Peter - if we accept that men with a G6 act irrationally we logically also have to accept that the medical professionals surrounding us advising us to act, which is almost all of them, and the apparatus behind them, is not only a rigged game, but also organized crime.
I think the above statement is logical.
I am not ready to accept that.
You know, David, that's kind of disappointing. I was trying to build a bridge. I am actually mostly on your side and was trying to see how far we can go, you and I, in seeing the problem of overtreatment and maybe thinking about
how it can be addressed. I did not say patients were irrational, I said that some of the language used to describe their disease to them was confusing, and some of them might be making rational decisions based on imperfect information. "Rational" doesn't mean correct. It means well-supported by the information available.
Nor was I suggesting that surgeons are trying to mislead them. I think that surgeons try to lay out the options as clearly and fairly as they can and let the patients decide. They don't use the word "prostate cancer" for low-risk, low-volume Gleason 6 disease to try to 'scare' their patients. That's the only word they have. They try to explain Gleason scores and the unlikelihood of metastases and they hope it gets through. I talked to two surgeons. One recommended against surgery but said he'd be glad to do it if I wanted. The other -- my urologist who I finally chose for the surgery -- made a strong pitch for AS then told me he couldn't ethically make a recommendation one way or the other. I think most urologists will admit that too many low risk men choose treatment but don't see what they personally can do about
it without either lying to the patient to make the surgical option sound more frightening than they believe it to be, or taking the decision away from the individual patients to try to make some sort of AS "quota" they have in mind.
I'm not trying to trick you. There is not slippery slope, no gotcha
if you budge from your safe position. Work with me here.
Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012:
1)neg (some inflammation),
3)positive 1 of 14 GS6(3+3) 3-4%, 2nd opinion GS7(3+4)
Mild Pre-op ED
DaVinci RRP 6/14/12. left nerve spared
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
Start 24 mo ADT3 7/26/12
Adjuvant IMRT 66.6 Gy 10/17/12 - 12/13/12
Leaky but better, Trimix, VEDForum Moderator - Not a Medical Professional