Hello SiMo

Great that you are involved with your own body and the knowledge that can
keep it functioning well. It is also great that you are involved with
raising others knowledge in regard to this issue of prostate cancer.

The answers that you get to your question will be very varied. Each of the
individuals here had to come to grips with the many treatment options and
constraints of their own personal situation and personal choices.

My story is based on the fact my dad died of prostate cancer at 83. He found
out when he was 70. It was advanced at that time so they removed the
testosterone and watched and waited.... his passing was not easy.

I am 56, my PSA was 5., slightly elevated and slowly rising. My urologist
advised a biopsy that came back as positive for cancer. I had to make the
choice you are researching. Should I actively watch to see what happens and
decide later? I chose to be more proactive. Rational exists for both choices
but I chose to be active. I probably have another 25 years so I might as
well go and be proactive. I am married and happily sexually active. The
facts of impotence and incontinence were a consideration that was important
to my choice.

Radiation seemed to not be indicated because of my age. Side effects may
increase with time. Surgery may be difficult after radiation therapy but not
impossible.

I chose robotic surgery that I am just recovering from. Surgery was on
10/13/07. They removed the prostate and seminal vesicles and I was
discharged the next day. Erectile function is returning and urinary control
is expected to be better as time progresses. I was told the cancer was not
seen outside of the prostate but follow up PSA tests will be needed.

Getting back to your question. I could have maintained active watching and
not have had the risk of the surgery or the post op effects. I would have
had the knowledge that I had a cancer growing and I might have it escape
it's local confines and be more difficult to eradicate later. I am happy
that "the beast is gone" but I will still have the worry in the back of my
mind that some has escaped and will return later.
I am happy with my process of finding out as much as I could prior to and
then taking charge of my decision process. I I'm pleased with the surgery
and the side effects seem to be lessoning and can be managed if they were
not to return to normal.

For me, I am glad I knew early and was able to take an active decision on my
health care. I made my choice and I can live with it. I don't think I could
just be a passenger in my life and bumble along not knowing  or not being a
captain in the ship of my destiny. I have a reasonable life expectancy, and
for me, watching till my choices were diminished or more difficult was not
an option.

You will hopefully get a variety of opinions in your research. If you have
monitored this group, there are varied opinions voiced. Each person has the
right and obligation to themselves to research and then to chose for
themselves. Not easy and not universally in consensus.

Keep monitoring this group, mention it to the members of the men's group and
also monitor it yourself to understand this complex issue.

Peter

Mi Dios, Muchacho, go find a real doctor and report this fraud to the
authorities. His advice makes sense only if you're way down on a heart
transplant list or have a similar reason to believe you don't have ten
good years left above the surface of the planet. Even when PC treatment
survival was a statistical wash (I think it's better than that now;
someone else will address that), that meant half of us ("median"
quibbles aside) benefited from it, many long enough to essentially
fuhgheddaboutit. Definition or no definition, I'll shout "CURED" from
the rooftops when I die from a heart attack, with a PSA of 0.5 and no
symptoms, 20 years from now. My overall QOL is higher now than before my
surgery three years ago, for these reasons:
1. My cancer helped motivate me to get serious about physical
conditioning. The results have been dramatic even though I was already
very athletic.
2. I can pee much better than I could pre-op (I'll beat you in filling a
pint bottle!) For that I'll take the pads in a heartbeat.
3. My orgasms are better than they were in the last couple of years
pre-op, and the details are just minor hassles. (Admittedly, I'd be less
cavalier about this one if my wife were upset about my increased ED,
even though it was necessary in order to shoot for a cure.)
4. I definitely had aggressive, probably fatal (because I have no other
significant threats) cancer three years ago. Now I *feel* free of it and
have almost infinitely greater odds of never seeing it again.
5. I rejected follow-on, "just-in-case" treatment which virtually
certainly *would* have impacted QOL and had far lower likelihood of
doing significant real good.
6. I'm now in FAR greater charge of my disease, my health, and my QOL
than I was three years ago. That should last for at least another
several years, much longer than had I not discovered and treated my cancer.

The vast majority of men here with serious QOL issues have advanced
cancer, either because their initial early treatment ultimately failed
or ... hint! ... they waited too long to seek and destroy it the first
time around.

Change doctors.

I.P., proving I'm still alive.

On Nov 7, 3:41 pm, SiMo <SiMoMousta...@gmail.com> wrote...snip...

Find a new doc as fast as you can, this guy is dangerous.  There are
several studies that clearly show that treatment results in fewer
deaths than doing nothing.  For example, see

J Urol. 2007 Mar;177(3):932-6; 13-year outcomes following treatment
for clinically localized prostate cancer in a population based cohort;
Albertsen PC, Hanley JA, Penson DF, Barrows G, Fine J.

Cancer. 2005 Jan 13; Survival in prostate carcinoma-Outcomes from a
prospective, population-based cohort of 8887 men with up to 15 years
of follow-up; Aus G, Robinson D, Rosell J, Sandblom G, Varenhorst E.

N Engl J Med. 2005 May 12;352(19):1977-84; Radical prostatectomy
versus watchful waiting in early prostate cancer; Bill-Axelson A,
Holmberg L, Ruutu M, Haggman M, Andersson SO, Bratell S, Spangberg A,
Busch C, Nordling S, Garmo H, Palmgren J, Adami HO, Norlen BJ,
Johansson JE; Scandinavian Prostate Cancer Group Study No. 4.

IMO, it's important for a man to know.  He can then run other tests
and try to decide
1) does his PCa require invasive treatment or will it remain indolent
for the remainder of his life; this is not an easy question to answer,
but tests, published guidelines and a doc familiar with all treatments
including active surveillance can help to make a good decision
2) if the disease appears indolent, can he live a psychologically
normal life knowing that he is not treating the cancer
3) if he selects treatment, then which treatment

IMO, a doc should inform the patient of what the PSA test might
uncover and then discuss the consequences of treatment or no treatment
(likelihood of "cure", types of treatment including AS, QOL / SEs).
The patient should then make an informed decision about testing...Best
wishes and good health, ron

Up until the late 80s, what your doctor told you was more or less the
true state of affairs.  Since then, with PSA testing, early detection,
and aggressive treatment of early cases. the situation has changed.
There are still lots of doctors who think what your doctor thinks, but
they are increasingly in the minority.  So, it is possible your doctor
is right, but there are certainly many doctors who would tell your the
opposite.

I suggest you read The Prostate by Peter Scardino or Pathrick Walsh's
Guide to Surviving Prostate Cancer.  Both the world famous experts on
the subject believe that early detection and treatment are worthwhile,
but they also discuss the controversy.  Also, they emphasize that
prostate cancer is a complex disease.  So while your doctor's advice
might be appropriate for a man in his late 70s, the situation would be
very different for a man in his 50s.

Today, in the US, the great bulk of men treated for prostate cancer have
a good quality of life.   That is true also for the men in this group,
but there are of course some who  have had problems.  Note in this
regard that men with problems are more likely to participate in a group
like this than men for whom everything has been smooth sailing.  So
don't be put off by tales of woe.

I think so.

I don't think your doctor is right, but his view is not uncommon
in the medical community.  One problem we face is that, at
present, much of the evidence for the efficacy of treatment is
broadly statistical.  We have some statistical predictors of
whether or not a man's cancer will become dangerous, and some
statistical predictors of whether or not a particular treatment
will help him.  But it's still impossible with the current state
of the science to say of any particular man - "Your cancer will
never become dangerous", or "Your prescribed treatment _will_
cure you."

So some men are given treatment who will not benefit from it,
either because they didn't need treatment, or because the
treatment didn't stop the growth of their cancer.

But that's very different from saying there's no evidence of life
extension.

This seems to me to be a philosophical issue, not a medical one.
Would people be better off not knowing that they will grow old
and die?  If mature adults should be expected to cope with that,
should they be able to cope with having a little more knowledge
about when and how death will come to them?

Although I know that a high percentage of people wouldn't agree
with me, I think we should try to be people for whom the truth is
something to be recognized and dealt with, not avoided.

It is a problem, but this one too has a philosophical component.
There are men in this group who wear diapers, have inflamed
hemorrhoids, and/or can't get an erection.  Some of those men
dissolve into tears and lie awake crying every night.  Others
blow it off.  For them a wet diaper is a simple inconvenience, a
limp penis is something that means they make love in different
ways, and an inflamed hemorrhoid is, well, a minor pain in the
a.s.

There are men in perfect health who are depressed all the time
and other men in constant pain and in wheel chairs who deal with
it effectively and go about their business.

I don't mean to minimize the QOL issue.  It is significant.  I
just don't think that people should assume that prostate
treatment is going to ruin their lives.

It's for each man to decide.  For myself, the answer is Yes.

Speaking for myself at least, absolutely no offense taken.

   Alan