Ben Stiller’s Essay About Prostate Cancer Is Moving But Not Scientific

“The problem that the medical community has struggled with regarding the PSA test is that for every PSA success story, there’s another man who has been unnecessarily treated as a result of an elevated PSA,” said Dr. Timothy J. Daskivich, a urologic oncologist and director of health services research for the Cedars-Sinai department of surgery in Los Angeles. “These are often men with low-grade cancers (the most common type of prostate cancer in the U.S.) or men with limited life expectancy.”

But Stiller did not have a low-grade cancer, and he did not have "limited life expectancy." So, it sounds to me like he made smart choices all the way around.

Why do you call 3+4 prostate cancer "favorable risk."

My own personal experience: I had frequent urination, but it truly never occurred to me I might have cancer, though maybe an enlarged prostate. Fortunately, my internal medicine family doc always included a PSA test as part of my annual physical. The numbers increased in successive years from the 2 range, to the 3 range, to the 4 range, to the 5 range, and then over six. Only then did the doc convince me to see a uro, and only then did a DRE reveal a palpable tumor, confirmed by biopsy, and ultimately by pathology as 3+4 in every core of one half of the gland, and after surgery found to be in the other half as well.

Sometimes it sounds as if you're advocating that men completely ignore their prostate, never get treated, and let the cards fall as they may. I'm certainly glad that I had the surgery, and I'd do exactly the same thing today as I did six years ago.

You asked:

clocknut said...
Why do you call 3+4 prostate cancer "favorable risk."

That's right. Based on what we know (primarily Gleason score 3+4), Stiller appears likely to be in the NCCN favorable intermediate risk category. The literature provides evidence that men with favorable intermediate-risk prostate cancer have prostate cancer-specific mortality and all-cause mortality rates similar to the rates in patients with low-risk prostate cancer and thus may be candidates for active surveillance as an alternative to treatment, dependent on other case characteristics. As such, I'm a bit baffled by your comment/question; did you not know some 3+4 cases are candidates for AS, clocknut?

[This is in contrast to those (not Stiller) who are in the unfavorable intermediate risk category (mostly characterized by 4+3), where patients have prostate cancer-specific mortality and all-cause mortality rates similar to the rates in patients with high-risk prostate cancer. These patients would not be candidates for active surveillance.]

You should look these up.

His life was not at risk; not from PC.

clocknut said...
...it sounds as if you're advocating that men completely ignore their prostate, never get treated, and let the cards fall as they may.

That's a very, very odd thing for you to say. Can you point to one time (use the HW "quote" function with the thread link, so we ALL can see it) when I have ever, EVER said anything that closely resembles this? Of course if you can't, it then becomes immediately clear that you are simply taking "the low road" by attempting to attack the person rather than a point made by the person when you have nothing substantial to say about that point. That's called an "ad hominen attack, " and your tendency to resort to this tactic is why "Locked" HW/PC threads seem to follow you around like your shadow!

Your comment, quoted above, makes it clear that you lack a fundamental knowledge of how Active Surveillance works. On top of that, your statement is an insult to men who are or have pursued an initial strategy of Active Surveillance.

Post Edited (JackH) : 10/13/2016 4:45:00 PM (GMT-6)

Halbert,

Stiller's been hiJacked.

In my opinion, there are cycles of disregard for whichever forum rule addresses the idea that others' treatment choice be respected. It has happened several times with a relatively few vocal individuals in the 5 years or so since I found Healingwell.

The moderators are volunteers, and most are challenged with battles of their own. It would help all if self awareness of 'bedside manner' was innate in all members of this peer support forum. Since that is not the case, all we can do is persevere in upholding the support model. The site owner's intent of support over agenda will prevail in time.

Thank you to Peter for the site, the mods for the balancing act, and the many members who share experience and support without judgement.

Explorer

yeah, clocknut, I didn't think there were any quotes...none whatsoever. Your comment has no "facts" whatsoever. Listen, there's no need for you to be so defensive...nobody said you made a poor choice; nobody said that. Let's focus on helping others make good, informed choices going forward. Help them to understand risks, and not over-react...which we know is a common cause of PC overtreatment. Let's help encourage favorable-risk cases (which is most, but not all cases) to slow-down, not rush, educate themselves on the true & unique nature of prostate cancer, and ultimately to make a "risk-savvy" decision.


Speaking of risk, and knowledge of risk, or perhaps more broadly "risk literacy," I'll encourage readers to test your own understanding of risks by going to this website (the Harding Center for Risk Literacy) to "Check your knowledge about risks and uncertainty of everyday life." Click the "Risk Quiz" link upper right-hand corner.
/www.harding-center.mpg.de/en


And then check out this 16-minute TED talk on Risk Literacy (take the test, above, first, because some answers are in the TED talk):
/www.youtube.com/watch?v=g4op2WNc1e4

JackH
Test was too short, but it revealed I'm only average. I got only 50% (one out of two correct),but I think I am still smarter than a 5th grader!!
Dan
P.S. Loved Night at the Museum

I think it's a silly little test, it's somewhat biased towards an individual with a half way decent mathematical education.

But.............

"Congratulations on completing your statistical and risk literacy test!

Your numeracy score is better than about 75-100% of all college educated individuals. Roughly, this means that out of every 100 people who take the test, you will do better than about 90% (90 people) of all other people. This is the highest score one can receive on this test. "

So there are 3 possible scores. 0,1, and 2. Woo hoo, I got 100% percent on a basic math test with 2 questions.

No worries, alephnull. How'd you do on the Harding Center test? I suspect with your background you did well. I also did pretty well, with my BS in a technical field from a top-10 university + MBA...but obviously with these backgrounds we are not the norm.

I got 6/8. I am "Risk Competent" apparently.

Surprisingly, I got an 8/8 though I was quite unsure of 3 of my answers. Luck I think.

Paul