial feelings of fear, anxiety, or perhaps even "hysteria" (according to one very well-known physician who specializes in treating PC cases), or a "wall of shock."Many men who have preceded you through that door called "prostate cancer diagnosis" would tell you that a solid patient education is the key to calming your fears and successfully addressing your individual & unique case. A solid patient education takes a little time (perhaps understated), but this thread is intended to be a good starting point for you...Welcome.
Please continue to help keep this thread focused on content...information for newcomers.
Tony, thanks! Now that this is a "sticky" post, I will also go back soon and remove the redundant "Welcome" message in green text, above, and enhance the "Welcome" in the very first post...at A Yooper's excellent suggestion.
( I will go back and delete this black text, too. thanks!)
Post Edited (Casey59) : 8/1/2013 10:24:37 AM (GMT-6)
Post Edited (Redwing57) : 10/17/2013 11:40:44 AM (GMT-6)
Post Edited (Tudpock18) : 2/27/2014 10:27:06 AM (GMT-7)
Post Edited (PeterDisAbelard.) : 9/4/2015 10:36:49 AM (GMT-6)
Post Edited (Tudpock18) : 1/6/2016 12:42:29 PM (GMT-7)