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charles metzger md, mba's avatar

That pretty much lays out both sides of the issues...Shared decision is the key, using incomplete and confusing data (including the economic incentives involved) to try and make sense of the whole process. Less time spent figuring out which side is right and just admitting that this is an evolving journey that every prostate cancer patient enters at a different point. We do know that Gleason 3+3 is a different animal (except when it isn't) in most men and careful AS can delay or prevent treatments that have serious side effects. That much we know. My hope is that micro ultrasound will help make AS less intrusive (costs less, done in office) so that AS follow up can be less costly and easier done (all in the office). Let's hope the biomarker field improves to even make the PSA a less objectionable test. Let's also not forget that knowledge about prostate cancer or cancer in general evolves and changes...this does not make it a right or wrong issue but an ever changing and evolving process. Quit the right and wrong attitude and remember we are all in this together.

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Harley Myler's avatar

Just incredibly useful. I am PI-RADS 2 on AS and this piece, the Vorstman view vs Holden was just incredibly illuminating. At the end of the day they are both subject to the stochasticity of medicine. It reduces every case to a unique milieu that cannot be addressed adequately by the group statistic. This is where the clinician comes in and how well they understand the science and the patient. This is more stochastic than medicine itself. The only way for a man to mitigate this issue is to become knowledgeable about his own disease. Good luck if he does not have the mental acumen to do that.

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