I did. My performance was uncertain prior to my RP. It's no longer
uncertain.  ):-(

I.P. but that's it

In my case, I had free margin all around and an original PSA of 4.8,
but it metastasized to the lymph nodes and now, 3 years later, I'm
hormone refractory with an incurable cancer at age 59. I'm not sure the
overall odds (of this discussion), but to me, it's a question of are
you OK with the consequences which ever path you take.

Richard

Just to set the record stright, I didn't find his family doctor idiotic
because of what he said about PSA testing.  Indeed I outlined some of
the important current research on the matter, and I hope I indicated
that the matter is not settled.   But I hope we can also agree that
theoretical discussions of the merits of PSA testing have little
relevance for a man who has been diagnosed via a biopsy with prostate
cancer.  If he had never had PSA testing and thereby not had a biopsy,
he might have led a perfectly happy life without every being aware of
his prostate cancer.  But now he does know, and that changes the
situation.  Unfortunately he is on a borderline where, in the current
state of knoweldge, he could reasonably go either way, and he has to
decide on the basis of the limited information he has available.

Many epidemiologists and other physicians are skeptical about the merits
of PSA testing.  I hope that Dr. Kramer fares well.  But let me note
that in my case, had I foregone PSA testing, my Gleason 7 cancer would
probably not have been detected early enough for a cure.  Even sceptics
about testing and treatment of prostate cancer, unless they are on the
fringe, agree that most Gleason 7 cancers do better with aggressive
early treatment than with WW.  I think the Swedish study, which was a
prospective randomized study, does tend to confirm that.  In Sweden,
they don't do routine PSA testing, so the men in that study probably
tended to have more advanced and more aggressive cancers than would be
true in the US, so it is remarkable than even under those cirucmstances,
RP was better than WW.  Retrospective studies indicate that men with
Gleason 7 cancers face a significant risk of metastasis within 5 to 10
years, while such men when treated have reasonbly low recurrence rates,
and clinical recurrence is delayed.

The serious public health question about PSA testing and similarly about
the merits of treatment vs WW are to what extent the same is true of
Gleason 6 cancers.   Some number of those, probably greater than 15
percent, don't need to be treated, but unfortunately they can't be
distingushed from the others except in special cases.  Whether Gary is
such a case is not something I can determine, but I suspect his family
doctor knows little about the matter.

Dr. Kramer's argument is based on looking at overall figures.  The
question is how the side effects and other morbidity of treating men
whose cancers will never bother them is to be balanced against the
benefits to men whose early cancers are cured or for whome metastatsis
is delayed.  If you took out every man's prostate at age 40, we would
have many fewer deaths due to prostate cancer but a much larger number
of deleterious side effects.   If we never treated any prostae cancer
except by hormone therapy when clinical symptoms arose, we would have
more men suffering from advanced disease.  Indeed, in the US before PSA
testing, that was close to the case.  Dr. Kramer probably argues that
the only way to settle whether, in balance, PSA testing is worth it is
by a propsective randomized study.  I question whether in fact you can
even settle it that way for the reasons I gave.   So in the light of
absence of information, perhaps because he believes too many men are
being overtreated, he thinks PSA testing is unwarranted.  That is the
so-called 'do no harm' policy.  In other words don't introduce a medical
procedure until you are sure it is effective on the basis of a
prospective randomized study.  But he has to agree that under such a
public health policy, some men, such as I, will suffer.  He may even be
such a man himself.   There is, I believe, at least one example of a
prominent authority on prostate cancer who argued similarly , developed
prostate cancer which was discovered too late to do anything about it
and died of it.

Gary's doctor did seem ignorant about the recent Swedish studies on the
effectiveness of RP vs WW.  Either that or he failed to mention it to
his patient.