In regard to the one study that reported on anxiety being a determinant for leaving AS at 9%, I would suggest that progression and rising PSA cause anxiety and can lead to a rushed decision to leave AS.
I think the 2/3rdds dropout rate is high--although it may be on the decline. I think many men go on AS with the expectation that it will be forever. It wull be for some, but not all. I included all reasons for dropping out that were presented. They don't often look at anxiety and mental distress,
As long as I can recall, Peter Carroll has always maintained that his UCSF cohort shows APPROXIMATELY 1/3 of men remain on AS, 1/3 of men progress, and 1/3 of men opt for treatment.
Frankly that is hardly differnt to what you report here - so Imaybe there is no radical change - 64% to 66%??
The 50% JH number does need some explanation since it shows a lower number opting for treatment - or cnversely a higher number remaining on AS. Does this report those who fell out the study for any reason?
Great collection of articles Howard and congratulations for bringing this dirty secret into the open.
I am concerned that people still seem to consider the only alternatives to AS to be surgery or radiation. In the past few years it has become possible to consider testosterone influencing pharmaceutical
treatment with Erleada or Nubeqa to be first line treatments for prostate cancer
Please make your readers aware of the book - Keys to Understanding Prostate Csncer edited by Mark Sholtz for additional information
A very interesting and thoughtful newsletter. Thanks.
One quick question: You said:
"I had imagined those of us with low-risk prostate cancer would be surveilling into the sunset, or at least until we transitioned into less aggressive management of our lesions, such as watchful waiting sans the regular digital rectal exams, PSAs, MRIs, and biopsies."
So, if someone opts for watchful waiting without DREs, PSAs, MRIs or biopsies, what are they watching? Or is it simply just the last stage of Kubler Ross grief - acceptance, and moving on.
All best wishes,
Ed Bradley (76 years old, on AS for the last 3+ years, hoping to stay on AS, with as few biopsies as possible, as long as possible!)
Thanks for the kind words, Ed.
When they started watchful waiting in Scandinavia, as I understand it, it was a disaster. Death rates from prostate cancer soared.
They sent the old Vikings out on the ice floes to die.
As Laurence Klotz, father of AS, says, there were was "too much watching and too much waiting."
(Not really Kubler-Ross. Funny enough. She wrote "Death and Dying" less than a mile from where I am right now as a prof at UChicago in Flossmoor, Illinois.)
There is a lot of debate among AS patients in their 80s today--who tend to have low-risk Gleason 6--about whether to stay on AS or to lapse into a type of WW. I just turned 75 and haven't had a. biopsy or MRI in almost seven years--after five years of annual biopsies. So I am on a sort of AS--but I am monitored with a type of PSA test.
Thanks, Richard. There is PSA anxiety.
In regard to the one study that reported on anxiety being a determinant for leaving AS at 9%, I would suggest that progression and rising PSA cause anxiety and can lead to a rushed decision to leave AS.
I think the 2/3rdds dropout rate is high--although it may be on the decline. I think many men go on AS with the expectation that it will be forever. It wull be for some, but not all. I included all reasons for dropping out that were presented. They don't often look at anxiety and mental distress,
As long as I can recall, Peter Carroll has always maintained that his UCSF cohort shows APPROXIMATELY 1/3 of men remain on AS, 1/3 of men progress, and 1/3 of men opt for treatment.
Frankly that is hardly differnt to what you report here - so Imaybe there is no radical change - 64% to 66%??
The 50% JH number does need some explanation since it shows a lower number opting for treatment - or cnversely a higher number remaining on AS. Does this report those who fell out the study for any reason?
Great collection of articles Howard and congratulations for bringing this dirty secret into the open.
I am concerned that people still seem to consider the only alternatives to AS to be surgery or radiation. In the past few years it has become possible to consider testosterone influencing pharmaceutical
treatment with Erleada or Nubeqa to be first line treatments for prostate cancer
Please make your readers aware of the book - Keys to Understanding Prostate Csncer edited by Mark Sholtz for additional information
Keep up the good work
Howard,
A very interesting and thoughtful newsletter. Thanks.
One quick question: You said:
"I had imagined those of us with low-risk prostate cancer would be surveilling into the sunset, or at least until we transitioned into less aggressive management of our lesions, such as watchful waiting sans the regular digital rectal exams, PSAs, MRIs, and biopsies."
So, if someone opts for watchful waiting without DREs, PSAs, MRIs or biopsies, what are they watching? Or is it simply just the last stage of Kubler Ross grief - acceptance, and moving on.
All best wishes,
Ed Bradley (76 years old, on AS for the last 3+ years, hoping to stay on AS, with as few biopsies as possible, as long as possible!)
Thanks for the kind words, Ed.
When they started watchful waiting in Scandinavia, as I understand it, it was a disaster. Death rates from prostate cancer soared.
They sent the old Vikings out on the ice floes to die.
As Laurence Klotz, father of AS, says, there were was "too much watching and too much waiting."
(Not really Kubler-Ross. Funny enough. She wrote "Death and Dying" less than a mile from where I am right now as a prof at UChicago in Flossmoor, Illinois.)
There is a lot of debate among AS patients in their 80s today--who tend to have low-risk Gleason 6--about whether to stay on AS or to lapse into a type of WW. I just turned 75 and haven't had a. biopsy or MRI in almost seven years--after five years of annual biopsies. So I am on a sort of AS--but I am monitored with a type of PSA test.
Here's to a forever AS for you.
Howard