As predicted, my Nobel winning comments were lost to me forever so I will just have to scratch along with what remnants I can remember.
First of all, I do feel this is an appropriate subject and is worthwhile discussing. If only we could get the AUA to focus on ODOT instead of just screening I think patients would be better served. In any case, if I was King of the Prostate World I would dictate a three pronged approach to ODOT:
1. The AUA and ASTRO out with specific guidelines for biopsy and treatment. For example, how many cores in a biopsy should be standard? Should PCA3 and free PSA tests be performed pre-biopsy? What about MRI and Color Doppler prior to treatment? How about Polaris and/or Prostyvision? And, most importantly, when should AS be recommended as the primary treatment instead of a more radical first step, e.g. what G score, how many cores, what % in the cores and what PSA? The point is that patients and their doctors are pretty much left to their own devices on these matters today and I think it would be quite helpful if there was more prescriptive documentation from the experienced associations of physicians.
2. Along the lines of what PeterDA suggested in another thread, the name of G6 cancer should have some differentiation rather than just another prostate cancer. Something like Extremely Early Prostate Cancer or Pre-Treatment Prostate Cancer. Anyway, some descriptor that asknowledges the likely situation. I just can't quite get to totally changing the name away from cancer.
3. Having Medicare and, subsequently, other insurance carriers refuse to approve payment for radical treatments for men who are recommended for AS per the guidelines in #1 above. This has been suggested on this site for years by David (Purg).
Anyway, thus endeth my miscellaneous thoughts for the day.
Age 62 (66 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, only minor discomfort. Everything continues to function normally as of 11/2/12. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4 yr: .2. My docs are "delighted"! My journey: