screening PSAs

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OTN said:
There is zero chance (0%, empty set, null) that this is a new prostate cancer diagnosis. Any oncologist suggesting it is has political motivations for doing so.
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???

How can you make a definitive statement like that? I'm not saying that you're definitely wrong, but your post more so reads like someone who has political motivations for stating that this is NOT a new cancer diagnosis.

The report is that he hasn't had a PSA checked since 2014. Why is it crazy for him to metastatic pCA, especially Gleason 5+4=9 disease?

Even if that report was mistaken and he had a PSA in 2019 (and not since then) he could totally have developed metastatic disease from nothing in 5-6 years.

To suggest that there is NO POSSIBLE WAY that his PCP didn't screen him for prostate cancer (for whatever reason, be it for personal or political reasons) AS IS RECOMMENDED by the USPSTF (and there is a whole separate discussion about value of PSA screening in all men, let alone men > 70) is.... hyperbolic.

If he had pCA when he was president, we would've very likely have learned about the diagnosis in SOME manner. It's far too juicy of a story to truly keep under wraps, HIPAA be damned.

It's not like he got colon cancer because he didn't get his RECOMMENDED colonoscopies. He followed instructions from USPSTF and did not get PSA screening.

I mean it doesn't even matter if he has metastatic disease, average lifetime from diagnosis to death in metastatic cancer is 8 years.
 
evilbooyaa said:
???

How can you make a definitive statement like that? I'm not saying that you're definitely wrong, but your post more so reads like someone who has political motivations for stating that this is NOT a new cancer diagnosis.

The report is that he hasn't had a PSA checked since 2014. Why is it crazy for him to metastatic pCA, especially Gleason 5+4=9 disease?

Even if that report was mistaken and he had a PSA in 2019 (and not since then) he could totally have developed metastatic disease from nothing in 5-6 years.

To suggest that there is NO POSSIBLE WAY that his PCP didn't screen him for prostate cancer (for whatever reason, be it for personal or political reasons) AS IS RECOMMENDED by the USPSTF (and there is a whole separate discussion about value of PSA screening in all men, let alone men > 70) is.... hyperbolic.

If he had pCA when he was president, we would've very likely have learned about the diagnosis in SOME manner. It's far too juicy of a story to truly keep under wraps, HIPAA be damned.

It's not like he got colon cancer because he didn't get his RECOMMENDED colonoscopies. He followed instructions from USPSTF and did not get PSA screening.

I mean it doesn't even matter if he has metastatic disease, average lifetime from diagnosis to death in metastatic cancer is 8 years.
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If a sitting president didn't have his PSA checked since 2014, that's worse and it's also something I simply do not believe.
 
Are we really going to keep playing the "your very reasonable common sense suspicions are looney conspiratorial thinking you probably got from some fringe extremist website so we will censor and mock you instead" gaslighting game? Occam's razor is a myth? Bullets really can zigzag and do U-turns in mid-air? The past 5 years of cycling this with an eventual "can't we just move on" mea culpa when what was always obvious can no longer be denied hasn't taught you anything? How many times do we have to go through this?

Equating even a grade group 5 prostate cancer to a neuroendocrine cancer in terms of aggressiveness is pretty disingenuous.

But... right now I am trying to figure out why the man I treated a year ago for a grade group 5 prostate cancer (prostate+nodes+LT-ADT) now has developed a femoral neck pathologic fracture despite effective hormone suppression with an undetectable PSA since. Looking back at his sim a year ago there was maybe a tiny something there. Maybe. If you squint really really hard. So maybe this really is a magical disease. What's the explanation for this? By treating the prostate did I induce a metastatic lesion ala some Ralph Weichselbaum voodoo?
(to clarify, this was not a NEPC, it was an acinar adenocarcinoma with a pretreatment PSA of 8).
 
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OTN said:
If a sitting president didn't have his PSA checked since 2014, that's worse and it's also something I simply do not believe.
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But WHY do you feel that that is worse?

USPSTF specifically recommends against checking PSAs in men over the age of 70. 11 years ago (in 2014) Joey B was 71. He got guideline concordant care.

If JB was a FM boards answer choice, he got a very acceptable SOC. Again, I'm not agreeing or disagreeing with the USPSTF recommendations, but just stating that they do exist and JB's care was concordant.

alwaysbeIMRTing said:
Are we really going to keep playing the "your very reasonable common sense suspicions are looney conspiratorial thinking you probably got from some fringe extremist website so we will censor and mock you instead" gaslighting game? Occam's razor is a myth? Bullets really can zigzag and do U-turns in mid-air? The past 5 years of cycling this with an eventual "can't we just move on" mea culpa when what was always obvious can no longer be denied hasn't taught you anything? How many times do we have to go through this?

Equating even a grade group 5 prostate cancer to a neuroendocrine cancer in terms of aggressiveness is pretty disingenuous.

But... right now I am trying to figure out why the man I treated a year ago for a grade group 5 prostate cancer (prostate+nodes+LT-ADT) now has developed a femoral neck pathologic fracture despite effective hormone suppression with an undetectable PSA since. Looking back at his sim a year ago there was maybe a tiny something there. Maybe. If you squint really really hard. So maybe this really is a magical disease. What's the explanation for this? By treating the prostate did I induce a metastatic lesion ala some Ralph Weichselbaum voodoo?
(to clarify, this was not a NEPC, it was an acinar adenocarcinoma with a pretreatment PSA of 8).
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If there is a prostate adenocarcinoma that is going to be so poorly differentiated that PSA is an insufficient marker for disease tracking (a, it's definitely going to be a GG5 one.
 
I was firmly in the "anything is possible" camp, especially with Gleason 9 disease. I was also fine with not checking a PSA as a screening tool. Maybe not the best idea for a POTUS but in my Overton Window for reasonable.

What I find fishy is that they said he had a "surgical procedure" for BPH presumably in 2019 or 2020.

I find it hard to believe he had bad enough LUTS that he needed a procedure but no one checked a PSA. It's no longer screening when you have a dude that needs a procedure. It's part of standard of care.
 
BobbyHeenan said:
I was firmly in the "anything is possible" camp, especially with Gleason 9 disease. I was also fine with not checking a PSA as a screening tool. Maybe not the best idea for a POTUS but in my Overton Window for reasonable.

What I find fishy is that they said he had a "surgical procedure" for BPH presumably in 2019 or 2020.

I find it hard to believe he had bad enough LUTS that he needed a procedure but no one checked a PSA. It's no longer screening when you have a dude that needs a procedure. It's part of standard of care.
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I agree that’s the strange part for me
 
alwaysbeIMRTing said:
But... right now I am trying to figure out why the man I treated a year ago for a grade group 5 prostate cancer (prostate+nodes+LT-ADT) now has developed a femoral neck pathologic fracture despite effective hormone suppression with an undetectable PSA since. Looking back at his sim a year ago there was maybe a tiny something there. Maybe. If you squint really really hard. So maybe this really is a magical disease. What's the explanation for this? By treating the prostate did I induce a metastatic lesion ala some Ralph Weichselbaum voodoo?
(to clarify, this was not a NEPC, it was an acinar adenocarcinoma with a pretreatment PSA of 8)
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Kinda, sorta supporting the "**** happens" hypothesis. By the time you get to the 80-84 age group, 95th percentile PSA is around 12, go up to 85+ yo...and its 33!

There are PSA negative tumors. There are heterogeneous cancer populations within the prostate (some clonagens PSA secreting). Some cancer is in fact "magic"...or an outlier.

Grade of prostate cancer goes up on average with age (not like bCa).

I see old guys with PSA 6, GG5 disease fairly frequently.

I just see no shocking news here regarding Biden (an old guy diagnosed with high grade metastatic pCa). I think the fact that there was clearly a cover up regarding PS has made us lose our critical faculties. (also, it's hardly germane to anything anymore...please lets consider things like the payment ramifications of the present budget bill instead).
 
communitydoc13 said:
I see old guys with PSA 6, GG5 disease fairly frequently.
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Yes. I just saw another one of these a few minutes ago. GG5, node positive, all cores involved, ECE+, mostly GG4. PSA 7. PSA had been regularly monitored for years.

The process that is baffling me is rapid metastatic dissemination following biochemically effective definitive treatment and androgen deprivation. Clearly the cancer was castrate sensitive with the PSA dropping to <0.06 ng/mL with Lupron. Suggesting a heterogeneous disease process with a component of the cancer not really producing the PSA nor responding to Lupron metastasizing and chewing through the femoral neck anyway? I mean, that does sound like NEPC. But that's not what it was if I trust the pathologist. Maybe I shouldn't.
 
A spokesperson said Biden first learned of his diagnosis late last week. "Prior to Friday, President Biden had never been diagnosed with prostate cancer," the spokesperson said.

Okay, so diagnosed with gs9 prostate cancer, petted with mets (presuming it wasn't a bone biopsy up front), with confirmation of being castrate sensitive in 4 days? i think we all know this is not possible.
 
alwaysbeIMRTing said:
Yes. I just saw another one of these a few minutes ago. GG5, node positive, all cores involved, ECE+, mostly GG4. PSA 7. PSA had been regularly monitored for years.

The process that is baffling me is rapid metastatic dissemination following biochemically effective definitive treatment and androgen deprivation. Clearly the cancer was castrate sensitive with the PSA dropping to <0.06 ng/mL with Lupron. Suggesting a heterogeneous disease process with a component of the cancer not really producing the PSA nor responding to Lupron metastasizing and chewing through the femoral neck anyway? I mean, that does sound like NEPC. But that's not what it was if I trust the pathologist. Maybe I shouldn't.
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PSA is not a reliable marker in a subset of high gleason grade prostate cancers. GG5 with undetectable PSA is not nearly as relevant as GG3 with undetectable PSA.

PSA 7 with all cores involved is HIGHLY suspicious for a de-differentiated comopnent (NOT necessarily neuroendocrine)

pubmed.ncbi.nlm.nih.gov

Clinical and Genomic Characterization of Low-Prostate-specific Antigen, High-grade Prostate Cancer - PubMed

In this study, we found that low-prostate-specific antigen, high-grade prostate cancer has a very high risk for prostate cancer death, may not respond well to androgen deprivation therapy, and is associated with neuroendocrine genomic features. These findings suggest that current nomograms and...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Ray D. Ayshun said:
A spokesperson said Biden first learned of his diagnosis late last week. "Prior to Friday, President Biden had never been diagnosed with prostate cancer," the spokesperson said.

Okay, so diagnosed with gs9 prostate cancer, petted with mets (presuming it wasn't a bone biopsy up front), with confirmation of being castrate sensitive in 4 days? i think we all know this is not possible.
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All initial metastatic prostate cancer is considered castrate sensitive until proven otherwise. Has anyone seen someone with new diagnosis of mPCA NOT have a response to ADT? Perhaps they should have said 'presumably' castrate sensitive.

But dude/dudette, biopsy and then PET then start ADT in 4 days sounds pretty doable for A FORMER PRESIDENT.

Seriously, I'm not a JB stan or anything, but the conspiracy theories from otherwise very reasonable people are wild right now.
 
Ray D. Ayshun said:
i think we all know this is not possible.
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Not possible for our patients.

Castrate sensitive is the de-facto state of prostate cancer (not always true in reality but until you demonstrate castrate resistance, progression with low T…it's castrate sensitive).

Biden could get a PET the same day as his biopsy results (not us).

Not crazy....not crazy.

edit: whoops...taken care of above
 
evilbooyaa said:
PSA is not a reliable marker in a subset of high gleason grade prostate cancers. GG5 with undetectable PSA is not nearly as relevant as GG3 with undetectable PSA.

PSA 7 with all cores involved is HIGHLY suspicious for a de-differentiated comopnent (NOT necessarily neuroendocrine)

pubmed.ncbi.nlm.nih.gov

Clinical and Genomic Characterization of Low-Prostate-specific Antigen, High-grade Prostate Cancer - PubMed

In this study, we found that low-prostate-specific antigen, high-grade prostate cancer has a very high risk for prostate cancer death, may not respond well to androgen deprivation therapy, and is associated with neuroendocrine genomic features. These findings suggest that current nomograms and...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov



All initial metastatic prostate cancer is considered castrate sensitive until proven otherwise. Has anyone seen someone with new diagnosis of mPCA NOT have a response to ADT? Perhaps they should have said 'presumably' castrate sensitive.

But dude/dudette, biopsy and then PET then start ADT in 4 days sounds pretty doable for A FORMER PRESIDENT.

Seriously, I'm not a JB stan or anything, but the conspiracy theories from otherwise very reasonable people are wild right now.
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Of course biopsy, pet and start ADT is reasonable for a former president. It’s that same logic that makes it unlikely that they didn’t check a PSA on him for over a decade.
 
Bequerel said:
Of course biopsy, pet and start ADT is reasonable for a former president. It’s that same logic that makes it unlikely that they didn’t check a PSA on him for over a decade.
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Wut? There are literally guidelines (not saying they are correct) that recommend not checking a PSA over this interval in an 82 yo.

There are no guidelines that recommend not treating metastatic (or even very high risk) pCa in old guys in as timely a fashion as possible.

So, the very same doctor could have been practicing guideline concordant medicine by both not screening with a PSA and then treating a VIP quite rapidly upon diagnosis.

I'm baffled!!!
 
evilbooyaa said:
But WHY do you feel that that is worse?

USPSTF specifically recommends against checking PSAs in men over the age of 70. 11 years ago (in 2014) Joey B was 71. He got guideline concordant care.

If JB was a FM boards answer choice, he got a very acceptable SOC. Again, I'm not agreeing or disagreeing with the USPSTF recommendations, but just stating that they do exist and JB's care was concordant.



If there is a prostate adenocarcinoma that is going to be so poorly differentiated that PSA is an insufficient marker for disease tracking (a, it's definitely going to be a GG5 one.
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The leader of the free world should be receiving more screening and workup than the general population. Why? Because their job is significantly more important than the average person and being healthy is paramount. I’m honestly shocked they don’t do top to bottom MRI and every possible test annually. Drop 1 trillion plus on the pentagon but can’t get the president a PSA…
 
Faol said:
The leader of the free world should be receiving more screening and workup than the general population. Why? Because their job is significantly more important than the average person and being healthy is paramount. I’m honestly shocked they don’t do top to bottom MRI and every possible test annually. Drop 1 trillion plus on the pentagon but can’t get the president a PSA…
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Screening is not recommended, not because most people are less important than the president, but because it literally doesn’t save lives (debate about the study methodology aside), whether you’re a homeless man or the commander in chief.

Being the president doesn’t make you immune to false positives, overtreatment, overinvestigation and attendant harms of that.

Yearly MRIs would be a daft idea for the same reason
 
What I really want to know. Did Biden get digital rectal exams. And if he did, did he like them.

TRUMP PRESS CONFERENCE TRANSCRIPT

Mar-a-Lago, Palm Beach, FL

“Thank you, thank you everybody. I just had what many are saying—many doctors are saying—was the most successful physical in the history of presidential physicals. Incredible results. Just incredible.

Now look, they did everything. Bloodwork? Perfect. Vision? Perfect. Reflexes? Like a cat. And yes—we're going to talk about it—they did the, uh, digital rectal exam. It’s a tremendous exam, folks. Very important. Very underrated. Some people are too afraid to do it. Not me. I said, ‘Doc, go ahead. Let’s do it. Let’s check the prostate. Let’s make sure it’s still the best prostate any president’s ever had.’

And folks, he was impressed. He said, ‘Mr. President, I’ve never seen a prostate like this. Symmetrical. Smooth. Strong.’ A very, very high-functioning gland, believe me. A lot of people don’t know this, but they said George Washington never even had his checked. Total disaster. Probably why he’s not around anymore.

They said, ‘Sir, do you want a sedative?’ I said, ‘No sedative. I do this raw. Like a man. Like Andrew Jackson would have done—if they had the science back then.’

Now look, some people say, ‘Why talk about it?’ Because men don’t talk about it! That’s the problem. You gotta check the prostate. It’s one of the top ten most presidential organs. Probably top five. Maybe number one. If you don’t check it, you could have problems. And we don’t like problems. We like winners. And my prostate? Total winner.

So I’m calling on all men, 50 and up—or 45, if you’re tremendous like me—to get checked. It's fast. It's easy. It's a little uncomfortable, sure. But not as uncomfortable as Biden’s economic policies, okay?

I handled it perfectly. Some are calling it heroic. They said it could be the most patriotic DRE in American history.

Thank you. God bless you, and God bless my extremely normal, perfectly examined prostate.”
 
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The outrage that a US president may have been receiving guideline based care no more intensive than the general public.

You can't even win when you are not an elitist.

Globally, we should not be electing leaders who have a 70+% chance of harboring occult pCa.

The hardest lesson I've had from being a doctor has nothing to do with mortality. It is an awareness of the unfortunate fact that in general, we do not become wiser as we become older.
 
communitydoc13 said:
The outrage that a US president may have been receiving guideline based care no more intensive than the general public.

You can't even win when you are not an elitist.

Globally, we should not be electing leaders who have a 70+% chance of harboring occult pCa.

The hardest lesson I've had from being a doctor has nothing to do with mortality. It is an awareness of the unfortunate fact that in general, we do not become wiser as we become older.
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Personally not outraged, just struggling to believe the deets given his position and the timing. I'm about to have a convo with a patient and his wife about combo ivermectin/mebendazole in the treatment of met panc cancer. Point being, if there is the least bit of a cover-up here it will further erode faith in us. That's not to say that makes sense, only that people are looking to trust the medical establishment less. TBH, I think given the way they butchered clarity re his mental fitness, they should have given every last detail on the diagnosis and work-up in this case.
 
Ray D. Ayshun said:
Personally not outraged, just struggling to believe the deets given his position and the timing. I'm about to have a convo with a patient and his wife about combo ivermectin/mebendazole in the treatment of met panc cancer. Point being, if there is the least bit of a cover-up here it will further erode faith in us. That's not to say that makes sense, only that people are looking to trust the medical establishment less. TBH, I think given the way they butchered clarity re his mental fitness, they should have given every last detail on the diagnosis and work-up in this case.
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We've got covfefe in office now. The one-sided outrage is really hypocritical IMO
 
Ray D. Ayshun said:
That's not to say that makes sense, only that people are looking to trust the medical establishment less.
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100%

Extraordinarily hard to combat this. We are seeing in real time how culture evolves when you allow every person to both self select and then be aggressively targeted by information that will preferentially feed fear responses and dopamine.

The result IMO is that simple (and almost universally false) narratives take hold. Science (even medicine) usually just not so simple, with all sorts of qualifiers and contingencies applicable to nearly every situation.

If your priors are being influenced by the Biden teams previous behavior...that's fair. But, this is really hardly a story.

We're hosed.
 
communitydoc13 said:
100%

Extraordinarily hard to combat this. We are seeing in real time how culture evolves when you allow every person to both self select and then be aggressively targeted by information that will preferentially feed fear responses and dopamine.

The result IMO is that simple (and almost universally false) narratives take hold. Science (even medicine) usually just not so simple, with all sorts of qualifiers and contingencies applicable to nearly every situation.

If your priors are being influenced by the Biden teams previous behavior...that's fair. But, this is really hardly a story.

We're hosed.
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This story would've made me cream my jeans:

Day 1: Former pres JB was found to have prostate cancer today (or yesterday) after presenting to his PCP a few weeks ago with new symptoms.

Day 10: Based on full body imaging, it was determined that the prostate cancer former pres JB was recently diagnosed with has spread to his bones. He has been started on targeted treatments that have been shown to be effective for years in tests performed by doctors at Harvard and other institutions with many leather bound books.
 
communitydoc13 said:
The result IMO is that simple (and almost universally false) narratives take hold. Science (even medicine) usually just not so simple, with all sorts of qualifiers and contingencies applicable to nearly every situation.
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That's rich after the Biden administration completely botched the pandemic with binary scientific thinking to justify unscientific mandates. Pro-this, anti-that. It's all complete bulls88t. So yeah, I completely agree with simple narratives being almost universally false. Motives, however, usually are simple. His family and staffers would conspire to hide his dementia to retain the presidency but not a diagnosis of cancer? How does that make any sense? Why would a family who has enriched themselves using political influence want to retain something as trivial as the power of the presidency? It's either a non-story or one of the biggest presidential scandals in our history? What a joke and embarrassment for us all.

medgator said:
We've got covfefe in office now. The one-sided outrage is really hypocritical IMO
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If you're outraged at that, then all the more reason for one-sided outrage at Biden. Why do you think he's there? Biden was elected as a mainstream Democrat, quickly devolved into late-stage Brezhnev, and the far left millennial staffers relocated the capital to crazy town. It was disheartening to see so many in the medical profession put their sanity into long-term storage and move with them. My personal opinion is that most of them knew it was all bulls88t but went along anyway because the desire to not be thought of as stupid/conspiratorial reigned supreme.
 
alwaysbeIMRTing said:
That's rich after the Biden administration completely botched the pandemic with binary scientific thinking to justify unscientific mandates. Pro-this, anti-that. It's all complete bulls88t. So yeah, I completely agree with simple narratives being almost universally false. Motives, however, usually are simple. His family and staffers would conspire to hide his dementia to retain the presidency but not a diagnosis of cancer? How does that make any sense? Why would a family who has enriched themselves using political influence want to retain something as trivial as the power of the presidency? It's either a non-story or one of the biggest presidential scandals in our history? What a joke and embarrassment for us all.


If you're outraged at that, then all the more reason for one-sided outrage at Biden. Why do you think he's there? Biden was elected as a mainstream Democrat, quickly devolved into late-stage Brezhnev, and the far left millennial staffers relocated the capital to crazy town. It was disheartening to see so many in the medical profession put their sanity into long-term storage and move with them. My personal opinion is that most of them knew it was all bulls88t but went along anyway because the desire to not be thought of as stupid/conspiratorial reigned supreme.
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I've seen you before.

Look around you brother.
 
alwaysbeIMRTing said:
Ummmm... ok.

Reddit is over that way if you feel the need to threaten random people because this bothers you so much.
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Not a threat. Didn't mean for you to take it that way.

A pandemic is different than personal health decisions. Public health itself is peculiar in that it deals with population based outcomes. I believe that even the basic ethical issues surrounding messaging and risk analysis vary significantly between say... behavioral mandates in a pandemic and whether to personally get screened for prostate cancer.

A "correct" answer can be hard to come by.

But please just look at our present executive positions regarding health...our "Surgeon General", our head of HHS, our likely expenditures on health based research, the destruction of our global outreach regarding massively effective preventative measures and public health initiatives, the likely precipitous downward pressure on payment and access in our own system, contingent on debt, the loss of personal autonomy regarding reproductive issues, the likely trends in environmental impacts on health, based on deregulation and lack of enforcement regarding environmental violations by industry, and yes the loss of personal autonomy regarding gender affirming care for some.

If the above make any coherent sense to you regarding the gentle balance between personal autonomy and maximizing health outcomes, you can explain it to me.

You can also explain what far left means, but we will get censured.
 
communitydoc13 said:
Not a threat. Didn't mean for you to take it that way.
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I'm not sure how else to take a comment insinuating that you know who I am and to check my six.

To be honest, it's probably not hard to figure out as I came here to post about that "red dot" article and probably doxxed myself as to which one I was. I live downtown in one of the most dangerous cities in the US at the moment which I am watching deteriorate on daily basis as crime runs out of control. Just had a motor vehicle stolen in broad daylight and 2 others broken into within the past 3 months. So, I'm not really worried in the scheme of things. Yes, I'm armed because I have to be.

communitydoc13 said:
You can also explain what far left means
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Everything you just wrote above. It's safe to say we disagree on everything.
 
alwaysbeIMRTing said:
I'm not sure how else to take a comment insinuating that you know who I am and to check my six.

To be honest, it's probably not hard to figure out as I came here to post about that "red dot" article and probably doxxed myself as to which one I was. I live downtown in one of the most dangerous cities in the US at the moment which I am watching deteriorate on daily basis as crime runs out of control. Just had a motor vehicle stolen in broad daylight and 2 others broken into within the past 3 months. So, I'm not really worried in the scheme of things. Yes, I'm armed because I have to be.



Everything you just wrote above. It's safe to say we disagree on everything.
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Apologies. I meant I've seen this type of rhetoric and thinking (moving fairly quickly from a discrete issue to global sense of demise and references to "far leftists") before by other posters.

I also meant to look around at the present health care climate and initiatives by present admin. I have no interest in doxxing everybody. I'm not even trying to figure out who you are.

FWIW, I grew up in one of the most dangerous cities in the US. In the city, not the burbs. Took public transpo into my 20s. That city now (and for past 18 months) has experienced a remarkable reduction in homicides. The most dangerous eras in that city were in the 1970s (before my time and before white flight) and 1990s (when I was young and living in the city).

I do encourage you to consider what the real risk to you is from the urban violence. (My oldest child lives in Brooklyn....excess deaths there are far lower per capita than the rural county where they grew up).

I never have and probably never will carry. If you show up at my house, you'll get a hug.
 
communitydoc13 said:
Apologies. I meant I've seen this type of rhetoric and thinking (moving fairly quickly from a discrete issue to global sense of demise and references to "far leftists") before by other posters.

I also meant to look around at the present health care climate and initiatives by present admin. I have no interest in doxxing everybody. I'm not even trying to figure out who you are.

FWIW, I grew up in one of the most dangerous cities in the US. In the city, not the burbs. Took public transpo into my 20s. That city now (and for past 18 months) has experienced a remarkable reduction in homicides. The most dangerous eras in that city were in the 1970s (before my time and before white flight) and 1990s (when I was young and living in the city).

I do encourage you to consider what the real risk to you is from the urban violence. (My oldest child lives in Brooklyn....excess deaths there are far lower per capita than the rural county where they grew up).

I never have and probably never will carry. If you show up at my house, you'll get a hug.
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That's fair. I don't think you are actually coming to kill me and will give you the benefit of the doubt.

I have the luxury of being a large man. I rarely get messed with but it does happen. I don't need to carry a gun as much as I would if I were a small female in terms of levelling the playing field. So to be honest, I usually don't. If I were the latter, it would be a different story. But I am protected in my home and vehicle. I have watched the homelessness and drug issue explode over the past few years. The police don't have the resources to really do anything about it. Fentanyl zombies are everywhere. I just watched a methhead run across the interstate (these are the people breaking into my cars). I watched one guy the other day clearly having a polysubstance psychotic episode walking down the sidewalk screaming that he was going to "r*pe and k*ill b*tches" Nobody doing anything about. I see that stuff all the time now. Half the cars on the road are unregistered with unlicensed drivers. You can drive as fast and as recklessly as you want and not get pulled over because the police have higher priorities than chasing down speeders. So my insurance is 5X the cost here vs. a suburb. 911 calls here can take 5-10 minutes to get answered. I called the non-emergency line to report my recent auto theft and it took almost an hour to get someone. It didn't used to be like this here.

The excess deaths you are referring to in rural areas are not due to violent crime and likely health and suicide related. I didn't know the stats off the top of my head, so I looked this up to confirm: In 2021, the rate of violent victimization in urban areas was 24.5 victimizations per 1,000 people. That’s more than double the rural area rate of 11.1. The rate of property victimization in urban areas was 157.5 per 1,000 people. In rural areas, the rate was 57.7. And to be fair, it's mostly the property crime that has become out of control (fueled by the drug epidemic and anti-police narrative and consent decrees of the recent past IMO), but you are kidding yourself if you don't think you are at increased risk of violent crime in our cities, with some cities being far worse.

I visited Japan (Sapporo) a few months ago. There was no homeless, there was no crime, there was no open air drug use, there were not people having psychotic episodes in public. Everyone on the train was quiet and respectful. It did not smell like marijuana everywhere. It's really an amazing thing to get on the plane in San Francisco and the next day see that. Yes, it's a different culture. But my point is that it doesn't have to be like it currently is here. We can clean our cities up. I appreciate your optimism, but people need to take responsibility for their own safety. When you're walking down the sidewalk and the individual I referenced above is punching a street sign and screaming that in front of you, it does not make you a bad person or somehow bigoted to cross to the other side of the street or even to run away.
 
alwaysbeIMRTing said:
you are kidding yourself if you don't think you are at increased risk of violent crime in our cities, with some cities being far worse
Click to expand...
the excess risk for people my kid's age is from MVA. The MVA alone more than make up for risk of homicide.

Your personal encounters in a city dwarf those experienced in a rural setting. There is of course more risk of violent crime. Every New Yorker is on public transport with crazy people all the time...guess what....they are still often paying through the nose to live there (for many reasons).

I'm looking to retire to a city. I love the diversity. I don't really mind the pot smell. I like the vitality.

To each his own. The US has always been a hyperviolent place. Mostly people that know each other kill each other. Most mass murders are dudes blowing away their families. Overwhelmingly, females are killed by their significant others. If you believe the FOX News alerts, you'd imagine it's daily bedlam...it is not.
 
Bequerel said:
Of course biopsy, pet and start ADT is reasonable for a former president. It’s that same logic that makes it unlikely that they didn’t check a PSA on him for over a decade.
Click to expand...

Wrong on bolded. They were following guidelines. Both on not screening a 70+ year old male for prostate cancer, and for getting biopsy, PET, and ADT ASAP for someone with symptomatic disease.

Ray D. Ayshun said:
Oh, this insanely dedifferentiated neuroendocrine cancer that has more moves than Keith Hernandez spit is also def Castrate sensitive?
Click to expand...

How do you know its neuroendocrine? A prostate adenocarcinoma that is so de-differentiated that it doesn't secrete PSA (the way normal prostate tissue does) doesn't necessarily mean it doesn't respond to ADT, at least not initially.



A general warning for the entire thread going forward - keep this focused to JB's prostate cancer. I'm willing to entertain the 'alternative hypothesis' of 'it is being covered up by his handlers and he actually had this long ago' as it relates to his prostate cancer.

If this devolves further into generalized politics, posts will be deleted, warnings will be handed out, and the beatings will continue until morale improves.
 
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