The more I learn about
prostate cancer the less I know about
it. The one thing that seems to remain true is that it is complicated. By that standard this thread seems to be getting somewhere -- we seem to be finding areas of agreement ... but always with serious reservations as well. The discussion remains complicated and I think that nicely fits the subject at hand.
From my point of view there are two reasons why we don't allow the offering of "medical advice" on this forum. The first is that if we allow doctors to do their thing on this forum, before you know it we'll have lawyers doing their thing as well and the site will be litigated to rubble. The other reason -- and this one is just me and I have no idea where Peter the Admin stands -- is that decisions about
prostate cancer treatment or non-treatment always involve trade-offs where things that men value greatly are put at risk on either hand and, while I am very comfortable helping
men with their decisions it is important to me that it remains their
decision and that they not be pushed in that decision, even to correct some perceived imbalance in the industry. (Note that in using the word "perceived" I do not mean to imply that I dispute the existence of those imbalances. OD and OT are very real problems and are part of the confusing mess that men should weigh in making their decisions.
To show that there are scarcely any statements so obvious that I can't find a counterargument with which I also somewhat agree, I am sometimes troubled by the statement "Education is the key to <some problem>." I agree that education is totally necessary for men to make sensible decisions but... when it is presented as the first step in some sort of Stalinist five-year plan to remake the world, I start wondering if the word "education" always means the same thing. As I see it, education about
prostate cancer gives a man more things to think about
and generally makes his decision more complicated. The sort of education that is intended to make it easier for men to choose some particular option, however sensible, can cross over the line into "indoctrination" which is to say, pushing, which makes me nervous.
The subject at hand -- whether there are diagnoses of prostate cancer which offer so little risk that perhaps they should be called something else since the word "cancer" is excessively alarming -- is one of those areas where I think education can border on indoctrination. My own position, actually, is mildly, but confusedly, positive. I think that with a low enough PSA and a low enough volume of disease on biopsy, some Gleason 6 cancers could be termed "pre-cancers" to try to keep men from running willy-nilly for treatment. "Pre-cancer" still has the word "cancer" in it and is scary enough, I think, to keep men's attention. I don't much like the term "IDLE neoplasm" because I don't think we have the cellular tumor markers or genetic understanding to use a term so fluffy-bunny reassuring for any
Gleason 6 cancer at this time.
But on the other hand the medical community hasn't made any decisions about
changing the taxonomy yet
and I don't think it is good for discussions on this forum to imply that they have. The idea still remains very controversial among doctors and I, for one, am glad that it is their problem to hash out and not ours.
Post Edited (PeterDisAbelard.) : 8/5/2013 8:42:52 AM (GMT-6)