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Re: Rich1234 post# 21514

Wednesday, 08/12/2009 6:40:05 PM

Wednesday, August 12, 2009 6:40:05 PM

Post# of 30387
Besides your points, which I find interesting, there is another issue: Whether or not the cancer will be treated (e.g. in older men with a slow growing cancer), the doctor and the patient NEED TO KNOW.

Gold Seeker's position is that since most (but not all) older men with a slow growing prostate cancer should not be treated, let us not diagnose it!

Another thing that GS leaves aside is that the biopsy can tell how aggressive a cancer is. Some older men get an aggressive prostate cancer. Well, according to GS those guys should die of that cancer because it is better not to diagnose them since most patients will get no treatment.

Yet another thing that GS does not consider is that the biopsy can tell if the cancer is aggressive or slow growing:

At this time, the pathologist can also look at the cancer cells to determine how abnormal they are. This is called the cancer’s “grade”. A high grade means that the cells are very abnormal and that the cancer is more likely to spread. (from http://prostatecancer.about.com/od/symptomsanddiagnosis/a/diagnosis.htm)

Thus, a RECAF test would help because it could trigger a biopsy (but reducing significantly the number of unnecessary biopsies PSA produces) and the pathology would determine how aggressive the cancer is and therefore the subsequent treatment of the patient.

Finally, GS does not consider how the medical system works. If a patient is RECAF positive chances are that he or she has cancer. The doctor will look for that cancer using other tools which are more location specific and expensive. If the cancer is not found, then the doctor will check the patient periodically and follow up with another RECAF test.

In terms of the lung cancer example, GS is also disregarding how it works: Here is how it DOES NOT work: There is the suspicion of a lung cancer, the doctor orders a RECAF test and it comes positive (because the patient is an old man with an indolent prostate cancer). The doctor schedules an operation to remove the lung... RECAF is just ONE piece of the diagnostic thread. It is also likely that the patient would get a PSA test and if it is positive then (a) the RECAF test would have less weight in determining the diagnosis and (b) the patient should be studied for prostate cancer because it could very well be that the lung is healthy after all, but the patient has an aggressive prostate cancer that might kill him.

All these overlooks happen when things are simplified to an extreme that is not consistent with reality. Life is complex.

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