"Robert A. Fink, M. D." <[email hidden]> wrote in message "]news:[email hidden]...
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Robert said:
Dr Fink doesn't want to give us the option of deciding on our own
individual
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risk assessment. He doesn't want you to know if you have cancer or not
and
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thus keep you in the dark because of the generalization that all prostate cancer patients should not have known. Why bother going to a doctor in the first place. He has a cynical
position.
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We are all going to die anyways of something or another in the long run. If the survival rates of those having treatment or not is the same than
it
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becomes entirely an emtional issue. You need to support the emotional
needs
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of the individual and the hell with the doctor.
Hey, WHOA! Please don't put words in my mouth. This all started with my posting of an article concerning the opinions of a credentialled researcher and commentator. I never said that anyone should be "prevented" from having all the tests one wants (and is willing to pay for). Anyone who wants to have needles inserted through their rectal wall is fully entitled to that bit of pleasure; I make no attempt to deny such folks their preferences.
But for me, who had a borderline PSA test (7) 10 years ago and who is otherwise healthy (at age 66), it doesn't make sense for me to get "screening tests". My family physician agrees, and that's good enough for me. But, those of you who want to be pushed and prodded, please be my guest!
Best,
Bob
Robert A. Fink, M. D. Neurological Surgery 2500 Milvia Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555
I am thinking that virtually everyone posting here recently is in favor of pushing and prodding. They get very upset if anyone does not do what they command.
"Leonard Evens" <[email hidden]> wrote in message "]news:[email hidden]...
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George Conklin said:
"Leonard Evens" <[email hidden]> wrote in message "]news:[email hidden]...
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dale.j. wrote:
>In article <[email hidden]- >arthlink.net>, "George Conklin" <[email hidden]> >wrote: > > > >> Not according to the article. Early detection simply >> means you know
about
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>>it earlier. > > >But wouldent that be a good thing?
Again it depends. If there is no known effective treatment, knowing about it early rather than late may not be helpful.
For prostate cancer I think it is generally helpful.
That is a value statement. The science is not yet established.
You don't
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necessarily have to treat prostate cancer just because you know you have it. It depends on the details of the diagnosis, the age of the patient and some other factors.
>Dale J. >
Or, it might not matter at all given current treatments, right?
That's right. It might not. But I think there is significant evidence that current treatments are helpful in many cases. I keep describing my particular case, where I had to make a decision about what to do based on the available evidence. I opted for treatment and I think the science, while uncertain, combined with my particular attitudes towards different risks, justified that. From the sorts of things you say, it seems to me---again a value judgement---that you don't understand much about current knowledge about prostate cancer, but you still seem to like to make statements about it.
Anything you have read is filtered through your emotional need to justify whatever it was you did. But your personal case is irrelevant in a science group. I'm sorry your emotions get in the way all the time.
"George Conklin" <[email hidden]> wrote in message "]news:[email hidden]...
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"Leonard Evens" <[email hidden]> wrote in message "]news:[email hidden]...
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George Conklin said:
"Leonard Evens" <[email hidden]> wrote in message "]news:[email hidden]...
>Robert A. Fink, M. D. wrote: > >>On Sat, 03 Jul 2004 17:57:22 GMT, "Fernando"
<[email hidden]>
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>>wrote: >> >> >> >>>Leonard, George and Dale.... >>> >>>Always enjoy your answers and viepoints on subjects >>>discussed.....I
have
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>>>learned a lot from all of you..... >>> >>>To "Dr" Fink, I am POSITIVE he is on the wrong >>>track..... >>> >>>I have 9 brothers....4 of us have been Dx'd with >>>Prostate
Cancer...after
>>>knowing that 3 of my brothers had PCa, a Dr friend >>>of mine suggested
I
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go
>>>for a complete phyisical exam including PSA... After >>>this, I found out that my PSA was 5.2 ( at 49 years
old)....subsequent
>>>test indicated that I also had PCa !!! 5 years ago, >>>I had RRP....my
last
>>>PSA test was still undetectable....In the meantime, >>>One of my
brothers
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died
>>>of PCa, another is on his last days and the other is >>>still fighting
the
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>>>cancer strong.... >>> >>>I have SOLID evidence and experience that screening >>>is very, very
valuable
>>>in treating PCa. >>> >>>To "Dr" Fink, maybe he should go back and do his own >>>studies. >>> >>>Fernando >>> >> >> >> >>Fernando, >> >>Your "statistics" are what is called "anecdotal". You >>need thousands of cases in order to prove a >>statistical correlation, and those studies which >>*are* truly statistical are quite equivocal as to >>whether widespread screening with the PSA followed by >>aggressive treatment/biopsy really makes a difference >>in survival. > >You are lissutrating the difference in perspective I >mentioned in another response. It is true that if you >want to discuss the entire population of prostate >cancer patients, then his particular story is just one >item which may prove nothing about the generaly >population. > >However, as I noted previously, the evidence does >support PSA testing for men with family histories like >Fernando's. Do you know of any studies which dispute >that assertion?
Your assertion is just that. You are culturally biased into
thinking
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that
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action is always better than inaction. It must be due to that math background which asserts that proofs ought to exist, and if they
don't,
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assert them.
So you are now a cultural anthropologist to add to your other talents?
You know very little about my biases, cuturally or otherwise. Also, you obviously know very little about mathematics or mathematicians. Few of us think that proofs ought to exist, and we certainly don't assert proofs that don't exist. But we are trained in the exact use of
language.
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Were that the case, you would not be asserting what is not proven in hopes that someday it might be because you wish it were to be true. As
for
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cultural anthropology, yes, I am familiar with that to say the least.
That's a good point but how do you propose studying something you don't want people to get tested for because you don't feel they should get treated ?
"Leonard Evens" <[email hidden]> wrote in message "]news:[email hidden]...
Quoted message said:
George Conklin said:
"Leonard Evens" <[email hidden]> wrote in message "]news:[email hidden]...
>Robert A. Fink, M. D. wrote: > > >>On Sat, 03 Jul 2004 17:57:22 GMT, "Fernando" >><[email hidden]> wrote: >> >> >> >> >>>Leonard, George and Dale.... >>> >>>Always enjoy your answers and viepoints on subjects >>>discussed.....I
have
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>>>learned a lot from all of you..... >>> >>>To "Dr" Fink, I am POSITIVE he is on the wrong >>>track..... >>> >>>I have 9 brothers....4 of us have been Dx'd with >>>Prostate
Cancer...after
>>>knowing that 3 of my brothers had PCa, a Dr friend of >>>mine suggested I
go
>>>for a complete phyisical exam including PSA... After >>>this, I found out that my PSA was 5.2 ( at 49 years
old)....subsequent
>>>test indicated that I also had PCa !!! 5 years ago, I >>>had RRP....my
last
>>>PSA test was still undetectable....In the meantime, >>>One of my brothers
died
>>>of PCa, another is on his last days and the other is >>>still fighting
the
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>>>cancer strong.... >>> >>>I have SOLID evidence and experience that screening is >>>very, very
valuable
>>>in treating PCa. >>> >>>To "Dr" Fink, maybe he should go back and do his own >>>studies. >>> >>>Fernando >>> >> >> >> >>Fernando, >> >>Your "statistics" are what is called "anecdotal". You >>need thousands of cases in order to prove a statistical >>correlation, and those studies which *are* truly >>statistical are quite equivocal as to whether >>widespread screening with the PSA followed by >>aggressive treatment/biopsy really makes a difference >>in survival. > >You are lissutrating the difference in perspective I >mentioned in another response. It is true that if you >want to discuss the entire population of prostate cancer >patients, then his particular story is just one item >which may prove nothing about the generaly population. > >However, as I noted previously, the evidence does >support PSA testing for men with family histories like >Fernando's. Do you know of any studies which dispute >that assertion?
Your assertion is just that. You are culturally biased into thinking
that
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action is always better than inaction. It must be due to that math background which asserts that proofs ought to exist, and if they don't, assert them.
So you are now a cultural anthropologist to add to your other talents?
You know very little about my biases, cuturally or otherwise. Also, you obviously know very little about mathematics or mathematicians. Few of us think that proofs ought to exist, and we certainly don't assert proofs that don't exist. But we are trained in the exact use of
language.
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Were that the case, you would not be asserting what is not proven in hopes that someday it might be because you wish it were to be true. As for cultural anthropology, yes, I am familiar with that to say the least.
You are reading your own preconceptions into what I've said. I've not said anything was "proven" about prostate cancer. Actually, the word "proof" has to be carefully examined in medicine. Rarely can medical researchers prove anything deductively as a mathematician would. Almost always, conclusions are based on statistical analysis. Such analysis can at best tell you what is probable about a given population. Also, there is usually considerable variation in such a population which depends on a variety of factors. So it doesn't make sense to say that it has been proven that a certain treatment is or is not effective without specifying the details of the diagnosis, the treatment, how long the patients are followed, etc. Using one's naive intuition can lead one astray. For example, you regularly claim that if a long term study hasn't shown any results up to now, it is not likely to do so. But that is clearly a false conclusion as I've demonstrated before by examples.
What are your qualifications in cultural anthropology? I minored in it in college. But that was long ago, and despite attempts now and then to keep up, I suspect my knowledge of the subject is outdated.
"Robert A. Fink, M. D." <[email hidden]> wrote in message "]news:[email hidden]...
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dale.j. said:
What cancer do we not have an effective treatment for if found early enough? I'm curious because I thought that if cancer were found early the treatments would be effective and I was also under the impression there are treatments for all types of cancer.
Lung cancer, for one. Also, to a greater or lesser extent, ovarian cancer, malignant glioma (brain tumors), many adult leukemias, pancreatic cancer, and a number of forms of stomach cancer, to name a few.
There are, indeed, treatments for all cancers; but there are not many "cures" with some tumors.
Best,
Bob
And to what degree prostate cancer follows its own path is unknown too.
"Paul A." <[email hidden]> wrote in message "]news:[email hidden]...
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I have a PSA that's varied in a range from 5 to 13 (the 13 happened soon after starting testosterone therapy); it's now back to a steady 6-7, and I'm still on testosterone. I've also had two negative needle biopsies.
Sadly, there are very few physicians around (maybe it's because of lawsuit anxiety) who are willing and able to explain to a patient what the risk tradeoffs are -- and to say right out that it's a personal and subjective decision how to choose between the alternatives. Aggressive diagnosis and treatment may lengthen your lifespan -- but again, it may not, and it's
not
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without its own risks and costs. Most urologists seem to be very aggressive in biopsying and in attaching great significance to high PSA. The one I was seeing certainly was.
Fernando -- the one with a family history of aggressive prostate cancer -- certainly has high risk factors. But even in his case, I'd say that a physician should not dictate the choice of whether or not to biopsy. The most aggressive course of treatment would be prostatectomy, on the grounds that even a negative biopsy might have missed a tumor that was there. On the other hand, the treatment following a positive biopsy might not actually prolong his life significantly.
What you are pointing out is the resistance of the medical business to study RESULTS, not procedures. Maybe the data will be in in another 10 years. The HRT studies for women were delayed for about 45-50 years, and even now many people will not accept the fact that HRT doubled cancer rates, etc. Treatments and current practice are what we focus on in this country. Results? We excuse those.
"Leonard Evens" <[email hidden]> wrote in message "]news:[email hidden]...
Quoted message said:
Robert A. Fink said:
Robert said:
Dr Fink doesn't want to give us the option of deciding on our own
individual
Quoted message said:
Quoted message said:
Quoted message said:
risk assessment. He doesn't want you to know if you have cancer or not
and
Quoted message said:
Quoted message said:
Quoted message said:
thus keep you in the dark because of the generalization that all
prostate
Quoted message said:
Quoted message said:
Quoted message said:
cancer patients should not have known. Why bother going to a doctor in the first place. He has a cynical
position.
Quoted message said:
Quoted message said:
Quoted message said:
We are all going to die anyways of something or another in the long run. If the survival rates of those having treatment or not is the same than
it
Quoted message said:
Quoted message said:
Quoted message said:
becomes entirely an emtional issue. You need to support the emotional
needs
Quoted message said:
Quoted message said:
Quoted message said:
of the individual and the hell with the doctor.
Hey, WHOA! Please don't put words in my mouth. This all started with my posting of an article concerning the opinions of a credentialled researcher and commentator. I never said that anyone should be "prevented" from having all the tests one wants (and is willing to pay for). Anyone who wants to have needles inserted through their rectal wall is fully entitled to that bit of pleasure; I make no attempt to deny such folks their preferences.
But for me, who had a borderline PSA test (7) 10 years ago and who is otherwise healthy (at age 66), it doesn't make sense for me to get "screening tests". My family physician agrees, and that's good enough for me. But, those of you who want to be pushed and prodded, please be my guest!
Do you continue to have PSA tests, or have you stopped all such testing? If your PSA is rising, why don't you have a biopsy to at least see what the situation is? It is a relatively safe procedure and if done properly not particularly painful. If it turns out you do have prostate cancer, you don't have to have it treated. Why don't you make the decision with all the information available?
I know there are arguments for your course of action, and I am not suggesting that your decision was wrong. But I am curious as to just how you rationalized your choice. ^^^^^^^^^^^^
A value-neutral of saying this would be, "But I am curious as to just how you made your choice." What you have written shows you think he made a mistake.
"Robert" <[email hidden]> wrote in message "]news:[email hidden]...
Quoted message said:
"Robert A. Fink, M. D." <[email hidden]> wrote in message "]news:[email hidden]...
Quoted message said:
Robert said:
Dr Fink doesn't want to give us the option of deciding on our own
individual
Quoted message said:
Quoted message said:
risk assessment. He doesn't want you to know if you have cancer or not
and
Quoted message said:
Quoted message said:
thus keep you in the dark because of the generalization that all
prostate
Quoted message said:
Quoted message said:
Quoted message said:
cancer patients should not have known. Why bother going to a doctor in the first place. He has a cynical
position.
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Quoted message said:
We are all going to die anyways of something or another in the long
run.
Quoted message said:
Quoted message said:
Quoted message said:
If the survival rates of those having treatment or not is the same than
it
Quoted message said:
Quoted message said:
becomes entirely an emtional issue. You need to support the emotional
needs
Quoted message said:
Quoted message said:
of the individual and the hell with the doctor.
Hey, WHOA! Please don't put words in my mouth. This all started with my posting of an article concerning the opinions of a credentialled researcher and commentator. I never said that anyone should be "prevented" from having all the tests one wants (and is willing to pay for). Anyone who wants to have needles inserted through their rectal wall is fully entitled to that bit of pleasure; I make no attempt to deny such folks their preferences.
"That bit of pleasure"? You are dealing with that phobia of yours of invasive procedures from a strickly emotional point of view.
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But for me, who had a borderline PSA test (7) 10 years ago and who is otherwise healthy (at age 66), it doesn't make sense for me to get "screening tests". My family physician agrees, and that's good enough for me. But, those of you who want to be pushed and prodded, please be my guest!
You may have had prostatitis or something else elevating your PSA. No said PSA was 100% specific for anything. More definitive testing would have to
be
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undertaken and if you want to put your head in the sand and don't want to know if it's cancer or not then find plenty of sand.
Here we go again: if you don't do what I tell you to do, then you are putting your head in the sand. Shame.
"Leonard Evens" <[email hidden]> wrote in message "]news:[email hidden]...
Quoted message said:
George Conklin said:
"Leonard Evens" <[email hidden]> wrote in message "]news:[email hidden]...
>dale.j. wrote: > > >>In article <[email hidden]- >>arthlink.net>, "George Conklin" <[email hidden]> >>wrote: >> >> >> >> >>>Not according to the article. Early detection simply >>>means you know
about
>>>it earlier. >> >> >>But wouldent that be a good thing? > >Again it depends. If there is no known effective >treatment, knowing about it early rather than late may >not be helpful. > >For prostate cancer I think it is generally helpful.
That is a value statement. The science is not yet established.
You don't
>necessarily have to treat prostate cancer just because >you know you have >it. It depends on the details of the diagnosis, the > age of the patient and some other factors. > > > > >>Dale J. >> >
Or, it might not matter at all given current treatments, right?
That's right. It might not. But I think there is significant evidence that current treatments are helpful in many cases. I keep describing my particular case, where I had to make a decision about what to do based on the available evidence. I opted for treatment and I think the science, while uncertain, combined with my particular attitudes towards different risks, justified that. From the sorts of things you say, it seems to me---again a value judgement---that you don't understand much about current knowledge about prostate cancer, but you still seem to like to make statements about it.
Anything you have read is filtered through your emotional need to justify whatever it was you did. But your personal case is irrelevant in a science group. I'm sorry your emotions get in the way all the time.
This "science" group has precious little science of any kind. You certainly don't usually address any scientific issues. This is a characteristic of many other "science" groups. You just spend your time telling me how "emotional" I am. But I think, despite my highly "emotional" state, I actually spend much more time discussing the actual science than you do.
