Does Treatment Kill G6 Patients

[gusgold]

urotoday.com/center-of-exce...

[Scruffybut1]

Absolutely fascinating conundrum for a thoughtful doctor. Well done him, new thoughts. Makes me pleased that my G4+5 was based on 12 cores all cancer.

[pjoshea13]

Thanks Gus,

ADT is for palliation & has a short mean-time-to-failure. Why use up that option before it is needed & suffer the morbidity?

The downside for palliation is the selection for more serious PCa. A compelling reason for delay.

A word on Gleason 6.

Ryan wrote "the prostate cancer community, myself included, is engaged in a legitimate and thoughtful debate as to whether Gleason 6 should be reclassified as something other than cancer"

A few years ago, Dr. Myers suggested: "Just don't call it cancer!" That is a seriously wrong solution to the problem. IMO

The problem wasn't the overtreatment of Gleason 6. Doctors have been happily treating Gleason 6 for years. The problem was the U.S. Preventive Services Task Force's really dumb solution - don't screen.

The solution that the USPSTF should have proposed was augmenting the PSA test with one or more of the many tests that add specificity for PCa. & that's what Myers should have suggested too.

At the moment, urologists have a financial incentive to jump from PSA test to biopsy. Medicare should insist on additional blood or urine tests. 80% of biopsies are negative. Perhaps the number of biopsies could be cut by 75%.

The reason why Myers was wrong to suggest not telling a patient that he has a Gleason 6, is that we all had Gleason 6 at some point. My cancer was diagnosed when it was Gleason 4+3. I guess the previous biopsy missed all the Gleason 3+3 cells.

25-30% of U.S. Gleason 6 cases will progress. Active surveillance requires repeat biopsies. Again, a panel of tests would eliminate most of them.

You can't tell a Gleason 6 patient that he doesn't have cancer, because he has to agree to active surveillance.

-Patrick