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A_DeMichele said:
Urorad guy not treating the nodes? Got bless him. Everyone now is treating the nodes, since that’s the only way to get 45 fx approved
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I think about this a lot.

If I was 52 and was diagnosed with 3+3 prostate cancer, I would want to see both a surgeon with significant Da Vinci experience (too many publications is a negative) and a Radiation Oncologist.

I want them both to offer me Active Surveillance.

If the RadOnc pushes hydrogel, I'm going for a second opinion. I'm totally OK with having the conversation, but not being pushed.

I would then ask for conventional XRT, prostate + proximal SVs, no nodes.

This is not necessarily what I'd want for other people, of course. This is just what would make ME feel the most comfortable. There are some dudes who would rather die than lose sexual function. There are other dudes who think surgery is the only "real" treatment.

We can't see the future, we don't know absolute truth. The best we can do is try to keep our patients on the spectrum of "reasonable medicine" in a way that they don't experience "process regret". Monday Morning Quarterback is a whole different thing.
 
elementaryschooleconomics said:
I think about this a lot.

If I was 52 and was diagnosed with 3+3 prostate cancer, I would want to see both a surgeon with significant Da Vinci experience (too many publications is a negative) and a Radiation Oncologist.

I want them both to offer me Active Surveillance.

If the RadOnc pushes hydrogel, I'm going for a second opinion. I'm totally OK with having the conversation, but not being pushed.

I would then ask for conventional XRT, prostate + proximal SVs, no nodes.

This is not necessarily what I'd want for other people, of course. This is just what would make ME feel the most comfortable. There are some dudes who would rather die than lose sexual function. There are other dudes who think surgery is the only "real" treatment.

We can't see the future, we don't know absolute truth. The best we can do is try to keep our patients on the spectrum of "reasonable medicine" in a way that they don't experience "process regret". Monday Morning Quarterback is a whole different thing.
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I think prostatectomy is an insane treatment (highest ED, urinary incontinence, higher need for salvage local treatment). I would not get surgery if I was 45 or 75, low risk or high risk.

If very low risk, I would elect AS. If low-fav intermediate, I would elect SBRT or brachy. If higher, I would elect combo brachy and conventional frac IMRT treatment. Would also do spacer.
 
RickyScott said:
If remember correctly, In protect trial, 50% of fully potent men who had active surveillance at 60 had ED at 65. It was about 60% in xrt arm, so 10% increase, and usually responsive to PDIs (which are good for overall health anyway)
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It's a trial from the UK. The weather is horrible there.
 
If I were 52 with lr prostate cancer, step 1 is an MRI. If nothing of note, step 2 is as. While soc to treat this patient, I think it's wrong to do so in someone so young without an MRI. I'd also want to know if I might be under treating.
 
Ray D. Ayshun said:
If I were 52 with lr prostate cancer, step 1 is an MRI. If nothing of note, step 2 is as. While soc to treat this patient, I think it's wrong to do so in someone so young without an MRI. I'd also want to know if I might be under treating.
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What’s the point to the MRI if you are going to be treating anyway? Do you use a different dose and fractionation based on how the MRI looks?
 
thesauce said:
What’s the point to the MRI if you are going to be treating anyway? Do you use a different dose and fractionation based on how the MRI looks?
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If pirads 5 lesion, not low risk probably. Needs targeted biopsy. Might need adt, treatment of svs, and discussion about pelvis
 
thesauce said:
What’s the point to the MRI if you are going to be treating anyway? Do you use a different dose and fractionation based on how the MRI looks?
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If treating regardless, I say no point
A guy that age should have had MRI before biopsy, that's what I would want
If going to be doing surveillance, MRI can be useful in identifying how good biopsy was in first place and as baseline going forward to prevent additional surveillance biopsies "just because"
So many guys on surveillance would rather get treatment than another biopsy once they hit 2-3x
 
Ray D. Ayshun said:
If pirads 5 lesion, not low risk probably. Needs targeted biopsy. Might need adt, treatment of svs, and discussion about pelvis
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I wouldn’t go looking for reasons to escalate the therapy in a scenario of PSA barely above normal and low volume G3+3.

Long-term follow up of studies looking at such patients long before MRIs became so popular show virtually 100% bpfs. Yeah, you might catch that 1 in 1000 that will benefit, but then you are doing 999 for nothing.
 
Lets just go back to DRE and throw in a genetic test. Combine those two and see if it is a better predictor than anything else (ie the zillions spent on PSA/MRI/surveillance biopsies).

Dinosaur style..
 
thesauce said:
I wouldn’t go looking for reasons to escalate the therapy in a scenario of PSA barely above normal and low volume G3+3.

Long-term follow up of studies looking at such patients long before MRIs became so popular show virtually 100% bpfs. Yeah, you might catch that 1 in 1000 that will benefit, but then you are doing 999 for nothing.
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I'd want the MRI to confirm AS is wise. BPFS is probably 75% if it's as it looks if he/I does nothing.
 
I think the energy of being angry with people who stand up for POC or other disenfranchised groups would be better spent on other things. Most of these folks, if probed, don't exactly come back as thoughtful individuals oozing kindness. And many sadly are cretins, like gum stuck on your shoe.

Screaming at someone "wokism" is not helpful, productive or meaningful. However, on the other extreme.. cancelling someone's JOB despite taking all measures to be sensitive (the Hamline U prof case) is ridiculous overkill.
 
Chartreuse Wombat said:
Context below

vinayprasadmdmph.substack.com

Are Republicans allowed to be doctors?

A growing movement says no. Should we be concerned?
vinayprasadmdmph.substack.com vinayprasadmdmph.substack.com
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That article was so silly. It's sad because Vinay writes really good stuff about oncology and his other work has caused people to blacklist everything he says from their lives. For oncology, hes still one of the few voices to push back against the ridiculous and growing pharma/shill messaging. Both voices are of value to clinicians.
 
NotMattSpraker said:
That article was so silly. It's sad because Vinay writes really good stuff about oncology and his other work has caused people to blacklist everything he says from their lives. For oncology, hes still one of the few voices to push back against the ridiculous and growing pharma/shill messaging. Both voices are of value to clinicians.
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Please explain what was silly.
 
NotMattSpraker said:
That article was so silly. It's sad because Vinay writes really good stuff about oncology and his other work has caused people to blacklist everything he says from their lives. For oncology, hes still one of the few voices to push back against the ridiculous and growing pharma/shill messaging. Both voices are of value to clinicians.
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At risk of going out on a limb… I think he raises an uncomfortable but pertinent question. I am pretty far left of center and academia has always been progressive in recent years, which I support… but I am little concerned about the growing intolerance for those with conservative views -I bet there are quite a few folks who truly do question whether conservatives should be allowed to practice medicine, which truly is ‘silly’
 
Chartreuse Wombat said:
Please explain what was silly.
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To me it seems like an alarmist thought experiment designed to rile up conservative readers. If you look at the comments, that's exactly what it did. II realize that's the way of the world now, but it's still silly. Does Vinay think that someone could be banned from all medical schools for their political beliefs? Come on.

Do you really not know any republican doctors? I know a lot of them.

Lamount said:
At risk of going out on a limb… I think he raises an uncomfortable but pertinent question. I am pretty far left of center and academia has always been progressive in recent years, which I support… but I am little concerned about the growing intolerance for those with conservative views -I bet there are quite a few folks who truly do question whether conservatives should be allowed to practice medicine, which truly is ‘silly’
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Im curious what you want to happen here. This was the STS response to the slide, which is very reasonable. A Statement from STS President Thomas MacGillivray and the STS Board of Directors | STS

Their job is to grow the membership, being inclusive is the best way to do that. Certainly, being contrarian about a contentious current events issue is not a good idea for a society message. If people are sad that STS is not openly against affirmative action, then they can drop the society.

To be clear, even though Im not conservative or republican, I bet I mostly agree with both of you. I just don't think Vinay's article is good or the STS did anything wrong.
 
He seems to conflate party affiliation with certain specific beliefs. (Nevermind that his chart summarizes those who have a party. I'll never vote republican, but am a registered independent. Like Bernie Sanders). In any case, not all republicans are anti-choice. There are certain issues that we as doctors should be inflexible about. If not choice, then I'm sure there's something we can agree on. Perhaps it's simply that academic medicine, and academics as a whole, hold to certain ideals that happen to be more in line with the dem party line. Perhaps there are reasons for this that go beyond just getting Obama elected. I'm pretty sure nobody would be upset if an admitted Nazi was passed over in the hiring process. It wouldn't be because he didn't know how to dress sharply. There's gotta be a line somewhere, and it's simplistic to say it's just political party. Unfortunately, in the last 6-8 years it's become quite stark, and perhaps that's where the issues lie, but the principles underlying the parties don't differ that greatly. The confederate flaggiest dude out there would be shocked if he actually looked up the definition of liberalism.
 
NotMattSpraker said:
To me it seems like an alarmist thought experiment designed to rile up conservative readers. If you look at the comments, that's exactly what it did. II realize that's the way of the world now, but it's still silly. Does Vinay think that someone could be banned from all medical schools for their political beliefs? Come on.

Do you really not know any republican doctors? I know a lot of them.



Im curious what you want to happen here. This was the STS response to the slide, which is very reasonable. A Statement from STS President Thomas MacGillivray and the STS Board of Directors | STS

Their job is to grow the membership, being inclusive is the best way to do that. Certainly, being contrarian about a contentious current events issue is not a good idea for a society message. If people are sad that STS is not openly against affirmative action, then they can drop the society.

To be clear, even though Im not conservative or republican, I bet I mostly agree with both of you. I just don't think Vinay's article is good or the STS did anything wrong.
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I don’t really object to what STS said… AA is one of those topics I go back and forth on, but I don’t think it is wrong for STS to push back on a view expressed by a member that contrasts with the view of the majority members.

Regarding the article… it may not be the greatest way to frame the argument, but I appreciate the underlying point. Since graduating med school nearly a decade ago, I have seen a marked shift toward the left in academia. While, as a liberal, I tend to be supportive of left-leaning policies, I worry that we may be veering toward illiberalism -where some are starting to question a doctor’s ability to practice medicine (or even their worth as a person) based on their political beliefs. It’s feeling increasingly rigid out there and it makes me nervous.
 
NotMattSpraker said:
To me it seems like an alarmist thought experiment designed to rile up conservative readers. If you look at the comments, that's exactly what it did. II realize that's the way of the world now, but it's still silly. Does Vinay think that someone could be banned from all medical schools for their political beliefs? Come on.

Do you really not know any republican doctors? I know a lot of them.



Im curious what you want to happen here. This was the STS response to the slide, which is very reasonable. A Statement from STS President Thomas MacGillivray and the STS Board of Directors | STS

Their job is to grow the membership, being inclusive is the best way to do that. Certainly, being contrarian about a contentious current events issue is not a good idea for a society message. If people are sad that STS is not openly against affirmative action, then they can drop the society.

To be clear, even though Im not conservative or republican, I bet I mostly agree with both of you. I just don't think Vinay's article is good or the STS did anything wrong.
Click to expand...
I am not trying to be provocative.

You think that the STS Board response is reasonable. Perhaps it is but I would bet good money that the STS Board has no idea what the membership thinks about these issues. I am happy to be proven wrong but it is tiresome to have "leadership" state what a group believes in when they know nothing about what the group believes. You can say that this is leadership but ask yourself has ASTRO represented your beliefs?

ASTRO invited Kendi and paid him handsomely (is that word allowed?). I completely disagree with the ASTRO Board on this decision yet to question that decision is to be labeled a racist...

I also question the information about party affiliation by specialty type in the Prasad piece (that was the silly part for me). I suspect the survey data is really weak but it seems to support an underlying narrative that is hard to disprove.

I do hold some conservative beliefs along with liberal beliefs as well. I am a registered independent and will always be so but if you don't think that many in the academy are afraid to speak their minds (especially if it is not consistent with the dominant narrative) then you are not paying attention.
 
Lamount said:
I don’t really object to what STS said… AA is one of those topics I go back and forth on, but I don’t think it is wrong for STS to push back on a view expressed by a member that contrasts with the view of the majority members.

Regarding the article… it may not be the greatest way to frame the argument, but I appreciate the underlying point. Since graduating med school nearly a decade ago, I have seen a marked shift toward the left in academia. While, as a liberal, I tend to be supportive of left-leaning policies, I worry that we may be veering toward illiberalism -where some are starting to question a doctor’s ability to practice medicine (or even their worth as a person) based on their political beliefs. It’s feeling increasingly rigid out there and it makes me nervous.
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The problem is that literally everything has become political during that time frame. Science, masks, climate change, vaccines etc. Everything is political. Even when it shouldn't be
 
Lamount said:
I don’t really object to what STS said… AA is one of those topics I go back and forth on, but I don’t think it is wrong for STS to push back on a view expressed by a member that contrasts with the view of the majority members.

Regarding the article… it may not be the greatest way to frame the argument, but I appreciate the underlying point. Since graduating med school nearly a decade ago, I have seen a marked shift toward the left in academia. While, as a liberal, I tend to be supportive of left-leaning policies, I worry that we may be veering toward illiberalism -where some are starting to question a doctor’s ability to practice medicine (or even their worth as a person) based on their political beliefs. It’s feeling increasingly rigid out there and it makes me nervous.
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Liberals against leftists. It’s a real problem in San francisco
 
RickyScott said:
Liberals against leftists. It’s a real problem in San francisco
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Liberalism and leftism overlap but for their tolerance of the existence of conservatives…

From my point of view, 99% of the time, politics should be the subject of a lighthearted debate, not a reason to dismiss or dislike someone
 
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Lamount said:
Liberalism and leftism overlap but for their tolerance of the existence of conservatives…

From my point of view, 99% of the time, politics should be the subject of a lighthearted debate, not a reason to dismiss or dislike someone
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But many conservatives are neoclassical liberals? My issue with leftsits is the intolerance of liberal values like freedom of speech. Arguing for meritocracy without regard to DEI is an absolutely legitimate argument, even if you disagree with it. It’s not fringe and it’s not racist and well intentioned, intelligent people can fall on both sides.
 
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RickyScott said:
But many conservatives are neoclassical liberals? My issue with leftsits is the intolerance of liberal values like freedom of speech. Arguing for meritocracy without regard to DEI is an absolutely legitimate argument, even if you disagree with it. It’s not fringe and it’s not racist and well intentioned, intelligent people can fall on both sides.
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Agree. I’d much rather debate someone with whom I disagree… there is no need to silence dissenting voices. The very essence of reason is the ability to allow oneself to be convinced by a good argument
 
Oh you big tease. But I don't doubt it. The screaming anti-wokists almost always have some zinger waiting to get revealed. Infidelity, theft, sedition, or just good old fashioned racism, antisemitism and whatnot.

Sigh. Can we just stop it?
 
Lamount said:
Agree. I’d much rather debate someone with whom I disagree… there is no need to silence dissenting voices. The very essence of reason is the ability to allow oneself to be convinced by a good argument
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How do you rationalize with an irrational person? Especially if this is where are country is going:

www.forbes.com

Poll: Half Of Trump Supporters Believe Baseless Child Sex-Trafficking QAnon Claims

Most registered voters (55%) say they’ve never heard of QAnon.
www.forbes.com www.forbes.com

www.nytimes.com

The Most Influential Spreader of Coronavirus Misinformation Online (Published 2021)

Researchers and regulators say Joseph Mercola, an osteopathic physician, creates and profits from misleading claims about Covid-19 vaccines.
www.nytimes.com www.nytimes.com

 
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RadOncDoc21 said:
How do you rationalize with an irrational person? Especially if this is where are country is going:

www.forbes.com

Poll: Half Of Trump Supporters Believe Baseless Child Sex-Trafficking QAnon Claims

Most registered voters (55%) say they’ve never heard of QAnon.
www.forbes.com www.forbes.com

www.nytimes.com

The Most Influential Spreader of Coronavirus Misinformation Online (Published 2021)

Researchers and regulators say Joseph Mercola, an osteopathic physician, creates and profits from misleading claims about Covid-19 vaccines.
www.nytimes.com www.nytimes.com

Click to expand...

You don’t have to. There’s a lot of daylight between us, and conspiracy theorists. I bet that some of your esteemed colleagues (and perhaps even your friends) hold some conservative perspectives that they may be too uncomfortable to share… because they are afraid of being reflexively lumped in with Qanon supporters.

Additionally, there is a big difference between a good doc who holds “out there” beliefs and one who practices bad medicine based on these beliefs.
 
Lamount said:
You don’t have to. There’s a lot of daylight between us, and conspiracy theorists. I bet that some of your esteemed colleagues (and perhaps even your friends) hold some conservative perspectives that they may be too uncomfortable to share… because they are afraid of being reflexively lumped in with Qanon supporters.

Additionally, there is a big difference between a good doc who holds “out there” beliefs and one who practices bad medicine based on these beliefs.
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Used to be the case, unfortunately a lot of folks have been drinking the kool aid thrown at them. Politics has made its way into everything (nfl, vaccines, education, work, Disney, SDN, etc).
 
27% of America believe baseless sex trafficking claims? Geez that seems high. Should I believe this extremely reliable source/mainstream media poll?
 
RadOncDoc21 said:
How do you rationalize with an irrational person? Especially if this is where are country is going:

www.forbes.com

Poll: Half Of Trump Supporters Believe Baseless Child Sex-Trafficking QAnon Claims

Most registered voters (55%) say they’ve never heard of QAnon.
www.forbes.com www.forbes.com

www.nytimes.com

The Most Influential Spreader of Coronavirus Misinformation Online (Published 2021)

Researchers and regulators say Joseph Mercola, an osteopathic physician, creates and profits from misleading claims about Covid-19 vaccines.
www.nytimes.com www.nytimes.com

Click to expand...

What opens up the space here for conspiracies is the price gouging by hospitals and big pharma. It’s not unreasonable for a layperson to think that modern medicine is a “fraud” and corrupt when pharma charges 150k for a drug and the hospitals are even worse. Drives the public into the arms of hucksters like Dr. mercola.

When hospitals charge10x cms rates, they contribute to a generalized deligitamization and lack of trust in medicine. We all agree that some of the billing is basically legalized theft. Why is it so unreasonable that some of the public refuse to trust them with their health.

(Can you really trust your radonc and the medical system when the hospital receives 200k for your prostate cancer radiation.)
 
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RickyScott said:
What opens up the space here for conspiracies is the price gouging by hospitals and big pharma. It’s not unreasonable for a layperson to think that modern medicine is a “fraud” and corrupt when pharma charges 150k for a drug and the hospitals are even worse. Drives the public into the arms of hucksters like Dr. mercola.

When hospitals charges 10x cms rates, they contribute to a generalized deligitamization and lack of trust in medicine. We all agree that some of the billing is basically legalized theft. Why is it so unreasonable that some of the public refuse to trust them with their health.

(Can you really trust your radonc and the medical system when the hospital receives 200k for your prostate cancer radiation.)
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I mean big pharma, insurance, hospitals, corporations have been raping us for years. Back in the day, it was one side believed in tax cuts for the rich and the other believed in raising taxes. Depending on one’s situation, I could see an argument from either side but you have to admit we have crossed the line regarding rationale thinking. We can’t even agree on the basis of the arguments we use to agree upon.
 
Chartreuse Wombat said:
You think that the STS Board response is reasonable. Perhaps it is but I would bet good money that the STS Board has no idea what the membership thinks about these issues. I am happy to be proven wrong but it is tiresome to have "leadership" state what a group believes in when they know nothing about what the group believes. You can say that this is leadership but ask yourself has ASTRO represented your beliefs?
Click to expand...

No, which is part of why I dropped my membership. This was more about other things than Kendi. There are plenty of reasons to dislike ASTRO. Certainly they are highly performative on DEI so I wouldn't blame you. Their keynotes are just usually lame so I didn't see any issue with it. FWIW when they picked him, I read the book and also thought it was pretty dumb compared to others on the topic. I had a really nice journal club with some ROs though.

There is a really good book about how "activist scholarship" has evolved in academics out of postmodernism. It's called Cynical Theories by Helen Pluckrose. You might enjoy it, but warning its very dry.

Chartreuse Wombat said:
I am a registered independent and will always be so but if you don't think that many in the academy are afraid to speak their minds (especially if it is not consistent with the dominant narrative) then you are not paying attention.
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I didn't say that. I dont disagree. But it sounds like what you really want is for people "against the mainstream" to be able to speak their mind AND also that the masses will agree with them. Sorry, but that's not realistic in our hyperpolarized world. That's why we have California and Florida 🙂
 
NotMattSpraker said:
. Sorry, but that's not realistic in our hyperpolarized world. That's why we have California and Florida 🙂
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FL used to be pretty moderate.... In some ways it still is despite the bluster. No 6 week abortion ban, legalized medical cannabis etc. Maybe you're thinking Cali and Mississippi?
 
RadOncDoc21 said:
I mean big pharma, insurance, hospitals, corporations have been raping us for years. Back in the day, it was one side believed in tax cuts for the rich and the other believed in raising taxes. Depending on one’s situation, I could see an argument from either side but you have to admit we have crossed the line regarding rationale thinking. We can’t even agree on the basis of the arguments we use to agree upon.
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It's funny now it's not about taxes at all... Honestly the last guy actually shared some views with Bernie Sanders on free trade and covid cash handouts. Now it's literally about anything but taxes. Very tribal these days
 
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medgator said:
It's funny now it's not about taxes at all... Honestly the last guy actually shared some views with Bernie Sanders on free trade and covid cash handouts. Now it's literally about anything but taxes. Very tribal these days
Click to expand...

Ted Cruz VS Xbox: The Senator Criticized The Console For Being 'Woke' - Microsoft (NASDAQ:MSFT)

Ted Cruz (R-TX), U.S. Senator and former presidential candidate, targeted Microsoft (NASDAQ: MSFT)’s Xbox after the company announced it would include a new update to reduce the console’s carbon footprint.
www.benzinga.com www.benzinga.com
 
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