I also noticed the show 5 minutes into it. This follows a story Robert
Jordan did for the Tribune some time ago, in which he related his story
of a successful (potence+continence) DaVinci procedure, which he had
done down in Atlanta a year or so go. Made me really regret not looking
into the alternatives more, instead of quickly opting for RRP. I gotta
believe that my chances of a successful (potence+continence) procedure,
which I didn't have, would have improved with DaVinci.

The doctor would have to provide much more statistical information
to convince me.

Do the 12 million men include the many who have microscopic
tumors with low Gleason and PSA scores?

Do they include men over 80 years old who really don't need
treatment?

And to say that only one in 400 die is surely misleading.  If a man
has PCa for 15 years, then we have to compare the 29,000 deaths
not to 12 million, but to 12 million / 15.  In other words, 800,000
are newly diagnosed each year and 29,000 die, or one in 28.

Then we have to ask more questions:

How many men are treated?

Which of those men should be treated and which should not?

How many of the deaths were of men who might have been saved
by treatment?

The real issue for me is not whether treatment should be done,
but who should be treated.  Surely some men's lives are being
saved.  Surely others are being treated unnecessarily.  What we
need to do is have a better discrimination between those two
groups.

   Alan

That may be true.  The trouble is that we can't tell which ones they
are.   But the numbers he quotes to justify his conclusions are highly
misleading, to say the least.  You've heard the expression: there are
lies, damned lies, and statistics.

I think this is nonsense.  The American Cancer Society estimates that
roughly 234,000 cases of prostate cancer will be diagnosed this year.
If you assume this rate has been constant and multiply by 20 to
accumulate 20 years worth of such cases, you come up with something
between 4 and 5 million.  But that is a gross overestimate since most
prostate cancer is diagnosed in older men, and many of them die, from
all causes, not just prostate cancer, long before 20 years have elapsed.
 I don't know the exact figures, but I would be very surprised if there
were as many as 2 million men alive in the US who have been diagnosed
with prostate cancer.

The only way to get such figures it to count all the undiagnosed cases
of microscopic cancer which might be discovered on autopsy or if
prostates were removed for other reasons.  But the great bulk of such
cases involve innocuous cancers which will never rise to a level where
they could be detected by current methods, no less cause disease or
death.   There is a vast difference between such "cancers" and actual
diagnosed cases of prostate cancer.   Peter Scardino, in his book "The
Prostate" has a very good discussion of this issue.  He says that "for
every hundred men in the US who develop cancer cells in their prostates
during their lifetimes,  only 38 will be diagnosed with prostate cancer
by biopsy amd only 8.6 are at risk of dying of prostate cancer."

The likelihood of a cure depends of course on the specifics of the case,
but for a typical man with a T1C, Gleason 6, PSA < 10 cancer, the
likelihood of a complete cure is very high.  Even more aggressive cases
are often 'saved'by early treatment.  In addition, hormone therapy often
will allow men with advanced metastatic cancer to live out their normal
lives.   All told, modern treatment methods 'save' the great majority of
men who are diagnosed with prostate cancer.  He must be doing some very
creative counting to come up with a figure of 1 in 25.  He also seems to
be maintaining both that prostate cancer is essentially innocuous, so
you shouldn't worry if you get it, but it is also hopeless because no
one can do anything about it.

My cancer was T1C, Gleason 7=3+4, PSA = 4.5.  Scardino quotes figures in
his book showing that the  likelihood without treatment of my being dead
5 years after diagnosis would be 20 percent and after 10 years 50
percent.   My chances of avoiding that fate through treatment were much
better than that.  After my post-surgical pathology came out clean, my
chance of even showing PSA recurrence within 10 years, no less dying of
the disease, is only a few percent.   That is a lot better than 1 in 25.
 For a Gleason 6 case, the benefits are not that great.  It would take
15 years for the risk of dying of the disease to be 20 percent.  But I
think such men also benefit, provided they live long enough.

It is true that 15 x 29,000 divided by 12 million is a little less that
1 in 25.   But that ratio has nothing whatsoever to do with how many men
treatment is 'saving'.   What you have to do is to take the total number
of men who were treated and subtract both the number who would have
survived anyway without treatment and the number who died anyway.   That
difference would be number of men who were saved by the treatment.
Dividing it by the total number of men treated would give you the
fraction that were saved by treatment.   Experts, like Scardino, can
make estimates of that fraction, and despite the enormous uncertainties,
they are much larger than 1 in 25.

Perhaps not, if it were true.  But it isn't.

There is an old saying which applies in this case.  Figures don't lie,
but liars figure.

The question as posed is really stupid.  He should have asked if a man
deciding on treatment should accept it if the chances of it making a
difference were only 1 in 25.  It has little to do with society.

The answer would of course depend on what his chances would be if he
didn't do it.   If I were sure to die if I didn't do something, and
there were a 1 in 25 chance that I wouldn't if I did, and it wasn't so
expensive it would bankrupt my family, and it wouldn't totally destroy
my quality of life, I would probably decide to do it as a desperate
attempt to live.    If on the other hand, I was told that if I did
nothing, there was a chance of 20 out of 25 that I would be fine, but
that my chances of dying would be reduced from 5 in 25 to 4 in 25 by
choosing treatment, I would probably decide to skip it if the costs were
significant.

If this "doctor" was arguing anything, it had to be something along the
lines of the second scenario.  Even he doesn't believe that prostate
cancer is so deadly that only 1 in 25 men who are trreated survives.

What was the name of this "doctor"?