Bert, I should add that some experts I have spoken to think AS really isn't needed for the Gleason 6 patients, but in the future mainly will be for those with favorable Gleason 3+4. This onion has loads of levels. One is fear and anxiety on the road to being at peace with having anything that pretends to be a cancer. Even what you and I might consider a non-cancer, such as Gleason 6, leads 40% of such men to undergo treatment because of bad PR--these people just can't accept the idea of living with a cancer, nor can their partners and many of their urologists. Howard
Bert, I am not sure how to answer that. I think we can say that mortality in patients who go AS, have surgery or undergo radiation is roughly the same. So why bother with surgery or radiation of you are a Gleason 6? Is that a bad thing? Are you saying we should skip AS? I asked my urologist last week if I came in today and had my current PHI/PSA, I asked if I'd even have an MRI or biopsy or would be diagnosed, he said no. Howard
Yhere are guidelines for Watchful Waiting by the NCCN and AUA based on life expectancy not specially on age. Comorbidities have a greater impact on the choice of treatment, AS or WW as we grow older. I have had a stroke and am 75 with Favorable Intermediate Risk and 10 years or less life expectancy, so WW is the guideline I am following.
Bert, I should add that some experts I have spoken to think AS really isn't needed for the Gleason 6 patients, but in the future mainly will be for those with favorable Gleason 3+4. This onion has loads of levels. One is fear and anxiety on the road to being at peace with having anything that pretends to be a cancer. Even what you and I might consider a non-cancer, such as Gleason 6, leads 40% of such men to undergo treatment because of bad PR--these people just can't accept the idea of living with a cancer, nor can their partners and many of their urologists. Howard
Bert, I am not sure how to answer that. I think we can say that mortality in patients who go AS, have surgery or undergo radiation is roughly the same. So why bother with surgery or radiation of you are a Gleason 6? Is that a bad thing? Are you saying we should skip AS? I asked my urologist last week if I came in today and had my current PHI/PSA, I asked if I'd even have an MRI or biopsy or would be diagnosed, he said no. Howard
Where is the irrefutable and reproducible scientific data that active surveillance saves significant numbers of lives?
Yhere are guidelines for Watchful Waiting by the NCCN and AUA based on life expectancy not specially on age. Comorbidities have a greater impact on the choice of treatment, AS or WW as we grow older. I have had a stroke and am 75 with Favorable Intermediate Risk and 10 years or less life expectancy, so WW is the guideline I am following.
Absolutely, Geoff. Heart disease is our real enemy.. Howard
Agreed Howard. There are many variables to aging. One time I saw Dr Coop and he said after the exam to "take care of your heart". I am.