u/Slight_Turnip_3292

Seeking advice regarding bilateral pelvic lymph node dissection (ePLND) for Gleason 3+4=7 (Grade Group 2) prostate cancer.

My upcoming RALP with Dr. Dechet at the Huntsman Cancer Institute includes a bilateral pelvic lymph node dissection. However, when I discussed this with my local urologist, he dismissed the necessity of the node dissection, suggesting it is often performed at teaching hospitals primarily for training purposes rather than clinical necessity.

Given my favorable intermediate risk status (no cribriform pattern), I am trying to reconcile these conflicting perspectives. I recently came across new research (see link below) suggesting that pelvic node removal is increasingly recommended for patients in my risk category. This paper is particularly significant because its primary endpoint was the reduction in the risk of distant metastasis, rather than solely focusing on biochemical recurrence.

My local urologist has questioned why I am not choosing a local procedure, but I find the expertise of a high-volume RALP surgeon like Dr. Dechet to be far more compelling. I’ve decided that the travel required for a specialist is negligible. I would appreciate hearing if others have navigated this kind of disagreement between local surgeons and specialists regarding the necessity of lymph node dissection.

Has anyone else faced a similar discrepancy between a surgeon at a major cancer center and a local urologist/surgeon regarding the necessity of lymph node dissection?

https://www.auajournals.org/doi/full/10.1097/JU.0000000000004821

In JD's new book he writes “The decline of Christianity has left us without a shared moral language”

And then attempts to take a swipe at the "left" for self-indulgent self-discovery and the "right" focusing too much on GDP and economics (this because the current GDP is languishing).

Nonetheless, this statement of "shared moral language" is full of hypocrisy that it needs bursting like a festering pimple.

JD himself is an example of someone who sold out completely in pursuit of power. When he saw the popular appeal of Trump he did a complete reversal on Trump and went from assessing Trump as America's Hitler to America's savior. Zero integrity or moral backbone. He has offered only weak and obvious false reasons on his conversion to a Trump culty. Everyone knows he is just following the current political power flux.

The Christian Right have elected Trump as their champion. Trump is the most visibly amoral President in the entire history of our Republic.

He is an adjudicated rapist, he is all over the Epstein files so profusely that any other citizen would be jail right now, he is being nice nice to Ghislaine Maxwell because she has pedophila dirt on him, he has sex with porn stars while his 5th child is being nursed by his 3rd wife, he lies constantly, he is over the top selfish, massively greedy and corruption is his brand.

They have zero moral high ground to preach to anyone about "moral language". I guess what galls me the most is the faux facade of morality of the 21st American Christians. They are the most dangerous group in America today because tomorrow they could easily be cheering and laughing while they hang and burn those who lack their faith.

Major religions "Holy Scripture" is claimed to be inspired by God and is complete, infallible and completely trustworthy, yada, yada.

But isn't this a completely absurd claim Prima facie?

Why would a Supreme Being choose to transmit its "Word" through the fallible, corruptible, and unreliable channel of human production?

In my due diligence i have started applying simple, common-sense inquiries to the foundational claims of religion. The very concept of the existence of "Holy Scripture" is one of these. Here are few reasons I think it is absurd claim.

The Medium: If an omnipotent God can physically write with His own finger (as described in the Old Testament), why would He rely on fallible, fickle humans to draft, redact, edit, and select His message?

Furthermore, the existence of a human written "Holy Scripture" as a mode of divine communication is common and redundant. If a supreme deity truly wished to convey a singular, universal truth, why would it settle for producing yet another manuscript in an already saturated market of competing claims? It seems paradoxical for an omnipotent being to rely on a process so prone to human error, effectively burying its "true" message within a crowded field of alleged counterfeits with no clear way for a seeker to distinguish the divine from the merely human-authored.

Accessibility: Written language is a modern and historically elite skill. For the vast majority of human history, the overwhelming majority of people were illiterate. Why would a God choose a medium that is inaccessible to most people?

And then there is the translation barrier. In the Bible, God allegedly confounded people by creating language barriers. This very barrier is a major impediment to dissemination of the alleged "Word". In this case God set up a barrier to dissemination of Its alleged Holy Word.

Lack of Authentication: Modern transactions utilize integrity features to ensure both authenticity and prevent textual corruption. Yet, these "divine" texts have no authentication features and no corruption detection or error correction features. It is all just trust us bro.

It is bizarre that a God would leave His most important message vulnerable to the guile, stupidity, and deceit of humans without providing a form of divine authentication and non-repudiation. The Books are often selected by human committees and subject to human bias and political pressure.

If God wanted His message to be clear and preserved, He clearly has the capability to do so. Yet the evidence we have looks exactly like a product of human invention.

Because of this I refuse to debate religionist based on what their "Holy Word" says because the notion of it being from a God is absurd in the first place. Interesting perhaps from a human literal, historical or cultural standpoint but not a divine object.

This afternoon we were coming down Beauty Creek road and encountered a couple of guys that had their targets pinned to the large beautiful cedar trees and were blasting away. Anyone who has driven up that road know the tranquil beauty (hence the name) and old growth cedars that line the creek. I don't know if it was out of ignorance or sheer willful maliciousness.

Didn't know who to call to report this and I wasn't about to stop and talk to obviously clueless guys with semi-automatics. Really sad. Maybe the Forest Service needs to put up signs but certain things people should just know out of common sense.

Why would an infallible deity choose to transmit its "Word" through the fallible, unreliable medium of human production?

I am tired of the endless, vague theological debates that lead nowhere decisive. Instead, I’ve started applying simple, common-sense inquiry to the foundational claims of religion. The very concept of the existence of "Holy Scripture" is one of these. Here are couple reasons I think it is absurd that God would inspire a Holy Scripture and there are probably more.

1. The Medium: If an omnipotent God can physically write with His own finger (as described in the Old Testament), why would He rely on fallible, fickle humans to draft, redact, edit, and organize His message? It seems comical that a Supreme Being would choose such a prone-to-error process and leave Its true Holy Scripture to exist among all the other alleged counterfeits with nothing to distinguish it above a crowded field.
2. Accessibility: Written language is a relatively modern and historically elite skill. For the vast majority of human history, the overwhelming majority of people were illiterate. Why would a God choose a medium that was fundamentally inaccessible to the people He was allegedly trying to reach? And then there is the problem of translation. God alleged confounded people by creating language barriers but this very barrier was and is now a major impediment to dissemination of the alleged "Word".
3. Lack of Authentication: Modern legal/financial transactions utilize integrity features to ensure authenticity and prevent corruption (ie Non-repudiation). Yet, these "divine" texts contain zero markers of their origin or systems of check summing the text and the collection of the whole.

It is bizarre that a God would leave His most important message vulnerable to the guile, stupidity, and deceit of humans without providing a form of divine authentication and non-repudiation.

If God wanted His message to be clear and preserved, He clearly has the capability to do so - yet the evidence we have looks exactly like a product of human invention.

I have a rather large yard but the best place for a sauna is on my property line with about 5 ft of setback. I really want to use a wood stove as I have an endless supply of wood. It will be a small sauna for 2 to 3 people.

Question how much smoke does a wood fired sauna produce? I really don't want to piss off my neighbor.

This lines up well with his worldview. He just needs to have a feeling something is wrong, he doesn't need evidence to form a belief. Evidence is not an important feature of their ideology.

If indeed there is something diabolical why can't the evangelicals just call in some prayers and angels and neutralize it? Why does the satan guy win all the time and the Christians can't seem to do anything about it. Must be frustrating.

And if it is something big, diabolical and upstream wouldn't that mean there should be even more evidence?

What an embarrassment to have a weak minded and gullible person like Mike in political office. We all know he is just trying to please his idol.

Plantinga’s Free Will Defense posits that a world containing free will is superior to one without. He emphasizing that the capacity for free willed moral action is a supreme good and God has to risk moral evil in order to achieve that higher valued objective of free chosen moral good actions.

If we accept this premise as true moral autonomy would be achieved by the absence of divine coercion such as the promises of extrinsic motivations of rewards or threats of punishments. It is common place to hear theist claim that without God "all things are permitted" and sometimes even admit that if there wasn't a god they would be raping and pillaging. That is they are constrained only because of future consequences.

Non-believers demonstrate the highest form of free moral agency as their actions are uncorrupted by these future reward or punishment. In essence, non-believers have access to a higher virtue than believers.

By choosing "good for goodness' sake" without the expectation of celestial recompense, we can conclude that those who act independently of religious incentive are, by Plantinga’s own standards, the most aligned with the value of free moral choice and thus would be favored by God.

Living in a predominantly Christian culture, I have been exposed to apologetic works like "The Case for Christ" or "Evidence That Demands a Verdict." These books often rely on historical oddities or weak circumstantial arguments - such as the claim that ancient authors wouldn't have used women as witnesses or that the apostles wouldn't have died for a lie. And even sometimes employ false logical fallacies or vague philosophical arguments.

Similarly, I encounter arguments from Islamic apologists who claim the Quran is too perfect to be of human origin. Not as familiar with the Islamic arguments but they fall in to the same category.

This leads me to a fundamental question I like to ask before engaging with any proselytizers: Why is there so little evidence that His followers are forced to rely on these strained, rehearsed arguments?

If an omnipotent and omniscient God truly existed, His presence should be as self-evident and undeniable as the existence of the sun. The fact that His existence is a matter of intense, centuries-long debate rather than objective, universal knowledge strongly suggests to me that these religious claims are NOT rooted in reality. In addition, there is the fact that religion are constrained strongly by culture which suggests indoctrination is far more influential than any objective evidence.

In a way I think apologist and proselytizers refute what they claim by their own actions and intentions.

As a taxpayer we are all harmed by the unconstitutional decision by the DOJ to create a untracked fund that will be administered by group of political operatives. The power of the purse is controlled by Congress.

Since taxpayers have legal standing is it possible to sue the DOJ or the Executive for this blatant action and stop it?