𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜

Father of 5️⃣ | Urologist @laheyuro | Associate Prof | MIS robotic onc | 🎸| Personal finance rants | Workplace efficiency enthusiast | Founder @wellprept 👈

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

When I was 15, I learned firsthand what grit truly looks like.

It was 1990. My mother was 42 and two years into a confirmed Multiple Sclerosis diagnosis—a condition she had suspected since her twenties.

She was a dynamic middle school French teacher, beloved by her students. Her South African accent captivated them whenever she snuck in a few sentences in English. She had a way of lighting up any room.

My mother's passion for French took her from South Africa to Paris as a teenager, where she studied at the Sorbonne. Though English was her native tongue, she also spoke Afrikaans and Hebrew.

Fast forward to 1990: she was teaching at a private school in the NY suburbs, but the public schools offered better salaries (is this still true?). My mother wanted a position in the local public school system. However, the demand for French was dwindling, with Spanish on the rise. She couldn't get a public school teaching job.

So, she took a bold risk. She left her job and took a year off to get certified as a Spanish teacher. Only a year? How would that work? Despite not speaking Spanish, her strong foundation in romance languages gave her the confidence to learn quickly.

What she did next was remarkable. She went to the local community college and declared she wanted to take Intro and Spanish 101 simultaneously. The registrar said it was impossible—Intro was a prerequisite for 101.

"How about I register for Intro and audit Spanish 101?" she proposed. "If I pass both, you give me credit for both." They agreed.

She aced both classes.

That summer, she immersed herself in Spanish literature and Telenovelas. She used a Spanish-English dictionary and even a French-Spanish dictionary, finding it easier to map French to Spanish than English to Spanish. This detail still amazes me.

She repeated her (now precedented) request for Spanish 201 and 301 and aced them both, earning all the credits needed for Spanish Teacher Certification in one year. This landed her a job, eventually tenured, teaching both French and Spanish at the local public school.

My mother passed away from complications of Multiple Sclerosis three years ago. Her determination and resilience continue to inspire me.

Where did she get this incredible determination? Her father, my grandfather, immigrated from Lithuania to South Africa at age 14. He worked in a furniture factory, saving half of his weekly salary for English lessons. Through sheer hard work and perseverance, he eventually owned the factory.

As a young child witnessing her perseverance, I witnessed the true meaning of grit. Now, as I steer @WellPrept from idea into existence, and now help it expand... I frequently reflect on her tenacity. Every day, I try to embody her ability to tackle challenges head-on and her unwavering belief in herself.

I think you can see it in her eyes in the photo.

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@TylerSbrt @TonyFelefly @OpenMedicineHQ @dr_coops What if the anxious patient wants a weekly PSA? 😉

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@VickersBiostats Thanks for the clarification!

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

GG1 should be classified as "precancer" according to molecular analysis

[Scott Eggener @uroegg]

"GG1 shares molecular features with higher grade cancer, we must call it cancer"

"Great point, let's look into it"

Every one also present in benign and pre cancers, fairly certain we shouldn't call those cancers

QED to that counterargument

https://t.co/PDSxwScNJM

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@EricKnauerMD @rbarbosa91 @SAGES_Updates So I can take it off, and stick it where I want. Any other answer is wrong.

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@UroCancer @TylerSbrt @OpenMedicineHQ Whats your rule of thumb for mm of 4?

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@WenchangYue Yes it’s not right

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@TylerSbrt @OpenMedicineHQ Bagrodia doesnt fight you on this?

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@TylerSbrt @OpenMedicineHQ If the goal is to create an algorithm reflective of current practice, AS for all non crib GG2... we're not there yet. I agree maybe we should be. Maybe.

But if this particular flow chart becomes "Tyler's opinion" how generalizable is it?

love the conversation, genuinely.

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@TylerSbrt @OpenMedicineHQ Most urologists would use 20% as a rule of thumb (AFAIK), but of course actual mm of pattern 4 is more important than % because % doesnt account for small core length in a fragmented core.

40% is so close to GG3 I’d be very reluctant to use that as a rule of thumb

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

I think to go back 20 years to protect and use that q3 month instead of the more updated considerations from NCCN … could cause too much patient anxiety and limiting anxiety on active surveillance is very important.
I realize this is opinion rather than strong evidence, but there’s no way that checking PSA every three months is important

[Jonathan Evan Shoag 🇮🇱🇺🇸 @jeshoag]

Our latest in @JAMAOnc prebiopsy MRI is now used in ~2/3 of US prostate biopsies.

Up sharply since 2017 but still work to do.

With Stephen Rhodes and coauthors @SBasourakos @jimhumd @Chris_Barbieri1 @angela_jia_ @Soum_Roy_RadOnc @DrSpratticus @lponsky
@CaseUrology @UHhospitals @UH_RE_Institute @caseccc

https://t.co/NpV0QPeI2Z

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

It was only a matter of time

[Grok Bot @bot]

Grok Bot can talk now.

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@Gabe__MD @bot DM me I can share

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

Grok bots @bot are unresponsive and I am paralyzed now.

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@KeithNewton @bot You can use Bland, you can use Retell, lots of options.

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@Gabe__MD @bot It really has become indispensable for me. You too?
I have 30 bots doing my bidding.

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

Very logical
It's not like we castrate eugonadal men on active surveillance for prostate cancer, so how dangerous could we really have believed it to be?
But here's the evidence for all you non believers.

[JMFlores @jmfm1612]

Testosterone Therapy in Men on Active Surveillance for Prostate Cancer Is Not Associated With Increased Risk of Disease Progression | Journal of Urology https://t.co/9HXkL55dQZ @SaveYourSexLife @UrologyMSK @CAU_URO @HispanicUroNA @SMSNA_ORG @SMSNA4Patients

[𝙳𝚊𝚟𝚒𝚍 𝙲𝚊𝚗𝚎𝚜 @CanesDavid]

@robwalling You provide real value. That's why!