Last January my best friend of 40 years was where you are now. He
decided on robotic and it seems to have worked out well. He was out of
the hospital the next day and  was pretty much continent when the cath
was removed 6 days later. At this point he is virtually 100% continent
except for a bit of a squirt if he tries to hold too much for too long
then has to strain. He says he gets about a 50% woody if he thinks
about the ladies. Not too shabby for only 6 months post-op.

On July 16, Alex responded to Leonard:

A number of people, many of them medics, are contemptuous of Dr. Strum.

I suppose each has his/her own reasons; but I suspect that there is a
large component of jealousy, fear of discovery (uros, mainly), and just
plain resentment that anyone -- especially another medic! -- has the
impiety; is such a heretic, such a pagan (shudder!) as to criticize
their sanctified practices.

My impression FWIW is that Dr. Strum pulls no punches, states his case
plainly, and returns the contempt with interest up to date. And he backs
his contentions with science, notwithstanding those who claim that he
does not publish, which is a falsehood. He certainly is not invited to
the Medical Establishment's periodic hootenannies/conferences. I suspect
that that's because he is his own man.

All I know is that he and co-author Donna Pogliano saved me much
suffering and probably preserved my very life via their book, _A Primer
on Prostate Cancer_, subtitled "The Empowered Patient's Guide." I
certainly could not rely upon my (then) medic to do so.

The rant could continue, but I'll stop here.

Regards,

Steve J

"'MD' does not mean 'Medical Deity.'"
-- Stephen B. Strum, MD

(Just the sort of Strum statement that upsets other MDs)

Everyone considers watchful waiting/active/surveillance a legitimate
option for certain patients.  The issue is which patients this is
appropriate for.  I just reread what Strum and his colleagues say about
it at their website, and their recommendations may not be significantly
different from what others such as Scardino and Walsh recommend, but I
find them rather vague compared to the latter authors.

I think the major way in which Strum and his colleagues differ from
other experts, as illustrated at the website, is their apparent belief
that hormone suppressing therapy is an appropriate choice for some cases
of localized prostate cancer, where there is no clear evidence of
spread.  Personally, I believe that, with the exception of some men with
guarded prospects for life expectancy, hormone therapy as an initial
choice is a mistake for mem diagnosed with early prostate cancer.  I
could be wrong, but I think this is the general consensus.   Most men
diagnosed with prostate cancer, and I think that includes John, to whom
the advice was offered, should not be considering hormone therapy at
this point, although they should be aware of it as a possible future option.

I think Strum and colleagues may also may weigh the possibility of
spread more seriously in deciding on treatment than a typical urologist
might.   For an older man, this may be the right choice with watchful
waiting followed by hormone therapy when necessary.  Some urologists may
dive into surgery even for such men, and Strum's advice can be a
counterbalance to such tendencies.   But for younger men, even if there
is evidence of spread, surgery may still be the best option.

All these are complex issues and how they apply to any given man is not
clear.   I think that a typical man with T1C, Gleason 6, and PSA less
than 10, has little to learn from Strum's website.  For men with more
chancy diagnoses, they may find it useful to look there, but they
certainly shouldn't take what they find there as gospel.  I still say
they are better off starting with Scardino's book.  For men who likely
have metastatic disease, Strum as an oncologist may be worth listening
to, but I don't believe his opinions should take precdence over oather
oncologists, or even figures like Scardino and Walsh who, with their
colleagues have been engaged in research in these areas for years.  Of
course, any man in such a position---and some day I may be---should find
the best oncologist he can, explore everything he can find on the
subject and discuss it with his doctor.

Finally, let me address the issue of expertise.  A medline/Pubmed search
of the peer reviewed medical literature shows 6 publications by Strum.
A similar search shows 284 articles by Scardino.  One for Walsh shows
417 publications.  Strum has only published findings about aspects of
hormone therapy.  The others, in collaboration with other authors, some
of whom are oncologists, have published studies in every aspect of
prostate cancer.

Steve (Jordan), I apologize - you quoted Alex w/o attribution in one of
your posts and I did not realize it. If >>> are supposed to indicate a
quote, I was not aware of that; I always use quotation marks to clearly
indicate when I am quoting someone else. Nevertheless, it seems that
you did take some issue w/ my reply to [Alex] so I responded.
Strum is practically the only doctor who participates in the
www.prostatepointers.org P2P so I refer to it as "his" w/o any
implication of ownership. I don't care who owns it and that is
irrelevant to this discussion. I read each and every response by Strum
and I think I have some feel for the guy. If I have stated anything you
think is innaccurate - by all means, set me straight.

Bill Denton
RP 2/12/02
PSA .93
Memphis