In this case, may I suggest that it seems we have a difference of opinion.

The “gold standard.” That magical phrase physicians utter with the same reverence as one might invoke the Holy Grail or a particularly solid IKEA warranty. It’s the safe space of clinical inertia—comforting, defensible, and conveniently free of pesky nuance.

From my perspective, it appears that some doctors seem to believe that medicine is best practiced like cooking from a box mix: just add water (or ADT) and voilà, you have Evidence-Based Excellence™. Ask a question? Receive a number. Challenge the dogma? Watch the eyebrows raise and the malpractice risk calculator start whirring in the background.

As for eloquence—don’t sell yourself short. If clear thinking and a willingness to critically evaluate medical orthodoxy don’t qualify as eloquence, then we may as well hand the microphone to the nearest prescription pad and call it keynote speaker.

Your surgeon prescribing two years of ADT when your RO floated a 3–5% benefit? Classic. It’s like being told to wear a raincoat in the Sahara just in case. And yet, somehow, questioning this earns you a suspicious glance, as if you’ve suggested treating cancer with moonlight and essential oils.

But I hear you. When you're in a fight, you fight. It’s just unfortunate that sometimes you're not sure if your corner is shouting strategy or just reading off a flowchart in Latin.

Still, here's to the rebels, the researchers, and those of us who politely raise our hand in the temple of "standard care" and ask, “Yes, but… why?”

Now you’ve got me excited. Dammit.

the modern prostate cancer checklist: Elevated PSA? Check—because who doesn’t love a biochemical mystery. Gleason score creeping into the “let’s panic politely” zone? Check. Cribriform pattern? Absolutely, the architectural nightmare of prostate pathology. Perineural invasion? Of course—it wouldn’t be a proper horror story without it. So, what’s next? Apply the “gold standard” treatment because, statistically speaking, that's what everyone else is doing, and individuality in medicine is just so passé. Genetic testing? Optional, especially if you prefer your treatment plans designed by coin toss. Scans that can’t detect anything smaller than 2.7 mm? Perfect—nothing like the illusion of thoroughness. PSMA PET scans? Surely you jest—those are reserved for people with actual budgets. And finally, let’s throw in some ADT to suppress testosterone in a tumor that clearly threw that hormone overboard years ago. Makes perfect sense—if you're a character in a Kafka novel.

Now, if someone had bothered to stray from the algorithmic playbook, maybe we could’ve had a conversation about precision medicine—genomic profiling, to determine actual tumor behavior rather than assuming it’s playing by textbook rules. Or how about considering the patient’s entire medical history—like maybe cardiac health, quality of life priorities, and whether the tumor is actually hormone-sensitive before launching hormonal carpet bombing. Perhaps even using imaging that works, like PSMA PET, instead of squinting at shadows on a CT. But no, why do that when we can march to the beat of a one-size-fits-all protocol and call it progress?