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Medical Forum / Diseases and Disorders / Prostate Cancer / January 2006questions and answers fron a doctor on pca.....
Q: What is follow-up radiation (post-operative radiotherapy) and why would it be needed after a RRP? A: Sometimes, it is strongly advised when the pathology report shows positive surgical margins or extension of the tumor beyond the prostate gland. Also, it is often advised when the PSA begins to rise after surgery. There are two types of follow-up radiotherapy. 1. Adjuvant radiotherapy is given as a precautionary measure in patients who have adverse features in their pathology report. This radiotherapy is usually given 3 to 4 months after the operation when urinary continence has returned. It may be delayed further if continence has not yet returned. 2. Salvage radiotherapy is for a rising PSA, which means a recurrence of the cancer. This radiotherapy should be given before the PSA level rises above 1ng/ml. --------- Q: Is "watchful waiting" a treatment option after a diagnosis of prostate cancer? A: In my opinion, the answer is no, except for older men with low-grade tumors that are not very threatening. For the vast majority of men with prostate cancer, early definitive treatment is indicated. Some of the public information about prostate cancer is misleading. It suggests that prostate cancer is a toothless lion, i.e., that more men die with it than of it. There is a difference between a dead man whose prostate is found to contain cancer when it is extensively examined at autopsy and a living man whose cancer has been found because of an elevated PSA or abnormal digital examination. And the younger a man is, the more likely he will benefit from being cured. It is most likely that a clinically detected prostate cancer will progress with time. For example, waiting for a PSA to get up to 6-7 risks a 30% chance that the cancer would have escaped from the prostate at the time of treatment. Currently, there are watchful waiting studies of young men. It is called "active monitoring." If the PSA rises or repeated biopsies show more cancer or high-grade cancer, then treatment is initiated. The downside of this approach is that for men whose cancer ultimately requires treatment, it is treated at a later time and the repeated biopsies can me it more difficult to perform nerve-sparing surgery. Q: Is it a good idea to use hormone therapy before or in conjunction with surgery? What does it do in this situation? A: Hormonal therapy is used by some doctors to shrink the cancer before surgery. Available evidence suggests that while hormonal therapy makes it more likely that the surgical margins will be "clear," no convincing evidence exists to show it reduces tumor recurrence rates. A possible disadvantage of hormonal therapy before surgery is that it may cause scarring around the prostate gland that sometimes makes it more difficult to perform nerve-sparing surgery. comment on robotic surgery......... it is more difficult to suture laparoscopically. With robotic surgery, suturing is less difficult, but it still has limitations of access and lack of tactile feedback. The surgeon cannot tell how hard the robot is grasping tissue, or, if the angle of the needle is wrong and if the needle does not pass through the tissues easily, the robot continues to "muscle" its way through. With tactile feedback afforded by open surgery, the surgeon would "feel" the mistake and make the necessary adjustment. knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc >Q: What is follow-up radiation (post-operative radiotherapy) and why >would it be needed after a RRP? [quoted text clipped - 11 lines] >cancer. This radiotherapy should be given before the PSA level rises >above 1ng/ml. curtis I know you didn't write this, but do you agree with it? As far as I'm concerned, I believe ALL post-operative radiotherapy is SALVAGE therapy, where the initial dx was possibly WRONG. (have a look at the members of this group who had Surgery and are having Radiotherapy along with supplementary Hormonal treatment.) <snip balance of Q & A> -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC PALMER_ENT@webtv.net (c palmer) wrote: Q: What is follow-up radiation (post-operative radiotherapy) and why would it be needed after a RRP? A: Sometimes, it is strongly advised when the pathology report shows positive surgical margins or extension of the tumor beyond the prostate gland. Also, it is often advised when the PSA begins to rise after surgery. There are two types of follow-up radiotherapy. 1. Adjuvant radiotherapy is given as a precautionary measure in patients who have adverse features in their pathology report. This radiotherapy is usually given 3 to 4 months after the operation when urinary continence has returned. It may be delayed further if continence has not yet returned. 2. Salvage radiotherapy is for a rising PSA, which means a recurrence of the cancer. This radiotherapy should be given before the PSA level rises above 1ng/ml. curtis I know you didn't write this, but do you agree with it? As far as I'm concerned, I believe ALL post-operative radiotherapy is SALVAGE therapy, where the initial dx was possibly WRONG. (have a look at the members of this group who had Surgery and are having Radiotherapy along with supplementary Hormonal treatment.) ======== hi clarence - i believe that this is written more along the lines geared toward the newbie and not for someone who has more knowledge of the subject. the purpose that i posted it was to give someone who has limited knowledge of pca a better understanding of what's going on. i agree that post op radiation is the same as salvage radiation. i also believe that there is not a one size fits all solution to the pca problem and sometimes when the surgeon gets inside and gets a better look, they find out that nature gave everyone a surprise (not in a good way). ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc > PALMER_ENT@webtv.net (c palmer) wrote: > I know you didn't write this, but do you agree with it? > As far as I'm concerned, I believe ALL post-operative radiotherapy is [quoted text clipped - 9 lines] > the purpose that i posted it was to give someone who has limited > knowledge of pca a better understanding of what's going on. Once again, this NG is noticeably missing an FAQ. Maybe we oughtta get started on one (or get crackin' on one -- as they say elsewhere) after the first of the year. > Once again, this NG is noticeably missing an FAQ. Now THERE'S a keyboard war waiting to happen! Who moderates the FAQ when we disagree on the answers? Or can we agree to let any ensuing debate BE the answer, recognizing that a knowledgable debate provides more information than most pat answers anyway and any such debate identifies topics the experts can't agree on. Who determines when and which answers are just flat wrong? Which FAQs should be deliberately omitted to avoid giving somebody the impression that reading the FAQ makes him qualified to make some life-affecting decision -- that he doesn't still need to study several PC books and websites before choosing a treatment, for example? These things wouldn't matter if this were alt.favorite.icecream, but it ain't. I.P. I believe we (the entire "we") can come to a consensus on many issues. For instance, would there be any disagreement on what EBRT stands for? What a particle accelerator is and does? How it is aimed? What are the possible side effects? But, I think we could probably even come to an agreement on this one: I just found I have prostate cancer. What should I do now?  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05 PSA .07 .05 .06 .05 .08 Non Illegitimi Carborundum >> Once again, this NG is noticeably missing an FAQ. > [quoted text clipped - 13 lines] > > I.P. >> Once again, this NG is noticeably missing an FAQ. > > Now THERE'S a keyboard war waiting to happen! Who moderates the FAQ when > we disagree on the answers? If we can agree on the questions, then the list of Frequently Asked Questions can be assembled. A separate document, Frequently Debated Answers, can wait for the future. Steve Kramer suggested a FAQ. Maybe you could start here with Dr. Catalona's Q & A List and modify it from individual experiences of group subscribers. Here!! http://www.drcatalona.com/qa.asp -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC I'll look into it. And, Happy New Year! I guess you've been in 2006 for about ... what? 9 hours? We're still 6+ hours away here. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05 PSA .07 .05 .06 .05 .08 Non Illegitimi Carborundum > Steve Kramer suggested a FAQ. > [quoted text clipped - 9 lines] > > -- CC >I'll look into it. > >And, Happy New Year! I guess you've been in 2006 for about ... what? 9 >hours? We're still 6+ hours away here. and the same to you 09:22 Sunday 01-01-2006 (US or OZ) -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC I love all you guys and gals... (stop it :-)...and since Dr. Catalona did my surgery I would tend to go with his Q&A which he always has in the newslettter... But since there are so many thoughts on various topics...there doesn't to seem any perfectly correct answers. Curtis tells us what most newbies need to know...and if there are more details needed...folks will ask for them. And THEN...the folks here will rally with superb answers. Best to all, Ron B. Chicago "As far as I'm concerned, I believe ALL post-operative radiotherapy is SALVAGE therapy, where the initial dx was possibly WRONG." It has now been 4 years since my Dx and I have learned a lot since then and even seen some evolution in thought in that realtively short period. When I first got involved it appeared to me that surgery was generally considered a cure for local disease and that biological failure probably meant, as Clarence observes, that the initial Dx of local disease was wrong. It has become apparent, however, that surgery is not the panacea for local disease that we were told. If you listen to the rad-oncs they increasingly are talking about RT for residual local PCa in the prostate bed that was left behind during surgery. I think the incidence of this is far greater than has been believed, or perhaps it has increased w/ nerve-sparing surgery. This means, unfortunately, that RT for many many men having surgery may become an accepted part of the Tx protocol: RP followed by RT. I think we will see more and more adjuvant (before biological failure) RT and perhaps more RT as primary Tx since, if you are going to have to have RT anyway, why have RP too? The silver lining is that biological failure does not necessarily mean systemic disease and that salvage (after biological failure) RT can still be a cure. Notice also that the rad-oncs are now saying to have RT before PSA reaches 1.0 when it used to be .6. Is this the result of new studies or a quick way to increase the pool of customers? :-) Happy New Year to all. Bill Denton RP 2/12/02 PSA >.6 Memphis Curtis, The Q&A post is interesting, but based on personal experience I differ strongly with the opinion on robotic surgery. I picked robotic becausr with the DaVinci, the surgeon can see much better. I'd rather my doctor see as well as possible. I think human beings are much more visually oriented than tactile oriented. I had terrific results. Maybe I just got lucky, but I think it was surgical skill combined with the latest technology that made the good outcome happen. I predict that robotic surgery will eventually replace most open surgery. The misery factor post op is way less. I think the most vocal critics of robotic surgery are the surgeons who have perfected a soon to be considered out-dated technique. They may feel justifiably threatened. If I had it to do over, I'd pick robotic over open any day, assuming a skilled robotic surgeon like I had. Happy New Year to all. Steve U <!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> <html> <head> <meta content="text/html;charset=ISO-8859-1" http-equiv="Content-Type"> </head> <body bgcolor="#ffffff" text="#000000"> On New Year's Eve, Steve U wrote, in pertinent part:<br> <blockquote cite="mid1136067907.917583.80980@o13g2000cwo.googlegroups.com" type="cite"> <pre wrap="">The Q&A post is interesting, but based on personal experience I differ strongly with the opinion on robotic surgery. I picked robotic becausr with the DaVinci, the surgeon can see much better. </pre> </blockquote> OK, now I'm gonna indulge myself in a rant about incorrect terminology. I've done this before, to no avail. That's no reason to quit when you're right.<br> <br> The da Vinci prostatectomy system is <b>not</b> "robotic."<br> <br> According to dictionary.com, a "robot" is "a mechanism that can move automatically."<br> <br> "Automatic" means "operating with minimal human intervention; independent of external control."<br> <br> The da Vinci system (which BTW is named for the French hospital at which the system was developed, not the Italian fellow) is not a mechanism that can move automatically, independent of external control. Its very essence <b>is</b> external control.<br> <br> Then what is it? For those who just can't refer to it by the terms of its originators (see, <a class="moz-txt-link-freetext" href="http://www.davinciprostatectomy.com/">http://www.davinciprostatectomy.com/</a>) how about calling it what it really is, a "waldo."<br> <br> A waldo is a mechanism for manipulation by remote control of practically anything. It is based upon the novella by Robert A. Heinlein entitled, simply, "Waldo." A man who suffered from myesthenia gravis invented a means of manipulating things by remote control. <br> <br> Mechanisms for manipulating, frex, radioactive materials, have for years been called waldoes.<br> <br> That is exactly what the da Vinci prostatectomy system embodies.<br> <br> And will this little harangue of mine result in reform? I doubt it.<br> <br> Regards,<br> <br> Steve J <br> <br> "Do not go where the path may lead, go instead where there is no path and leave a trail." <br> ---Ralph Waldo Emerson<br> </body> </html> > Then what is it? For those who just can't refer to it by the terms of its > originators (see, http://www.davinciprostatectomy.com/) how about calling > it what it really is, a "waldo." Aaahhhh! It is a WLRP, then.... SignatureJerryW Please respond to group; email address is not valid 2/11/04 PSA 2.6, Suspicious DRE (age 62) 2/23/04 Biopsy: Gleason 3+4=7, T2a, left lobe 5/18/04 RRP, Path: Gleason 4+3=7, T2c, both lobes 7/13/04 PSA <0.1 10/12/04 PSA <0.1 1/18/05 PSA <0.1 4/26/05 PSA <0.1 10/13/05 PSA <0.1 But, but, but....... Robotic "sounds" so cool : ) Waldo? " I had Waldo Lathroscopic Surgery..." Now there's a marketing challenge! Cheers! On New Year's Eve, Steve U wrote, in pertinent part: The Q&A post is interesting, but based on personal experience I differ strongly with the opinion on robotic surgery. I picked robotic becausr with the DaVinci, the surgeon can see much better. OK, now I'm gonna indulge myself in a rant about incorrect terminology. I've done this before, to no avail. That's no reason to quit when you're right. The da Vinci prostatectomy system is not "robotic." According to dictionary.com, a "robot" is "a mechanism that can move automatically." "Automatic" means "operating with minimal human intervention; independent of external control." The da Vinci system (which BTW is named for the French hospital at which the system was developed, not the Italian fellow) is not a mechanism that can move automatically, independent of external control. Its very essence is external control. Then what is it? For those who just can't refer to it by the terms of its originators (see, http://www.davinciprostatectomy.com/) how about calling it what it really is, a "waldo." A waldo is a mechanism for manipulation by remote control of practically anything. It is based upon the novella by Robert A. Heinlein entitled, simply, "Waldo." A man who suffered from myesthenia gravis invented a means of manipulating things by remote control. Mechanisms for manipulating, frex, radioactive materials, have for years been called waldoes. That is exactly what the da Vinci prostatectomy system embodies. And will this little harangue of mine result in reform? I doubt it. Regards, Steve J "Do not go where the path may lead, go instead where there is no path and leave a trail." ---Ralph Waldo Emerson The Q&A post is interesting, but based on personal experience I differ strongly with the opinion on robotic surgery. I picked robotic because with the DaVinci, the surgeon can see much better. OK, now I'm gonna indulge myself in a rant about incorrect terminology. I've done this before, to no avail. That's no reason to quit when you're right. The da Vinci prostatectomy system is not "robotic." According to dictionary.com, a "robot" is "a mechanism that can move automatically." "Automatic" means "operating with minimal human intervention; independent of external control." The da Vinci system (which BTW is named for the French hospital at which the system was developed, not the Italian fellow) is not a mechanism that can move automatically, independent of external control. Its very essence is external control. Then what is it? For those who just can't refer to it by the terms of its originators (see, http://www.davinciprostatectomy.com/) how about calling it what it really is, a "waldo." A waldo is a mechanism for manipulation by remote control of practically anything. It is based upon the novella by Robert A. Heinlein entitled, simply, "Waldo." A man who suffered from myesthenia gravis invented a means of manipulating things by remote control. Mechanisms for manipulating, frex, radioactive materials, have for years been called waldoes. That is exactly what the da Vinci prostatectomy system embodies. And will this little harangue of mine result in reform? I doubt it. Regards, Steve J ============= hi steve - i agree with you about the waldo. most people do not understand the true world of robotics. having been in robotics since 1965 - long before it was called robotics, i've got a whole long list of credentials in the field of robotics. for example - i hold a senior member status in the robotics international in the society of manufacturing engineering (SME) as well as in artificial intelligence (AI) waldos are just what you described - remote units duplicating movements from a command post. an robot in an industrial setting would be like that of a unit on the end of the assembly line that in stacking units on a pallet. it is unmanned. it is capable of stacking the units side by side, and in rows or stacks in a 3-D world at approximately the same speed of a human. it does the work of a human. it does not get tired, pregnant, call it sick, go on strike, take vacations, can work 24 hours a day, in the dark, nor does it ask for pay raises. another plus for the robot is that it stops at the first thing that is "not right" it doesn't keep going and doing something wrong. now, if the robot is adapted with AI, it is capable of making decisions, like in a automobile engine plant that is boring out the cylinders and the tools are getting dull, so, the cut isn't the same as it was, so it is capable of sensing the difference, making changes in it's programming to compensate for the variable, then executing that program, and resume its job - unless, the tool is at the end of its limit and can not adjust anymore, then, the robot will send a message to the central status board, that it needs service and kind of service is required. i have seen a robotic suicide. kind of interesting. the robot got hung up in a loop and the arm kept beating itself on the "head" (in this case, the central command module center) until it destroyed it. now, let's take a little time to "see" into the world of true robotics and what is really in store for the surgeon in a prostate cancer operation. in robotics, there are feedback loops and tactile sensors. one of these sensors that we use everyday is the touch screen keypad like what is on a cell phone. it has tiny wires in it that make up a grid and when you press on it, you close the circuit between two layers of wires so that there is only one contact point and that it the error signal that is generated to tell the cell phone, in this case, that you pressed a "1" or a "2". now, if you place MULTIPLE layers of fine wires into the design, you can now sense pressure - depending on how many layers are pushed together. this allows the robot to apply enough pressure to pick up a box or an egg without crushing it. you see, the robot doesn't know how fragile an egg is, it has to be told that it can apply too much pressure, so this is the feedback loop that prevent the crushing of the egg. picture the surgeon who can get inside the body and "feel" his way around. if he could "feel" the lymph nodes if there was a way of him to sense the firmness of the lymph node. now, the next thing i want to give you a glimpse into the crystal ball is that of non - tactile measurements. using a dot matrix system of artificial eyesight, the robot can "see" applying this to an assembly line application, the robot can have "windows" that when it looks at a part being made, it can measure it by just looking at it. the end result is that EVERY part being manufactured was 100% measured and the company did not depend on a sampling rate. applying this to the surgeon, using machine vision, not only can he see what he is looking at, he could use machine vision to measure the size of the prostate or tumors while they are inside the body as well as distances between the margins and the erectile nerves. all of this before he makes his surgical cuts. can you picture how great it would be for the surgeon to have the light right where he wants it, a camera with zoom factor to see everything up close and personal, tactile touch to feel what he is operating on, and machine vision to to the measurements as he goes. now couple this with a precision laser cutting tool that is based on the feedback loops of the measurements to make his incisions, and look what the chances of a higher positive erectile response after surgery. also, while the surgeon is in there, if he sees something that he suspects that could be a tiny piece of pca tissue or BPH tissue to small to pick up, just crank up the laser power and zap it and the tissue is fried. i could go on, but this is what i see in the future. i feel that we are in the meat ball surgery phase right now, but it's the best that we've got. can't knock it - it saved my life. it's just turned into the new year so may 2006 be a year of leaps and bounds in the discovery of cures in the field of pca. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc Last year, Curtis Palmer wrote: An interesting review of the present and future of robotics -- and maybe of waldoes used in surgery, as well. Since he's an expert in the field, a presume he's familiar with Isaac Asimov's Three Laws of Robotics: 1 A robot may not injure a human being or, through inaction, allow a human being to come to harm. 2 A robot must obey orders given it by human beings except where such orders would conflict with the First Law. 3 A robot must protect its own existence as long as such protection does not conflict with the First or Second Law. Regards, Steve J From: mycroftscj1@cox.net (Steve Jordan) Last year, Curtis Palmer wrote: An interesting review of the present and future of robotics -- and maybe of waldoes used in surgery, as well. Since he's an expert in the field, a presume he's familiar with Isaac Asimov's Three Laws of Robotics: 1 A robot may not injure a human being or, through inaction, allow a human being to come to harm. 2 A robot must obey orders given it by human beings except where such orders would conflict with the First Law. 3 A robot must protect its own existence as long as such protection does not conflict with the First or Second Law. Regards, Steve J ========== hi steve - yes, i'm very familiar with asimov's laws. these laws are the ones really come into play during the industrial application on what is known as "pinch zones". places where the robot has to operate in that are tight quarters and if a human being was to walk into them, the sensors stop the robot from working. and we are talking some serious pressures here. when you have a hydraulic robot that can pick up 500 lbs at a time, a man would be no match for it, if the arm was to catch him in a pinch zone. steve - it's interesting that you bring up these laws, because after i wrote that about how a robot works in the operating room, one might wonder if harm is being done to the human. is the robot hurting them? that answer is no. it is helping humans to live. now, what will be interesting is to have the patient lay on the table. the robot can sense the position of the body, have the data of that patient's personal info loaded into it, such as where the prostate is located, what stage of pca and tumor growth. then, it would load up it's own programs to being the operation. making the incisions, while having all the sensors monitoring for the hidden problems, in case something was to happen, making decisions as the operation gets underway, and adjusting it's program so that this patient will get a program unique only to him in order to procure the best possible outcome. and the surgeon would never touch the patient. the surgeon is a supervisor - overseeing the operation. this is true robotics in the operating room. now, i don't know if a surgeon will ever be in a situation such as what is industry. take for example, an expert painter. you have a product come down the assy line and he paints it perfect. using the teach mode of the paint robot, every movement and control operation is recorded of what the expert is doing and placed in memory. now, we have cloned an expert and each and every piece with be sprayed perfect. what happened to the expert painter? he is taken off of the assy line and fills a supervisor's role. in manufacturing, you can put 10 robotic paint spraying machines on lines and he is to supervise them, making sure that the quality of the work is being performed. if one of the robots needs service, such as the paint mixture is off, the expert can quickly make the adjustments and the quality if right back up to where it should be. so, in essence, the plant has 11 paint experts but is only paying for one. what is great about robot operations is that if this is special finish and the part gets damaged in the field and needs to be re-made. all you have to do is download that program and you will have the exact same finish as it was the first time. humans can't do that. so, i don't know if we could have a surgeon who could supervise 10 robotic "surgeons" doing prostate surgeries at the same time because each human being is made slightly different, whereas, you want each part on the assy line to be exactly the same. as a footnote on asimov's laws....... there still is so much safety built into robots to make sure these three laws are obeyed to this day. there are jokers on the assy, who mess with the robots trying to get them to 'hurt' them so they can draw compensation benefits. in fact, the unions have been so anti "robot" that the u.s. manufactures had to put "made in america" stickers on the robots to keep them from been damaged because people thought they were "imports". but that's another story........ ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc Curtis Palmer replied to me regarding the Three Laws of Robotics, in pertinent part: (su-nip) > steve - it's interesting that you bring up these laws, because after i > wrote that about how a robot works in the operating room, one might > wonder if harm is being done to the human. is the robot hurting them? > that answer is no. it is helping humans to live. > It would be an interesting and possibly impossible project to teach a robot surgeon, which is controlled absolutely by the Laws, that cutting into the unconscious body of a human being was not a violation of the First Law. And no matter how carefully the robot surgeon is programmed, as in war, the first casualty of a battle is the plan. IOW, even if the robot surgeon could be taught to cut into the human body, what to do when the practically inevitable happens and something beyond its programming occurs? Will the human supervisory surgeon be able to prevent disaster? Too much for me, thankew. I'll take a well-experienced human surgeon any day. And hope that (s)he had a restful night. But it's fun to speculate. Regards, Steve J "The true aim of medicine is not to make men virtuous; it is to safeguard and rescue them from the consequences of their vices. The physician does not preach repentance; he offers absolution." -- H.L. Mencken It would be an interesting and possibly impossible project to teach a robot surgeon, which is controlled absolutely by the Laws, that cutting into the unconscious body of a human being was not a violation of the First Law. And no matter how carefully the robot surgeon is programmed, as in war, the first casualty of a battle is the plan. IOW, even if the robot surgeon could be taught to cut into the human body, what to do when the practically inevitable happens and something beyond its programming occurs? Will the human supervisory surgeon be able to prevent disaster? ======== hi steve - this is what is either too hard to believe or too scary. machines that can think. abc did an article on artificial intelligence at few years ago. in a lab, they created what we call box figures. these are nothing more than 2-D boxes attached at one point. they had two models. one used two boxes attached together and the other model used a series of boxes attached together, much like a centipede. when they were first put together, all they would do is flail about in a haphazard manner. then they programmed in "darwin's law" using the fact that these units were asexual and produced 4 offspring and the program "killed" the three weakest units leaving the strongest one to survive and the cycle was repeated again. in this experiment, they were able to clearly show evolution in hours that would have taken hundreds or thousands of years. within less than 2 hours, these box figures produced some kind of directional movement and within 24 hours, they produced coordinated movement. the two box figures produced movements similar to a butterfly and the centipede boxes produced movements similar to a centipede - all without programming them to do so. to take this one step further, this is exactly what these computer viruses are. a form of AI. they are able to get into a computer and think. they are able to do their job, adjust, and transmit themselves to someplace else. and in doing so, over a period of time, these viruses are not the same as the original message that was sent, so did they not do the same thing as the boxes? and a virus is capable of changing to its environment. where this is field is going - i don't know. but it is rapidly advancing in leaps and bounds. taking this to the operating table. i don't know if i would want a machine that is capable of thinking for my best interest. but as you said, it's fun to kick around these ideas and thoughts. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc This is OT but, speaking of AI, has anyone seen a little computer game called 20Q? My sister was given one for Christmas. You think of an object and and the game asks you 20 questions about it to which you can answer yes, no, sometimes, or unknown. The accuracy is absolutely uncanny! You will think from the questions that it is on the wrong track but it will astound you w/ the right answer. From what I've read uses a neural network that "thinks" like a real brain. I tell you what - it thinks better than mine! Bill Denton RP 2/12/02 PSA >.6 Memphis Try here: http://20q.net/ Beat it most of the time. Best victory was Chad: "Scraps or bits of paper, such as the perforated edges of paper for tractor feed printers or the tiny rectangles punched out from data cards." It *IS* entertaining. > This is OT but, speaking of AI, has anyone seen a little computer game > called 20Q? My sister was given one for Christmas. You think of an [quoted text clipped - 9 lines] > PSA >.6 > Memphis Thanks Steve for helping to inform the misinformed. I've ranted two or three times here over the last couple of years that the robot does not do the surgery, the surgeon does. The last time I had to correct a guy who called it "doctor assisted robotic surgery" implying the doctor assisted the da Vinci. What did he think the doctor did, just plug it in and watch it go? Good grief, the last thing I want is a machine making decisions over what to snip and not snip. Dave Perry On January 2, Dave Perry wrote: > Thanks Steve for helping to inform the misinformed. I've ranted two or > three times here over the last couple of years that the robot does not > do the surgery, the surgeon does. (ka-snip) I'm glad for the company of another Jeremiah, a voice crying in the wilderness. Just another frustration; along with men who are so apathetic that not only will they not ask their own questions, leaving such chores to their wives, but they will not even *think* about helping others. How many PCa patients actually participate in any sort of support activity? Five percent, maybe? And how about my recent post on PCa education for GPs, using an essay for medics by Strum and Pogliano? Not one response, not *one*. In fact, one of the links I posted no longer works. No one inquired about it, so I know that no one paid attention. Prostate cancer research and treatment will not achieve the support levels that the ladies, bless 'em, have gotten for BCa, so long as most men act like children. The women have done so much better because they are more realistic than men. They are forced to be because of what they are... Well, I've wandered too far OT. Sorry. Sometimes it just gets to be too damned much. But I won't quit. Regards, Steve J "No man is an Island, entire of itself; every man is a piece of the Continent, a part of the main; if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friends or of thine own were; any man's death diminishes me, because I am involved in Mankind; And therefore never send to know for whom the bell tolls; It tolls for thee." -- John Donne > how about my recent post on PCa education for GPs, > using an essay for medics by Strum and Pogliano? > Not one response, not *one*. In fact, one of the links > I posted no longer works. No one inquired about it, so >I know that no one paid attention. I saw, paid attention, and began a response, but my computer had PMS at the time and I gave up in disgust. IIRC, my comments centered around these thoughts: 1. I've found almost no docs yet who will stoop to accept leads from "civilians". It took me years, an ambulance transport, my apparently imminent death, and finely targeted MRIs to get a team of neuros to seriously consider my rationale indicating that I had Meniere's disease. 2. Let alone the internet via civilians. They just scowl and yell you to "watch out for the internet.'" 3. Even on mundane, well-e and long-established topics such as the link between ED and vascular disease or the interactions between grapefruit juice and some medicines, some won't even follow your insistent lead to do their own reading if they won't follow your leads. Those are the ones I fire and report. 4. Because Strum is self-published without per review, some academicians place little faith in his work. That, quote likely, is why some PC specialists know, say, and/or do so little about SEs, particularly osteoporosis. 5. All of which explains why I felt so compelled to do my own research -- much of it targeted and driven by you folks -- and make my own decisions about PC tx. > Prostate cancer research and treatment will not achieve > the support levels that the ladies, bless 'em, have gotten > for BCa, so long as most men act like children. > The women have done so much better because they > are more realistic than men. They are forced to be > because of what they are... But despite all that, the docs are very reticent to take women's differences into account. Just last week I saw an ad for the top local heart treatment center which listed the top half dozen heart attack warning symptoms ... none of which applied to women. 95% of female heart attack victims had warning signs weeks in advance, yet partly because 2/3 of female heart attack victims and many of their doctors fail to recognize women's unique warning symptoms, heart disease kills more women than any other cause -- six times as many as breast cancer. Just as with PCa, patients stand to gain a great deal if they can awaken doctors to more facts. I.P. |
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