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DiscussionHas Anyone Elected for No Treatment?
Prostate Cancer | Last Active: Sep 2 9:03am | Replies (44)Comment receiving replies
Replies to "These comments all offer the tremendous variability in how/why, and how fast, a cancer progresses to..."
You wrote "He started having lower lumbar back pain in his early '70's. He just thought he was getting old. This was in the days before there was a PSA test. He was dead within a month."
The problem is that there are a lot of different things we call "prostate cancer" — there's the slow-developing kind that your father died *with* at age 99 rather than *of*, there's the fast spreading kind that I got, which can escape the prostate in months rather than years or decades (my oncologist said about 5% of prostate cancers are like that), there's even-rarer small cell neuroendocrine prostate cancer (NEPC), which moves quickly into vital organs (that may be what your friend's father had). When you hear anyone still making a blanket statement in 2025 like "Prostate cancer is slow developing" turn your B.S. meter up to 11.
Fortunately, we have better tools these days, so instead of just talking about "prostate cancer", oncologists can consider the Gleason score, the PSA doubling time, genomic tests (e.g. Decipher), epigenetic tests (e.g. EpiSwitch), germline tests (e.g. Invitae), and advanced imaging (e.g. MRI, PSMA-PET) to make a much more-accurate diagnosis about whether your cancer is likely to be slow-developing or dangerously-aggressive. It's not just a matter of flipping a coin (heads we treat, tails we don't) any more.
p.s. I also discovered my cancer initially via back pain and then loss of mobility, but luckily, a) it wasn't NEPC, and b) there were much better treatments available in 2021 than there were even 5–10 years earlier, so I'm still going strong.