9 Comments

Correct, Jeff, if you can afford it with future replete with uncertainty for all, do it! Have it from an unreliable source at the Pearly Gates, each of us WILL be asked were we a sustaining member of The Active Surveillor.

Dr. Vorstman, yes, where is the discussion regarding PI RADS 4/5 and low risk upon biopsy; is it more common than one suspects? Continue to write to force experts or not alike "out of the closet" on issues you raise.

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Thanks for helping in sustaining/

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Thanks for the support, Jeff. Good to know I can outclass Paramount. Where do I stand in view of Apple, Netflix, or Hulu.

You're citing the monthly rate for the newsletter. The annual rate is cheaper.

My 2 cents.

Howard

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Howard,

Thank you for another year of The Active Surveillor. It is an invaluable resource!

So c'mon guys, $9.00 a month is a pretty darn good deal for the information you get. Cancel that Paramount + streaming service, it's all recycled garbage anyway! (So I say). Plus it has you sitting too much on your perineum!

Just my 2 cents.....which if you add $8.98 to, makes the 9 bucks!!

Just sayin'

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Thanks, Bert.

I am against overdiagnosis and overtreatment of prostate cancer.

I've been on AS for 14 years. It was my best choice when my first urologist tried to rush me into surgery. It turns out I didn't need treatment. That single core of 1 mm. Gleason 6 has disappeared

AS isn't perfect. It's better now, but there are too many biopsies and no explanation of risks from biopsyies.

As it stands now, too many men who might benefit from AS or non-treatment end up being treated with radiation and surgery and facing risks of incontinence and impotence or worse., 40% of men with low-risk disease end up being treated from the get-go.

Dr. Vorstman, what alternatives to AS would you recommend for these men?

Meanwhile, I hope all is well.

Howard

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So there are a couple of reasons why physicians woke up and decided active surveillance (AS) may be an appropriate way to handle some of these prostate cancers that take 40 years from the time of mutation to reach 1 cm in size. Two obvious concerns come to mind right away. One is that the treatments are clearly worse than the disease and the second is the fact that the grossly unscientific 12-core prostate needle biopsy samples blindly and randomly only 0.1% of the prostate. This ridiculous and risky test allowed doctors to talk about so-called cancer progression and cancer upgrading when the next biopsy showed something different.

The problem with the business of prostate cancer is that the current testing and treatment options available for AS lack scientific evidence for safety and benefits. What is the alternative to the current program? The great need is to find better markers and treatment options that can withstand the challenge - where is the irrefutable and reproducible data supporting these testing and treatment recommendations?

Hope all is well mate - cheers

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Thanks, Bert.

We need better markers for sure.

Happy Holidays.

Howard

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you too mate - starting to wonder about the MRI a bit - seeing a bunch of PI-RADS 4/5s and low-risk disease after biopsy - cheers

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Healthcare is financially driven and full of claims, opinions and assumptions. We need a little evidence-based fact-checking.

Only 11% of all medical treatments are of KNOWN benefit.

This means that for 11% of medical treatments there is irrefutable and reproducible scientific evidence of benefit.

Much of the prostate cancer arena lacks evidence of benefit and simply recycles misinformation.

> The Gleason 6 is a bogus cancer because the biological pathways for cancer development and spread are inactive.

> PSA testing fails to save significant numbers of lives - little wonder when it has a 78% false positive rate.

> Treatment studies have shown that - at 15 years, no treatment had similar survival to those that underwent surgery or radiation - even better, no treatment had none of the complications associated with prostate cancer treatment.

> Active surveillance is based upon PSA testing and treatments that are of unproven benefit.

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