There is more to it than words...

I'm very disappointed in Tony's latest comments concerning Ralfinaz. They strike me as absolutely unfair and inaccurate.

I always look forward to Ralph's comments whenever he chooses to add his thoughts on a topic. He's always reasonable, but never doctrinaire. He clearly understands AS and agrees that it can be a viable option, but he's also aware of its limitations.

What bothers me about these AS discussions is that a number of proponents of AS come across as dogmatic in the extreme. You either agree with them, or you're WRONG. I don't know if that's what has driven Yooper away, but I wouldn't be surprised.

The majority of posters seem to agree that AS can be a wise choice for many men with"low risk" prostate cancer, but some here seem to insist that it must be the FIRST choice in every such case, and I simply can't understand that.

Ralph, you're just about my favorite contributor here on HW, and I'll continue to look forward to your future comments.

Bill,
I apologize if my comments seem unfair. I did not want to come across that way. I was looking for when Ralph may believe that AS is appropriate and I have never seen him state it.

I thought it to be fair to ask. I admit being a bit frustrated by the title of this thread. It implies that someone is not using thought in their words about either PSA testing or G6, not 100% which.

If anyone, including Ralph, find my comments as disrespectful, please understand I super respect Ralph's contributions to advocacy.

Tony,
I find your question to Ralph to be unanswerable except in general terms, though I really wouldn't presume to speak for Ralph. I would be very surprised if, at this point in time, anyone can say definitively when AS is the only appropriate treatment. Ralph, and others, have said over and over that AS "can" be an appropriate approach to non-aggressive prostate cancer, but one would have to be God to say that if conditions a, b, c, and d are present then AS MUST be the approach. Those conditions of a, b, c, and d might suggest AS as a recommended approach, but are you willing to say that if certain conditions pertain it MUST be the approach? Is that what you're suggesting?

Personally, if my uro had taken that approach, I would have been looking for another uro, one less autocratic, one willing to consider subjective factors and acknowledge that we still have limitations of knowledge in this area....limitations that may rightly cause a man to opt for a more radical course of treatment, especially when age, co-morbidities, family situation, and other individual considerations are taken into account.

As I see it, newcomers to this forum are now universally counseled to consider AS as an option. Wonderful. But, that doesn't seem good enough for some here. They are preaching the "gospel" of AS and won't be satisfied until that's the ONLY suggestion offered.

Tony Crispino said...
Ralph,
Dangerous and inappropriate? I never said that? Please forgive me if you see my question as stating you have made dangerous or inappropriate statements. I guess I do think the title of this thread is a dissenting post to someone's comments though. And the first sentence is a bit off the topic of the body of the post but I take it to mean that you feel that someone is opposed to the PSA test. (Actually someone I can name is - Dr. Richard Ablin wished he never discovered it). But not me I am for screening every man in his lifetime.

My question presents an opportunity to state when you might think it IS appropriate to consider AS. I may be mistaken to believe that when you post it's in regards to screening, and when AS is discussed I see a presentation of data that would be used to discourage AS as opposed to encourage it.

Tony,
This morning when I looked at the HW board there were two posts from you. The second post that contained your words dangerous and appropriate prompted my response. That second post has now been deleted. I wonder why?

In this thread previously I posted:
"It is well known that there is a variation between diagnostic pathology and surgical pathology. Many studies during the last 20 years have shown such difference. The reason I posted the Stattin et al study is because it is recent and supports the premise. I am supportive of AS with the condition that the patient understands that a biopsy pathology might or might not totally represent the disease present and other tests can help them make a better decision. Saying that GS6 is hameless is not totally true and can hurt patients."

Isn't that clear enough? I support AS. Why should I not support something that could prevent unnecessary treatment. I am old but "out of it". To me is important to save as many lives as possible from dying and suffering from prostate cancer. If you are for evidence based medicine you know that the typical diagnostic result today might not totally represent the amount or aggressive nature of the cancer present in a large percentage of cases. Why is this wrong information or hard to understand? When uninformed men hear that GS6 is harmless. Is this totally true? You know better.This could cause those men to lower their guard...after all their cancer is harmless and according to a few here it never or hardly even will progress. How is that for evidence based medicine?

RalphV
BTW, the title of the thread is related to comments made in another thread (GS6 is harmless)without proper scientific support. That is why I said it takes more than words...

Ralph,
Again my previous post was not to state that your comments are dangerous and inappropriate but rather than the suggestion that it is dangerous in inappropriate to rule AS out as an option. I took it down because I didn't like the post myself. I regret that post because I was too strong and it was not what I wanted to express.

Again, please except my apology on that one.

Also, in total agreement with you, I do not agree with any notion that G6 is always harmless. But it very largely is not a life threatening condition and in many cases does not need treatment. In fact to the point that PeterDA took your title to mean, I do not like any suggestion to rename it a "non-cancer" either. We just do not have that tool to be able to differentiate indolent from aggressive disease down well enough to take that risk.

My concern is that over treatment in many cases is more dangerous than the disease itself at times. In the study I posted 2.4% of men with clearly defined low risk actually did die of the disease however, that study was highly criticized by the NCI as biased and not well put together.

Until we get better at defining low risk factors it will always be a controversy. For now I believe that the Klotz criteria, and the NCCN criteria are acceptable protocols for defining AS. And I think everyone should read them before deciding on active radical therapies.

Post Edited (Tony Crispino) : 8/18/2014 7:07:26 PM (GMT-6)

Tony,

You said...
In fact to the point that Peter took your title to mean, I do not like any suggestion to rename it a "non-cancer" either.

Neither do I. I like the term "non-metastasizing prostate cancer" since it still has "cancer" in it but delivers it to the patient along with a reassurance about the most frightening aspect of other prostate cancers. When the patient, inevitably, asks for clarification of the "non-metastasizing" part we can also explain about the uncertainties of diagnosis and the need for (at least) ongoing active monitoring.