Peter Attia· MD
but you have to deal with hot flashes and decrease libido and whatnot but again most of the patients who are intermediate or high intermediate risk are going to if if they if they end up uh not having a uh a negative margin or seminal vesicle invasion after prostatectomy they're still going to come to me for radiation anyway and they're still going to need to be on androgen ablation so there's a significant number now these days we'd certainly treat a lot less Gleason 6 than we used to we observe most of them yep but there's a lot of Gleon six folks that even in this day and age will choose to have radiation just because it's maybe a little bit more aggressive form of watchful waiting and in that case there is no Androen ablation and they just you know they just glidec of Gleason 3 plus 3 watchful waiting versus XRT no ablation no unfortunately there's no actual trial there's just observational studies that's that's kind of what we're dealing with there oh gosh and obviously you can't figure out what the biases are but what do those observational studies show they show you know essentially because people don't die from gleon 6 disease as we all know they really do because quality of life they do so well with the radiation there is just less of a chance of it progressing to seven and and when they come to me to be seen I get a it's interesting the