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Medical Forum / Diseases and Disorders / Prostate Cancer / June 2004Dr. Welch on new results
I forgot to paste in Dr. Welch's comments on the new study. Does everyone have prostate cancer? The sad fact is that we age, we men probably all do. By 80, it is close to or at 100%. Dr. H. Gilbert Welch, a professor of medicine for the Department of Veterans Affairs and at Dartmouth, said the new study should make men reconsider whether they want a P.S.A. test at all. "The study begins to highlight that we really don't know what we're looking at," Dr. Welch said. "There's a disconnect between the word 'cancer' as most of the public understands it - a very aggressive disease that leads to death if not treated - and the way the pathologist understands it, as a few cells that may not be relevant." It is becoming increasingly clear, Dr. Welch said, that the more pathologists look for cancer, the more they find it, but that this does not mean the cancer is worth finding. "At some point this has got to be crazy," he said. "Everyone can't have prostate cancer." ****** Yes, but we probably do. hi george - this is a case of figures don't lie, but liars do figure. yes, it is a fact that the older a man gets, the greater the chances are that he will have cells inside the prostate that have turned to cancer. but does that mean he has prostate cancer. they did a study on men who died and found that there were prostate cancer cells inside the prostate, yet the man wasn't dx'ed as having prostate cancer. and that is what they are playing on. those facts. to make a statement as to discourage psa testing is simply stupid. that's right - stupid!!! i will use my case - i was 56 when the psa turned up my psa. the DRE did not. not even on the day before surgery. the surgeon said he could not feel any lumps. yet, 1/3 the cores came back positive. the path report said the gland was full of cancer, and stage T2c - but contained. now, what does this all mean to this thread. simple. the psa test. it was the psa test that sounded the alarm to investigate further. it was the psa test that showed that something was there because it kept rising. and it was the psa test solely that started the change of events that saved my life. i was told that i would not live to be 70 if i would have let nature take it's course. i'm not on a soap box on this thread. i'm just trying to show how important to psa test CAN be, but it is not the only answer, but a tool that we have against the fight of prostate cancer. now, with that all said, how can any scientist or doctor tell the public to throw a known good working tool, stick your head back into the sand, and go back to the way it was before psa testing and disregard the psa results. just food for thought. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." > hi george - this is a case of figures don't lie, but liars do figure. > to make a statement as to discourage psa testing is simply stupid. > that's right - stupid!!! I'll see your "stupid" and rais you a "fraud"... or, maybe an "evil." Words mean things and so often people use ignorant, crazy, stupid, bigot, racist, etc. totally inappropriately (No offense intended, Curis; I'm on a whole 'nuther soapbox.). For example: Those who say "racist" usually are remarking on alleged actions that are really "bigotry" or maybe only "prejudice." But, I digress. Anyone saying the PSA testing is something that should be ignored, postponed, or whatever, is factually innaccurate. If it is a doctor, you must rule out "stupidity." You cannot be a doctor, at least not a medical doctor, if you are stupid. In today's climate, you'd also have to rule out "ignorance." No doctor who is not stupid could possibly not know, today, that PSA testing is saving lives the world over. I believe I am living proof of that and my dad is dead proof of it. So, if you rule out stupidity and ignorance, what are you left with? On some level, these people are trying to sway people away from life-saving/-extending testing. If for status, attention or money or some other thing of value, it is "fraud." If for any other reason, only "evil" comes to mind. > > hi george - this is a case of figures don't lie, but liars do figure. > [quoted text clipped - 16 lines] > that PSA testing is saving lives the world over. I believe I am living > proof of that and my dad is dead proof of it. Calling names does not change the fact that PSA really has not yet been shown to save lives. Dartmouth is not lying to you or to us. I am sorry your emotions have carried you away. >> > hi george - this is a case of figures don't lie, but liars do figure. >> [quoted text clipped - 24 lines] > shown to save lives. Dartmouth is not lying to you or to us. I am sorry > your emotions have carried you away. PSA tests better than no tests The important thing for mature men to remember, in light of findings that show the PSA blood test for prostate cancer in some cases does not detect the cancer - or its severity, is that PSA tests are far better than no tests. There is not doubt that a more accurate and specific blood test for prostate cancer would be a great improvement. But the millions of men whose cancers have been detected by PSAs - most of whom have experienced successful treatment - are testimony to the need to continue PSAs until a better test is available. In the meantime, health professionals will be evaluating a possible change in the threshold level for the PSA reading and incorporating more risk factors in the determination of the need for a biopsy procedure. The number one choice - for patients and health professionals - would be an improved test. A close second is finding the right balance between going too far and not far enough with biopsies and treatments in response to the initial testing procedures already available. > >> > hi george - this is a case of figures don't lie, but liars do figure. > >> [quoted text clipped - 26 lines] > > PSA tests better than no tests PSA has never been proven to lengthen life. That is what the PIVOT and other studies are all about. Time will tell. Science is not there yet. > The important thing for mature men to remember, in light of findings that > show the PSA blood test for prostate cancer in some cases does not detect > the cancer - or its severity, is that PSA tests are far better than no > tests. Once again, Dr. Welch would challenge that cultural assumtion. Cultural because the science has never been proven. > There is not doubt that a more accurate and specific blood test for prostate > cancer would be a great improvement. > But the millions of men whose cancers have been detected by PSAs - most of > whom have experienced successful treatment - are testimony to the need to > continue PSAs until a better test is available. Once again, not proven. > In the meantime, health professionals will be evaluating a possible change > in the threshold level for the PSA reading and incorporating more risk > factors in the determination of the need for a biopsy procedure. > > The number one choice - for patients and health professionals - would be an > improved test. True, but only if current treatments lenghten life. Not yet proven. It looks like based on on-going studies any differences will emerge only after 12 years, although from a demographic point of view if differences have not yet merged after 8 or 9 years to date, something dramatic will have to happen quickly if there is an effect. hi george - i have read your comments about what others have written. while i can see, up to a point, what you are saying, but i hoping you are giving some very serious thought about what is being said. i've already given you and others, my account as to how the psa test may have saved my life. what i fail to understand is how you shed little credit to that fact. you have quoted that the dartmouth doesn't lie to you or us. let me enlighten you on some basic facts. and this is coming from the horse's mouth. i'm a vietnam vet. i was lied to as to where i was operating out of. we were told that we were in the northern most tip of south vietnam, when history documents now show that i was well into north vietnam and was involved in the rescue of 16 downed pilots shot down in north vietnam. these are undisputed facts. i have the effects of the cancers and from being sprayed with agent orange, yet, they say i wasn't, but just this year admitted that they sprayed over 2 millions more gallons of agent orange than reported. why report this 35 years later? and where did they spray it??? this will all come out sooner or later. i have the medals for serving in vietnam, they will give me credit for being in danang harbor. they will give me credit for being in a motor whale in that harbor, but have denied me all benefits and compensation because they are saying i didn't serve in vietnam, nor that i even touched the soil of vietnam. i guess, i just wanted to joy ride in a dangerous harbor, at least that is how they are trying to make it look like. don't tell you that they don't lie to me. it will rub the sore spot just more raw than it is. i know for a fact that prostate cancer takes on the average 13 years to kill you from the time it is detected until you die. so, when i was told at age 56, that if i did nothing, that i would not see 70, and i knew the doctor was right. so, now that i've had the RP. let's say - for the sake of argument, that it comes back in 5 years. that is 5 years more life than i would have had, than if i did nothing. how can you say that the psa test didn't affect my life by extending it? remember, that is the ONLY indicator i had to show i had prostate cancer and the post op path report said that my cancer was already at stage T2c. so, if i live to be 70, my question to you and to dartmouth, did i have the psa test to thank? i think so, but then again, remember, we have a lawyer who represented the communist party, that is a senator now, we've had a draft dodger that was president, and we've now declared a state of war - for the first time in u.s. history - unprovoked, only to find that they can't find any evidence as to why we should have acted the way we did. so, why should i believe these results when we have proof that it does save and extend lives and that is a known fact. so, i guess my question back to you is simple. do you believe that there's nothing that can done for you when you are dx'ed with prostate cancer? that your life is not going to be extended or saved? is this what you saying because your comments reflect that and i'm just curious? the reason i'm asking is that everyone is entitled to their opinion, just as i am, and i want to hear what you truly believe in your heart. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." > hi george - i have read your comments > about what others have written. while i can see, up to a point, what [quoted text clipped - 4 lines] > have saved my life. what i fail to understand is how you shed little > credit to that fact. This is a science group and simply put, the science of cutting into a tumor has never established it saves lives. The studies trying to do so have not yielded any favorable results after 8-9 years. They may after 12 or so, but no one knows. Dartmouth has just pointed all that out. At some point the death rate from treatment must be taken into account too. > > hi george - i have read your comments > > about what others have written. while i can see, up to a point, what [quoted text clipped - 10 lines] > or so, but no one knows. Dartmouth has just pointed all that out. At some > point the death rate from treatment must be taken into account too. Let me add to my own post: some physicians do not get the PSA test themselves. I know one who does not, and here is another quote: But Dr. Stamey said, "I have some smart colleagues who are very proud of the fact that they used to stand up at meetings and say, 'I never had a P.S.A. test in my life, and I don't plan to have one.' " Given the new study, he said, "it looks like they were very insightful." > > > hi george - i have read your comments > > > about what others have written. while i can see, up to a point, what [quoted text clipped - 19 lines] > test in my life, and I don't plan to have one.' " Given the new study, he > said, "it looks like they were very insightful." And some physicians drink like a fish, do drugs and smoke 3 packs a day. They are not Gods. They are human too and subject the same mistakes and misjudgements as the rest of us. > > > > hi george - i have read your comments > > > > about what others have written. while i can see, up to a point, what [quoted text clipped - 26 lines] > They are not Gods. They are human too and subject the same mistakes and > misjudgements as the rest of us. True, but the goal of science to act according to proven data, not guesswork. The cultural norm to cut, cut and cut is just that: habit. Some physicians point out that habit is not a good guide to action. Thats all. My favorite quote on this subject is by Dr. Robert Lebowitz: "Most of us will die with prostate cancer, not from it. If I tell the 40% of the men in the USA who have prostate cancer to eat one piece of juicy fruit gum a day and by doing this they will never die from prostate cancer, I will be correct for all but 2 or 3% of them. We can laugh at that and say that the juicy fruit gum is not what saved them. But what if instead of juicy fruit gum I advise radical prostatectomy. Only 2 or 3% of men will die from prostate cancer and I might be fooled into believing they were saved by the radical prostatectomy. Laugh at the juicy fruit gum analogy but those gum chewers will not drip urine the rest of their lives. No prospective randomized study has ever been conducted anywhere in the world that shows radical prostatectomy is more effective than one year of triple hormone blockade." > My favorite quote on this subject is by Dr. Robert Lebowitz: > [quoted text clipped - 10 lines] > conducted anywhere in the world that shows radical prostatectomy is more > effective than one year of triple hormone blockade." Correct from a scientific point of view. The PIVOT and other studies are under way to prove or disprove surgery or doing nothing as an alternative. Unfortunately because all treatments seem about equally effective, it also might mean none of them are much good. > Correct from a scientific point of view. The PIVOT and other studies are > under way to prove or disprove surgery or doing nothing as an alternative. > Unfortunately because all treatments seem about equally effective, it also > might mean none of them are much good. Actually, Dr. Liebowitz is not advocating doing nothing. He points out that the only treatments that have been shown to improve mortality rates in prostate cancer are systemic treatments, and not local treatments. Most doctors wait until the local treatment fails, then switch to androgen blocking. Dr. Liebowitz starts with androgen blocking, and so far is producing the best survival rates ever seen for prostate cancer( although he hasn't hit the magic 15 year mark in his studies yet). Check out his article at: http://theoncologist.alphamedpress.org/cgi/content/full/6/2/177 Ed Friedman > > Correct from a scientific point of view. The PIVOT and other studies are > > under way to prove or disprove surgery or doing nothing as an alternative. [quoted text clipped - 13 lines] > > Ed Friedman Thanks. But self-selection of patients contaminates all such studies by individuals. Let us hope he is right. In the meantime, we need the controlled studies such as those which proved HRT RAISED not lowered the death rates for women. We will never know until then. But what distresses me is that we have basically no new information since my father had his bout with prostate cancer a whole generation ago. We men have failed miserably in pushing research. And 110 patient when millions of men are being treated? See what I mean? And warning: The site you suggest wants to put a cookie on your machine, and you need a firewall to use that site too. Shame. > > > Correct from a scientific point of view. The PIVOT and other studies > are [quoted text clipped - 28 lines] > And warning: The site you suggest wants to put a cookie on your machine, > and you need a firewall to use that site too. Shame. Anyway, here are his comments: Current treatment options for clinically localized or locally advanced cancer of the prostate include radical prostatectomy, radiation therapy, brachytherapy, cryotherapy, or "watchful waiting" (i.e., surveillance). Approximately two-thirds of patients are treated with either prostatectomy or radiotherapy. Although local therapies are potentially curative, they are associated with long-term, often permanent, side effects, and to date none have been demonstrated to provide a statistically significant survival benefit compared with surveillance in prospectively randomized trials. In the only prospective randomized trial comparing placebo to radical prostatectomy plus placebo, the Veterans Administration Cooperative Urological Research Group failed to demonstrate an overall survival benefit with a median follow-up of 23 years for patients undergoing prostatectomy compared to patients receiving no initial treatment OK, 23 years is a long, long time for a cancer survival. It simply states that no current treatment is better than nothing. Zilch. Ugh. > Anyway, here are his comments: > [quoted text clipped - 14 lines] > OK, 23 years is a long, long time for a cancer survival. It simply states > that no current treatment is better than nothing. Zilch. Ugh. That is a fairly accurate summary of what he said in his paper. What I find even more interesting are the things he says on his web site: http://www.prostatepointers.org/prostate/leibowitz/ He really tears apart the rationale for the "traditional" treatment of prostate cancer currently so popular in this country and talks about promising alternatives that he is working on, such as High Dose Testosterone Replacement Therapy. At least he is using his head to think about the problem, instead of blindly following the failed cookbook recipes of his predecessors. Ed Friedman instead of blindly following the failed > cookbook recipes of his predecessors. > > Ed Friedman Ed, many have been saved by what you discribe as "failed cookbook recipes of his predecessors" Ed, are we really on the same planet? Ed? Dale J.  SignatureEmail: dalej2@mac..com > instead of blindly following the failed > > cookbook recipes of his predecessors. [quoted text clipped - 5 lines] > > Dale J. What the study cited shows was that no one was saved. You only thought so. >> instead of blindly following the failed >> [quoted text clipped - 9 lines] > What the study cited shows was that no one was saved. You only thought > so. When you discuss the issue of whether or not any suitably randomized clinical study has shown an advantage over watchful waiting, followed when necessary by hormone suppressant therapy, you have a point. I don't agree with your conclusions, because I think there is other evidence available, and one has to look at the totality of the evidence. But insistence on a "gold standard" statistical study, is a plausible argument. Be that as it may, I am surprised that you are ready to jump on Leibowitz's bandwagon. There are very few prostate cancer experts who believe that any form of hormone suppressant therapy is appropriate as a primary treatment for early prostate cancer. Moreover such treatment has rather profound side effects. If you are skeptical about conventional treatment you should be even more skeptical about this method. Also, as you should be aware, but apparently you aren't, no statistical study can show that no one has ever benefited from early treatment for prostate cancer. On the basis of retrospective studies, the natural history of untreated prostate cancer is pretty well understood, and anyone who has looked at the figures has to conclude that treatment is effective. It does extend lives. The question is whether surgery and radiation are more effective than watchful waiting followed by hormone replacement therapy when necessary. I doubt if there are many people who believe that no treatment whatsoever is ever justified for patients with prostate cancer. Another question is whether on the average, a treatment's benefits for some men outweighs the side effects for other men who need not have been treated or for whom treatment was ineffective. Similarly, you keep harping about women and hormone replacement therapy. Here also it is a question of whether the benefits, which are real, outweigh the slightly increased risks of some diseases. Finally, as you are aware, there is one Swedish study which shows that radical prostatectomy, in comparison to watchful waiting followed by hormone therapy when necessary, reduced the risk of dying of prostate cancer within a period averaging about 6 or 7 years. Much has been made of the fact that overall death rates during the same period were not much different. But the study could come to no conclusion about that. In statistics there are criteria for concluding that no effect has been observed, but the data were insufficient to draw such a conclusion in this case. In any case, the population studied was very different from a typical US population of prostate cancer patients. In Sweden, they don't do PSA testing, so the men in study were diagnosed with prostate cancer much later than is typically the case in the US, 5 or more years later. There cancers were more advanced as was shown by the relatively large numbers who died within a 7 year period, in both groups. In the US, when cancer is diagnosed through PSA testing, very few men die so soon after diagnosis. To me the surprising thing about this study was that patients who had RPs were less likely to die of prostate cancer in such a short period of time. One the basis of earlier studies, I would not expect much difference between RP and WW for men whose prostate cancer was diagnosed relatively late in the game. The results from the PIVOT study are not in. You seem to think that because it hasn't shown any difference yet that it won't. You can't know that. We shall just have to wait to see. Moreover, it doesn't make sense to draw important public health conclusions from one or two studies. All studies, even the best designed ones, have defects. Of course, you seem to know the truth, so none of this is relevant for you. > >> instead of blindly following the failed > >> [quoted text clipped - 31 lines] > anyone who has looked at the figures has to conclude that treatment is > effective. It does extend lives. That is what is not proven. As for hormone therapy, I take no stand on it either. All treatmetments seem to have the same effect, good or bad. That though is not an optimistic statement. The question is whether surgery and > radiation are more effective than watchful waiting followed by hormone > replacement therapy when necessary. I doubt if there are many people > who believe that no treatment whatsoever is ever justified for patients > with prostate cancer. Belief is not science. The trouble is that as the original author stated, the one prospective study done showed no effect for current treatments after 18 years. Actually, hormone therapy is currently listed by the Mayo Clinic as one of the five treatment options for early stage prostate cancer. Ed Friedman > Be that as it may, I am surprised that you are ready to jump on > Leibowitz's bandwagon. There are very few prostate cancer experts who > believe that any form of hormone suppressant therapy is appropriate as a > primary treatment for early prostate cancer. Moreover such treatment > has rather profound side effects. If you are skeptical about > conventional treatment you should be even more skeptical about this method. > Actually, hormone therapy is currently listed by the Mayo Clinic as one > of the five treatment options for early stage prostate cancer. > > Ed Friedman I'll try to remember and ask my doc next week when I see him. He's a former Mayo resident of about 13 years ago. He never once mentioned it to me as a treatment. Dale SignatureEmail: dalej2@mac.com >>Actually, hormone therapy is currently listed by the Mayo Clinic as one >>of the five treatment options for early stage prostate cancer. [quoted text clipped - 5 lines] > > He never once mentioned it to me as a treatment. Of course not. Go to the Mayo Clinic website and see what they say yourself. It will be clear to you why your urologist didn't mention hormone suppressing therapy as a possible choice in your case. Ed Friedman is quibbling about words here and not paying attention to what they mean. > Dale > Actually, hormone therapy is currently listed by the Mayo Clinic as one > of the five treatment options for early stage prostate cancer. Reference? I just checked a Mayo Clinic website. They say the standard things about hormone suppressing therapy. It is one of several treatment options that are discussed. And it does follow after a long discussion of diagnosis and related matters which does start with the words "early prostate cancer". But anyone reading what they say would see easily that it would not normally be recommended as a primary treatment for early prostate cancer, particularly for younger men. > Ed Friedman > [quoted text clipped - 5 lines] >> skeptical about conventional treatment you should be even more >> skeptical about this method. Both Dale and George are correct. Dale is correct in that radical prostectomy has been shown to lower the death rate due to prostate cancer (see the New England Journal of Medicine article at: http://content.nejm.org/cgi/content/abstract/347/11/781). George is correct in that radical prostectomy has been shown to have no significant difference over watchful waiting in overall survival (see the New England Journal of Medicine article at: http://content.nejm.org/cgi/content/abstract/347/11/781). Ed Friedman > > instead of blindly following the failed [quoted text clipped - 7 lines] > > Dale J. > Both Dale and George are correct. > [quoted text clipped - 20 lines] > > > > Dale J. Same article!!! When complex factors are involved in a death, deciding which was the main one become very difficult. I know a man who had inoperable prostate cancer, and died of cancer involving the pancreas. That is what they decided. Were they related? Who knows. >>Both Dale and George are correct. >> [quoted text clipped - 25 lines] > inoperable prostate cancer, and died of cancer involving the pancreas. > That is what they decided. Were they related? Who knows. If you read the article, which I have, you will see that researchers are not that simple minded. They take account of such factors. That wasn't the issue. > >>Both Dale and George are correct. > >> [quoted text clipped - 29 lines] > are not that simple minded. They take account of such factors. That > wasn't the issue. It is the issue. Further, autopsies show routinely that 50% of the time that the so-called obvious cause of death is wrong or only partically right. In one study, teams of doctors had to decide who died of what. Just the change of a few deaths would have changed the result. >>>>Both Dale and George are correct. >>>> [quoted text clipped - 39 lines] > In one study, teams of doctors had to decide who died of what. Just the > change of a few deaths would have changed the result. Unless you read the article and pay attention to the precautions the researchers took to avoid such problems, you can't apply that sort of criticism. > >>>>Both Dale and George are correct. > >>>> [quoted text clipped - 43 lines] > researchers took to avoid such problems, you can't apply that sort of > criticism. With such a small sample, we are once again left with the low quality of what passes for research. Millions of men treated, only a hundred or so evaluated. It is easy to say who died. It is NOT easy to say who died of what, precautions notwithstanding. Yes, I read the article before. > Both Dale and George are correct. > [quoted text clipped - 7 lines] > the New England Journal of Medicine article at: > http://content.nejm.org/cgi/content/abstract/347/11/781). Sorry. It didn't show that. Statistics is a relatively subtle subject, and I don't think you understand it. The way a statistician would have stated it is whether or not the hypothesis that there was no difference between the two methods as to overall survival was shown to be highly probable by the numbers. That is what "significant difference" means. It means that it is highly unlikely that the rough equality could have occurred purely by chance. But there wasn't enough data to justify such a conclusion. The only conclusion that the authors were able to draw from the numbers was that the difference between the prostate cancer death rates for RP and WW was statistically statistically significant, i.e., that it is highly unlikely that it would have occurred purely by chance. Note that there is one further confusion here. "Significant" doesn't mean "large". It means that the observation is unlikely to have have occurred just by chance. One other important point. The followup period averaged 6 years. It is quite possible that a statistically significant difference in overall survival rates will show up if the population is followed for a longer period of time. In this connection, it should be noted that something like this is just what happened in an earlier Swedish study, the one which was the basis for the original claim that there is no difference between RP and WW. I'm not saying that I know that a difference would show up in a longer period of time. I'm just saying that you have to be careful about qualifying any statements you make by referring the characterisitics of the population studies for the period of time it was studied. You have to be very careful about generalizing to other populations. And you don't know what you don't know. > Ed Friedman > [quoted text clipped - 9 lines] >> >> Dale J. > > Both Dale and George are correct. > > [quoted text clipped - 16 lines] > occurred purely by chance. But there wasn't enough data to justify such > a conclusion. Here you go again rejecting the half of the article you peronally do not like. Until funding comes along for larger studies, we are stuck with the usual low quality of current medical research. >>>Both Dale and George are correct. >>> [quoted text clipped - 20 lines] > like. Until funding comes along for larger studies, we are stuck with the > usual low quality of current medical research. I've read the article. I'm not rejecting any part of it. In their conclusions they say the following about the difference between the overall death rates in the two groups. "This difference could be due to chance or to long term but hitherto unknown adverse effects of prostatectomy." A statistician reading this would pay attention to the first part of the statement. It is certainly true that the second part could in fact be true, but there is nothing in the study which suggests that it is true. It is pure conjecture. The statement about chance however suggests that the numbers don't allow them to come to any conclusion about the matter. You keep harping about science, but I don't think you understand it very well. The reason for doing double blind randomized studies is that you don't know what you don't know. It is easy to try to read numbers like tea leaves to prove or disprove what you would like to believe, but unfortunately, you have to follow the rules. On that basis, the only firm conclusion one can draw from this study is that, for the population studied, there was a significant difference in prostate cancer death rates for the period of the study. We can't draw conclusions about overall death rates. We can't even conclude that the advantage of RP will persist as the population is followed over time, although that seems plausible. Most important, since this population differed in important ways from men diagnosed with prostate cancer in the US, it is not easy to draw conclusions about the US from this Swedish study. > >>>Both Dale and George are correct. > >>> [quoted text clipped - 41 lines] > rates for the period of the study. We can't draw conclusions about > overall death rates. As I said, here you go again rejecting the part of the study you don't like. It is a FAct how long the two groups lived, and you cannot get rid of that by wish fulfillment. > Sorry. It didn't show that. Statistics is a relatively subtle subject, > and I don't think you understand it. The way a statistician would have [quoted text clipped - 8 lines] > i.e., that it is highly unlikely that it would have occurred purely by > chance. Leonard, You are correct that this study does not prove that there is no difference between survival rates of RP and WW prostate cancer (CaP) patients. What is important to keep in mind is the bigger picture - no study to date has conclusively demonstrated a significant difference in survival rates. You are also correct that the Mayo Clinic is not endorsing hormone suppresing therapy for early CaP - they are simply listing that as an option. It should be noted that one of the cons they list for this treatment is that eventually the cancer could become hormone resistant, which is definitely something you want to avoid. However, instead of nitpicking details, why not consider the overall picture. The real question is why are so many urologists ignoring the results of Dr. Liebowitz, when so far they are much better than any other study ever done on early prostate cancer? One possiblity would be if he staged his research so that people reported as having CaP really didn't have it. However, all of the patients in his study had CaP diagnosed via biopsies at their local institutions. Another possiblity is that urologists don't like the theory behind Dr. Liebowitz's protocol. Most urologists view testosterone (T) as the cause of and fuel for CaP. This is largely based on the study over 20 years ago by Fowler and Whitmore. Dr. Lebowitz is highly critical of this article and those conclusions (http://www.prostatepointers.org/prostate/leibowitz/HDTRT8.html). He views DHT as essential for prostate cancer to occur. His view is supported by the fact that men who have a genetic mutation that prevents the conversion of T to DHT do not get Cap (or BPH for that matter). Another possiblity would be if there were no scientific basis for what Dr. Liebowitz is doing, e.g. if he were using magnets in a belt to produce his results. However, his treatment is a perfectly logical approach to the hypothesis that DHT is what fuels CaP. While other urologist just try to stop T production (with a double blockade), he uses a triple blockade to also inhibit T to DHT conversion. This blockade is stopped after 13 months in order to minimize the chance of hormone resistant or hormone refractory CaP to develop. He then uses drug maintenance to inhibit T to DHT conversion. When the paper was written, none of the patients required further treatment (another round of triple blockade), although he states that he would do so if needed. In summary, if you read Dr. Liebowitz's paper, and all of his postings on his web site, you will discover a urologist who is willing to throw out all of the prejudices so common in his profession to embrace pure science. While it is still too early to claim that his methods will produce a 0% death rate after 15 years for early stage CaP (we still have to wait 7.5 more years), or even that his procedure is the best of any procedures currently available (it may be best for the time frame of the study, but that could change in the upcoming years), it definitely is not too early to claim that his procedure should be considered as a viable option in the treatment of early stage CaP, especially if you agree with his assessment that CaP should be viewed as a systemic disease and not a localized disease (think breast cancer and tamoxifan). Ed Friedman >> Sorry. It didn't show that. Statistics is a relatively subtle >> subject, and I don't think you understand it. The way a statistician [quoted text clipped - 16 lines] > study to date has conclusively demonstrated a significant difference in > survival rates. Remember that absence of proof is not proof of absence. Moreover, when you say "no study has shown a signficant difference", you mean no double blind randomized study has yet shown a significant difference. Such studies are considered the gold standard in biostatistics, but they are not the only sort of evidence that is relevant. For example, the fact that prostate cancer death rates have gone down in the US where we have PSA testing and aggressive treatment of early disease and the fact that this hasn't happened in Sweden where they don't do those things suggest that there may be a difference. Similar results in the Tyrol in comparison with the rest of Austria are also relevant. > You are also correct that the Mayo Clinic is not endorsing hormone > suppresing therapy for early CaP - they are simply listing that as an > option. It should be noted that one of the cons they list for this > treatment is that eventually the cancer could become hormone resistant, > which is definitely something you want to avoid. I think any unbiased person reading what they say will conclude that they don't recommend hormone suppressing therapy for early prostate cancer. For example, they discuss its use only for advanced prostate cancer and say nothing at all about its use for early prostate cancer. It is only because it is on a web page obtainable by following several links from one referring to early prostate cancer that one could consider it has anything to do with early prostate cancer. I think it is pretty clear this was just a mixup by the person setting up the website and not a Mayo Clinic recommendation. > However, instead of nitpicking details, why not consider the overall > picture. The real question is why are so many urologists ignoring the > results of Dr. Liebowitz, when so far they are much better than any > other study ever done on early prostate cancer? It is certainly possible that Liebowitz and one or two followers are right and all the other experts are wrong, but it is unlikely. > >> Sorry. It didn't show that. Statistics is a relatively subtle > >> subject, and I don't think you understand it. The way a statistician [quoted text clipped - 27 lines] > that there may be a difference. Similar results in the Tyrol in > comparison with the rest of Austria are also relevant. In vastly different populations, outcomes are different. Since the Swedish also live longer than we do, they obviously are doing something right. Using your logic, since they live longer than we do, then their treatments are better. Remember HRT for women? Until they found out they were doubling cancer rates, no one noticed. No one. >>>>Sorry. It didn't show that. Statistics is a relatively subtle >>>>subject, and I don't think you understand it. The way a statistician [quoted text clipped - 31 lines] > Swedish also live longer than we do, they obviously are doing something > right. Seden is doing a lot of things right. Sweden has universal health care, which we don't have. I'm sure other features in Swedish culture lead to longer life spans. In addition, they do early detection and treatment for breast cancer, but not for prostate cancer. Do you have any evidence that Swedish men with prostate cancer live longer than American men with prostate cancer. Also, many men in the US have good, if expensive, health care. If you compare such men with Swedish men and look at the sub-population with prostate cancer, is there any evidence that the Swedes do better? References would be appreciated. You have a tendency to talk in terms of vast generalisties mixing up disparate groups and trying to come to simple conclusions. You can't do that. > Using your logic, since they live longer than we do, then their > treatments are better. No. Since they live longer, and also do better in other respects such as infant mortality, their general health care is better. That doesn't tell us anything specific about prostate cancer. > >>>>Sorry. It didn't show that. Statistics is a relatively subtle > >>>>subject, and I don't think you understand it. The way a statistician [quoted text clipped - 41 lines] > look at the sub-population with prostate cancer, is there any evidence > that the Swedes do better? You were the one who wanted to look a global variables. So that is what I did. Now you change the subject. Sweden has longer life expectancies than we do, despite the so-called criticism of their prostate cancer issues. > It is certainly possible that Liebowitz and one or two followers are > right and all the other experts are wrong, but it is unlikely. Leonard, Please clarify exactly what Liebowitz is right about and the other experts wrong? Are you referring to his theory of DHT as being necessary for prostate cancer (CaP) to occur? Are you referring to his claim that the greatest danger of hormone suppression theory is that CaP will become hormone resistant or hormone refractory, and therefore the more cells involved (which is why late stage CaP responds worse that early stage CaP) and the longer time involved with exposure to hormone suppression (which is why he does intermittent blockade) the more likely that is to happen? Are you claiming that he is lying about his results? Have you actually read his paper and the material at his web site and can you point out any factual error that he has made? Ed Friedman > > Sorry. It didn't show that. Statistics is a relatively subtle subject, > > and I don't think you understand it. The way a statistician would have [quoted text clipped - 69 lines] > > Ed Friedman Ed, medicine is heavy on politics and theory. What we lack is outcomes. It is sad, but true that we spend billions of $ on treatments and hundreds of thousands of men have surgery every year, but the outcomes are studied in only a few hundred. It is really tragic. > > hi george - i have read your comments > > about what others have written. while i can see, up to a point, what [quoted text clipped - 10 lines] > or so, but no one knows. Dartmouth has just pointed all that out. At some > point the death rate from treatment must be taken into account too. I think most of us (including myself) who are being treated for PCa realize that the treatment (surgery, radiation or other) is not going to "save our lives". At best we can expect "remission" not a "cure" as that is all that present treatment options can guarantee. All we can hope for is that we will die a less painful death from other causes than what death from PCa has to offer. Depending on the "success" of the treatment we hope to buy a few more years. That's what I'm hoping for now that I am finishing up IMRT and HT. The side effects have been a bitch at times, but I'm still able to put one foot in front of the other and hopefully will continue to do so for a while longer than if my PCa had gone undetected and untreated by ignoring PSA results. The test is far from perfect, but it's the best we have for now. > > > hi george - i have read your comments > > > about what others have written. while i can see, up to a point, what [quoted text clipped - 23 lines] > longer than if my PCa had gone undetected and untreated by ignoring PSA > results. The test is far from perfect, but it's the best we have for now. > > > hi george - i have read your comments > > > about what others have written. while i can see, up to a point, what [quoted text clipped - 23 lines] > longer than if my PCa had gone undetected and untreated by ignoring PSA > results. The test is far from perfect, but it's the best we have for now. I wish you the best. I also hope that we don't end up like women: PSA may go the way of HRT. > > > hi george - i have read your comments > > > about what others have written. while i can see, up to a point, what [quoted text clipped - 23 lines] > longer than if my PCa had gone undetected and untreated by ignoring PSA > results. The test is far from perfect, but it's the best we have for now. Actually, I do expect a cure... not for me, though I think it is possible for me, but for others. If these are 8 to 9 year studies, that IS the flaw. It is necessary to have 8 to 9 year (to 15 year) studies wherein PCa is concerned, but 8 years only covers those people who die in 8 years. My PSA was 16 during OCT 2000. Now it's 0.07. My Gleason was 7. My pre-surgery stage was T2c, but post-surgery path showed some seminal vesicle involvement. If I had not had my PSA test in 2000, I would almost certainly have died by the time I was 50 (as did my father). I would now be in severe pain with cancerous mets throughout my bones (as was my father). My father died within the 8 to 9 year scope of this study, only because he was diagnosed two years later than he would have had there been PSA testing back then. Had there been PSA testing, he would would have outlasted the study. Regardless, PSA testing and the subsequent RRP may have saved my life. It almost certain extended it. It absolutely increased the length of pain-free and dehabilitating portion of it. Because of PSA, I have not yet experienced by first PCa symptom (thought he treatment symptoms are nothing to sneeze at). > > > > hi george - i have read your comments > > > > about what others have written. while i can see, up to a point, what [quoted text clipped - 42 lines] > diagnosed two years later than he would have had there been PSA testing back > then. Had there been PSA testing, he would would have outlasted the study. Well, the studies are on-going but no results favorable to PSA so far. Maybe there will be some results after year 12. > Regardless, PSA testing and the subsequent RRP may have saved my life. It > almost certain extended it. It absolutely increased the length of pain-free > and dehabilitating portion of it. Because of PSA, I have not yet > experienced by first PCa symptom (thought he treatment symptoms are nothing > to sneeze at). Conjecture. You don't know what your own history would be. And the huge number of people who go on and die of cancer of the prostate who have had surgery and everything else would have something to say. The reason why we have such suffering from cancer in the USA is that our physicians practice using very few or no pain killers. To get free of pain, you would have to travel to Europe, where medicine is more humane and more developed also. > > Regardless, PSA testing and the subsequent RRP may have saved my life. It > > almost certain extended it. It absolutely increased the length of [quoted text clipped - 5 lines] > > > Conjecture. No. Assertion. > You don't know what your own history would be. I have a damned good idea. I'm not trying to prove a theory, here. I'm taking a set of facts, assessing them, and coming to a logical conclusion.... the only reasonable conclusion given the set of facts. > And the huge > number of people who go on and die of cancer of the prostate who have had > surgery and everything else would have something to say. And I will almost certainly be one of them. But, because of PSA testing, I am not one now. > The reason why we have such suffering from cancer in the USA is that our > physicians practice using very few or no pain killers. To get free of pain, > you would have to travel to Europe, where medicine is more humane and more > developed also. Conjecture? > > > Regardless, PSA testing and the subsequent RRP may have saved my life. > It [quoted text clipped - 14 lines] > taking a set of facts, assessing them, and coming to a logical > conclusion.... the only reasonable conclusion given the set of facts. You are looking at wish-fulfillment. Only the yet undone science will show which processes are best. And that is the point: we men have not pushed research the way women have, and we suffer for it. > > And the huge > > number of people who go on and die of cancer of the prostate who have had [quoted text clipped - 11 lines] > > Conjecture? No FAct. It has been well documented over the years. > i think so, but then again, remember, we have a lawyer who represented > the communist party, that is a senator now, Do tell. Who and why and what? That's what lawyers do - represent people. we've had a draft dodger > that was president, As compared to one whose daddy got him into the Champagne Squadron of the Texas National Guard. IMHO, the draft dodger was more honest. and we've now declared a state of war - for the > first time in u.s. history - unprovoked, only to find that they can't > find any evidence as to why we should have acted the way we did. And worse still, not learning from the experience of others who went down that road. The Brits occupied Iraq in the 20's and encountered the same sort of opposition. Don't the neo-cons read any history? Cheers, Lech Edmonton Alberta >Don't the neo-cons read any history? They don't even read newspapers, as both the President. and Secretary of Defense are so fond of reminding us, so history is out of the question. The generation(s) to follow, on the other hand, will read plenty of history about the neo-cons, all of it scathingly critical. --dt > If it is a doctor, you > must rule out "stupidity." You cannot be a doctor, at least not a medical > doctor, if you are stupid. Oh Please!!!!!!!!!!!! There are plenty of stupid MDs and I only hope you find this out first hand by being treated by one. Drop the doctor hero worship, it makes you sound like you don't get out much. > > If it is a doctor, you > > must rule out "stupidity." You cannot be a doctor, at least not a medical [quoted text clipped - 6 lines] > Drop the doctor hero worship, it makes you sound like you don't get out > much. Perhaps both of you could agree on foolish. Look at all the treatments which have had to be abandoned. Just look at HRT for women for a very recent example of something doing more harm than good, but pushed for 50 years by people who unfortunately were not stupid, but misled. > hi george - this is a case of figures don't lie, but liars do figure. > [quoted text clipped - 35 lines] > "Many more men die with prostate cancer than of it. Growing old is > invariably fatal. Prostate cancer is only sometimes so." Yes curtis and if it saved one out of 10 or 100 was it worth the effort? In my thinking it was. For myself, if I had pca or any other cancer I damn sure would want to know about it. From there I will make a choice. Dale J. SignatureEmail: dalej2@mac..com > hi george - this is a case of figures don't lie, but liars do figure. > [quoted text clipped - 8 lines] > to make a statement as to discourage psa testing is simply stupid. > that's right - stupid!!! Dartmouth is a major medical center. I don't know why you think they don't know anything. > i will use my case - i was 56 when the psa turned up my psa. the DRE > did not. not even on the day before surgery. the surgeon said he could [quoted text clipped - 7 lines] > events that saved my life. i was told that i would not live to be 70 > if i would have let nature take it's course. That was an irresponsible comment to make to you because no one knows if it would have turned out that way because no one has studied such issues yet. Unfortunatly the PSA has never been shown to save lives. The best they have to go on is that death from prostate cancer has declined 3% in 20 years. It might have declined anyway as life expectancy has increased. Anyway, this is supposed to be a science group where science is discussed. I'm sorry you suffer, but that does not change research issues. > > hi george - this is a case of figures don't lie, but liars do figure. > > [quoted text clipped - 32 lines] > Anyway, this is supposed to be a science group where science is > discussed. I'm sorry you suffer, but that does not change research issues. George, I think you're beating a old dead carp to death. PSA is good George, not perfect, but better than nothing. Why in hell would any person not want to know they have a cancer. The earlier they find out the better the chances to cure it, right? So where does the science disprove that idea? Dale SignatureEmail: dalej2@mac..com > In article <UWQtc.3175$Yd3.**4@newsread3.news.atl.earthlink.net>, > [quoted text clipped - 46 lines] > > Dale What the current PIVOT sudies are doing is trying to find out if current ideas, including early detection, lengthen life or merely let you know of what is going to happen earlier. So far, there are no results either way. > PSA is good George, not perfect, but better than nothing. Why in hell > would any person not want to know they have a cancer. My uro thinks so, and I believe I will trust his judgment. My last PSA was 5.2 I have a cyst on my prostate that feels like a classic cancerous one. Whenever my uro has a resident in his office watching his practice, he has them do a DRE so they know what a cancerous prostate feels like. Yesterday the resident was a Chinese lady. First time I've had a lady MD do a DRE. Didn't feel much different than a guy. I've had five biopsies - all negative. Thank God for our Commie health care system. Hate to think what all that work would have cost me in the US. On a related note, I'm convinced saw palmetto works. I've been taking one 160 mg pill daily for over a year. I don't have any hard numbers, but my urine flow is definitely easier. If I miss a day I notice the difference. Cheers, Lech Edmonton Alberta ....and such angry postings. No wonder nobody on this Earth can get along. I grow weary of the politics everyone trys to drag into this subject. I'll just choose to lurk, and shake my head at the hate and the nonsense of it all. JH > > PSA is good George, not perfect, but better than nothing. Why in hell > > would any person not want to know they have a cancer. [quoted text clipped - 25 lines] > Lech > Edmonton Alberta > ....and such angry postings. No wonder nobody on this Earth can get along. > I grow weary of the politics everyone trys to drag into this subject. > I'll just choose to lurk, and shake my head at the hate and the nonsense of > it all. > > JH > > > PSA is good George, not perfect, but better than nothing. Why in hell > > > would any person not want to know they have a cancer. JH, I agree with you. I did not post the above in anger. Only to make a point. I also try real hard to stay away from politics. I cannot speak for the other poster you replied to. Do not choose to lurk only. If postings are not agreeable to you as some are not agreeable to me either, just filter them or try to screen the subject line. I've found I can bypass much that way. Regards Dale J. SignatureEmail: dalej2@mac..com > I did not post the above in anger. Only to make a point. I also try > real hard to stay away from politics. I cannot speak for the other > poster you replied to. I'm the other poster, and I don't see anything political in that particular post of mine. What it the reference to the Canadian Commie health care system? That was tongue-in-cheek. I don't particularly want to see politics raised here either, but if someone does it, I'm going to get in my one good shot. Cheers, Lech Edmonton Alberta >I'm the other poster, and I don't see anything political in that >particular post of mine. What it the reference to the Canadian Commie >health care system? That was tongue-in-cheek. No, it was your reference to neo-cons and my reply. >I don't particularly want to see politics raised here either, but if >someone does it, I'm going to get in my one good shot. Me, too. After all, there actually are things happening in this world that are even worse than us and our prostate cancers. But I suppose there are other more appropriate places to address them. --dt In article <Pine.A41.4.05.10406020732330.16336-100000@srv1.calcna.ab.ca>, > I'm the other poster, and I don't see anything political in that > particular post of mine. What it the reference to the Canadian Commie [quoted text clipped - 6 lines] > Lech > Edmonton Alberta Lech, nice to meet you. Hope everything is well. As I said, I try real hard to stay out of politics. I'm not Canadian, but if I were I guess I would not like my heath care system referred to as a commie type, (old fashion pride I guess). I know you are Canadian and I know now you were kidding, we all do that at times, however not everyone will see it as a joke. Canada and the U.S. have always been friends. I've visited Canada a number of times including your city, Edmonton. I motorcycled across the Trans-Canadian highway and up thru the Canadian Rockies to Jasper in 1977 and returned thru B.C., camped all the way. It was a time of my life, a great trip which I will always remember. The people of Canada were wonderful friendly folks. I often think about doing it again, but the reflexes are not what they used to be so it would have to be in a four wheeler. Anyway I'm going back to my spider hole but first I have to cut the grass. Sun is finally shining here in Minnesota, but that crisp Canadian air is still aloft which is fine with me. Best to all Dale J. SignatureEmail: dalej2@mac..com > As I said, I try real hard to stay out of politics. I'm not Canadian, > but if I were I guess I would not like my heath care system referred to > as a commie type, (old fashion pride I guess). I know you are Canadian Canadians don't mind. We think it's cute. Cheers, Lech > > PSA is good George, not perfect, but better than nothing. Why in hell > > would any person not want to know they have a cancer. [quoted text clipped - 14 lines] > Thank God for our Commie health care system. Hate to think what all that > work would have cost me in the US. Once again, the science has not been done, which is what the article is all about. > On a related note, I'm convinced saw palmetto works. > [quoted text clipped - 6 lines] > Lech > Edmonton Alberta |
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