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Medical Forum / Diseases and Disorders / Prostate Cancer / January 2006information like this can be very misleading..........
can you imagine what a man who has urinary problems and an small elevated psa rise would think and then tell his doctor if the doctor wanted him to get a biopsy? to make things even worse, the poster claims to be a doctor, but sure doesn't talk like one....... ~ curtis ========================= Erectile difficulties from dutesteride and finesteride Group: sci.med.prostate.bph Date: Tue, Jan 3, 2006, 12:17am (CST-2) From: ddsmd@rogers.com (Physician) I am a physician who was the medical director of one the largest erectile dysfunction/sexual dysfunction clinics in the world. Many of the treatments for BPH cause erection problems. Finesteride and dutesteride both block the formation of Dihydrotestosterone which is essential for normal sexual function and needed for good erections, for sperm production and ejaculation. These medications can also shrink an enlarged prostate. Even though only 3-5% of men will have profound erection problems when they start these medications the majority of men using them will have a significant and very real decline in the quality of their erections. Spontaneous erections and mornming erection will become less frequent and eventually stop which are one of many signs that a man's sexual functionis being weakened while on these medications. These changes that happen gradually and very few doctors know the correct questions to ask to detect these problems. But once erections have started to weaken it is my experience that these changes are usually irreversible. Stopping these medications will not restore normal erections again. Most men who experience erectile problems on these medications it is irreversible. I am also sickened by the large numbers of men who are receiving radical prostatectomies for small or minor elevation of the PSA. There are many men with no symptoms or signs of BPH but who have only a small increase in their PSA who are recieving biopsy's of their prostate. In Canada Urologists make a living doing procedures. So when a man is referred to an urologist even when the prostate is not enlarged and their are no symptoms the patients are often told that to be safe they should have an ultrasound and a biopsy. Well most men with prostate cancer never find out that they have it and die from something else. In fact if you did an autopsy on men 60 years old, 60% will have microscopic prostate cancer, 70% of men aged 70 years old will have prostate cancer, 80% 0f men over 80 will have microscopic prostate cancer, and 90% of men aged 90 years old will have prostate cancer but very few of these men will ever die or have problems from their cancer. That is why it is dangerous to be doing routine biopsies on men with a PSA below 10. Because if you are 70 years old you will have up to a 70% chance of that test showing that you have cancer, even though their is only less that a 1/10 chance that that cancer will ever enlarge and cause you problems. If the prostate is normal only if that PSA goes from below 10 to well over 10 do you need to have a biopsy. Most men with a positive biopsy within days or a few weeks are having a radical prostatectomy, which means they will never ever ejaculate again; they will never ever have a normal erection without using intra-penile injections. More than 50% will be incontinent of urine and have to wear diapers for the rest of their lives, and perhaps 20% will have fecal incontinence. In fact the majority of men I see who have profound sexual dysfunction from prostate cancer had no symptoms and the only reason they had the biopsy was because of a minor increase in their PSA. Since the introduction of the PSA test Urologists are doing 4 times more radical prostatectomy's even though their has been no decrease in the death rate from prostate cancer! Doctors may just doing more un-necessary surgeries on men who would never have had any problems if they had been left alone. If you have a PSA test that is less than 10, wait a few months and repeat it. Only if the PSA is rising, or you have signifcant enlargement, reduced or blocked urine flow or asymetry or a nodule should you consider a biopsy if your PSA is below 10. If you elect to have a biopsy remember if it is positive you will imediately have the quality of your life profundly changed in a very short period of time! Remember erectile problems rarely are caused by the prostate, it is the tests and procedures such as cystoscopies, biopsies and TURPS/prostatectomies done by urologists that damage the penis that are going to ruin your sex life, not the postate itself if it is left alone. All patients need to be fully informed before they can make an informed choice about the choices of treatment offered to them. 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 > ... > I am a physician who was the medical director of one the largest > erectile dysfunction/sexual dysfunction clinics in the world. > ... This statement would be much more credible if the author gave his name and the name of his clinic. What would be the motivation for claiming this but posting anonymously unless it was a lie? > ... > Since the introduction of the PSA test Urologists are doing 4 times more > radical prostatectomy's even though their has been no decrease in the > death rate from prostate cancer! > ... The author seems to know something about cancer, but his statistics aren't right. As I understand it, the death rate from prostate cancer dropped 30% in the United States between 1990 and 2003. Incidentally, there are some surprising misspellings in this article. It is possible that the author is not a native English speaker, but I'm wondering if it is a native speaker but with a deficient education in English. Alan > > ... > > I am a physician who was the medical director of one the largest [quoted text clipped - 4 lines] > his name and the name of his clinic. What would be the motivation > for claiming this but posting anonymously unless it was a lie? Posters have the right to be anonymous. He did say "was". He's in Toronto. His position does seem consistent with BC (Canada) and Uk webpages that I posted earlier. Perhaps that's why there's so few UK'ers and Canadians on this newsgroup. They're off enjoying their lives and doing the "watchful waiting". > > Since the introduction of the PSA test Urologists are doing 4 times more > > radical prostatectomy's even though their has been no decrease in the [quoted text clipped - 4 lines] > aren't right. As I understand it, the death rate from prostate cancer > dropped 30% in the United States between 1990 and 2003. http://www.cdc.gov/cancer/prostate/prostate.htm Among all racial and ethnic groups, prostate cancer death rates were lower in 1999 than they were in 1990. Decreases in prostate cancer death rates during 19901999 were almost twice as great for whites and Asian/Pacific Islanders than they were for African Americans, American Indian/Alaska Natives, and Hispanics. Although there is good evidence that PSA screening can detect early-stage prostate cancer, evidence is mixed and inconclusive about whether early detection improves health outcomes. In addition, prostate cancer screening is associated with important harms. These include the anxiety and follow-up testing occasioned by frequent false-positive results, as well as the complications that can result from treating prostate cancers that, left untreated, might not affect the patient's health <http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Prostate_Cancer_Deaths_Down_P ossible_Link_To_PSA_Test.asp> The death rate from prostate cancer is at an all-time low for both white and black Americans and a new study suggests that a primary reason may be increased use of the PSA blood test (prostate specific antigen test) to find prostate cancer early. However, study author Kenneth C. Chu, PhD, of the Center to Reduce Cancer Health Disparities warned men to talk with their doctors about the pros and cons of being tested. The drop in death rates comes "at the cost of a very large increase in the number of men treated for prostate cancer since 1986," wrote Chu and colleagues in the journal Cancer (Volume 97, Issue 6, 2003: 1507-1516). Treatments can cause serious side effects and many prostate cancers may grow so slowly they would never cause health problems if left untreated. The researchers looked at trends in both newly diagnosed cases of prostate cancer (incidence) and deaths from prostate cancer (mortality) then analyzed the trends further by disease stage. Study data covered from 1969 to 1999 and came in part from the National Cancer Institutes large national cancer survey program, Surveillance, Epidemiology, and End Results (SEER), which collects data from nine population-based US cancer registries. The drop in death rates for local, regional, and advanced cancers combined was due to fewer men dying from advanced prostate cancer, according to the new study. But medical treatments didn't save any more men with advanced cancer -- instead fewer men were diagnosed with advanced ("distant") disease. Chu and colleagues say the PSA test was finding prostate cancer in earlier stages, when treatments are more successful. "That is, tumors that, without intervention, would be diagnosed in the lethal, distant stage are being detected early by PSA testing, so that men are diagnosed in the localized or regional stage; the resulting marked improvement in prognosis leads to decreasing mortality rates," wrote the study author Use of the PSA test in other countries has shown mixed results so far. For example, in the United Kingdom prostate cancer death rates have dropped recently, as they have in the US. But there has been no large screening program and there was no large increase in incidence, as seen in the late 1980s in the US. SEER stops year 1975 - 2000 http://seer.cancer.gov/csr/1975_2000/results_figure/sect_22_zfig.02.pdf unless you can find something more recent in their statistics. Doesn't look like a 30% drop in deaths (to me) in Caucasians under age 65. What would it be (there) for the over 65'ers? J > Posters have the right to be anonymous. Sure ... but if they want us to believe surprising claims, they're whizzing in the wind unless they provide peer-reviewed facts to back up their claims, or at the very least provide their own credentials. > Perhaps that's why there's so few UK'ers and Canadians on this newsgroup. > They're off enjoying their lives and doing the "watchful waiting". I can think of two more discouraging explanations: they haven't a clue they have PC, and/or are NOT enjoying their lives any more. > prostate cancer screening is associated with important harms. > These include the anxiety That's a personal, emotional issue ... not a cancer issue. The two can be treated separately, just like a broken leg and hypertension. Even if I had a broken leg, I'd still want to know if my BP were kiling me so I could treat it, too. Anyone who can't handle cancer emotionally had better choose a heart attack or plane crash instead, or get his/her emotions treated along with his cancer, as some here have done. > and follow-up testing occasioned by frequent false-positive results Fairly easily resolved by DREs and biopsy ... unlike a false negative. > as well as the complications that can result from treating > prostate cancers that, left untreated, might not affect the [quoted text clipped - 5 lines] > grow > so slowly they would never cause health problems if left untreated. So, tell us which cases those are, so we can just watch them safely for the next 30 years. Dang ... wish I'd KNOWN 15 months ago whether my Gleason 8 TC3 was going to kill me within 25 years, rather than just PRESUMING it was highly likely to do so. > Chu and colleagues say the PSA test was finding prostate > cancer in earlier stages, when treatments are more successful. Uh, isn't that a vote FOR screening? > Doesn't look like a 30% drop in deaths (to me) in > Caucasians under age 65. Why would anyone EXPECT a drop in deaths under 65, given that PC so often surfaces in our late 50s and 60s and often takes 15 years to kill? I.P. > > Posters have the right to be anonymous. > > Sure ... but if they want us to believe surprising claims, they're whizzing > in the wind unless they provide peer-reviewed facts to back up their claims, > or at the very least provide their own credentials. Email him, if it's important to you. Curtis provided his email address. > > Perhaps that's why there's so few UK'ers and Canadians on this newsgroup. > > They're off enjoying their lives and doing the "watchful waiting". > > I can think of two more discouraging explanations: they haven't a clue they > have PC, and/or are NOT enjoying their lives any more. Not reading? one of the websites said deaths from PCA are down in UK. > > and follow-up testing occasioned by frequent false-positive results > > Fairly easily resolved by DREs and biopsy ... unlike a false negative. You alaredy saw a false positive - a man here who had stones, not cancer. > ... wish I'd KNOWN 15 months ago whether my Gleason 8 > TC3 was going to kill me within 25 years, rather than just PRESUMING it was > highly likely to do so. You're in the high risk group. See Table 1 http://www.cfpc.ca/cfp/2004/Jan/vol50-jan-cme-2.asp Outcomes of treatment A randomized trial of watchful waiting versus radical prostatectomy published in 20025 followed 695 men with localized (generally low- to intermediate-risk) prostate cancer diagnosed in Scandinavia before PSA screening was in use. After a median of 6.2 years follow up, development of metastatic disease was 17% in the watchful waiting arm and 11% in the treatment arm. Overall survival of the two groups at 6.2 years was similar (87.3% and 89%). Whether a significant difference in survival will emerge with longer follow up is uncertain. In a parallel report,6 no overall difference in quality of life was seen in the two groups. There were differences in erectile dysfunction and urinary leakage (both worse in the surgery arm) and urinary obstruction (worse in the watchful waiting arm). Canadian practice differs from Scandinavian in that tumours diagnosed here are at an earlier stage (due to physician awareness and PSA screening). Results might not, therefore, be applicable to our practices because earlier diagnosis would give an additional 5 to 6 years lead time and thus reduce any improvement in mortality that might otherwise appear after more extended follow up. The second randomized study compared surgery and radiation therapy, both combined with androgen deprivation.7 It reported worse outcomes with radiation therapy than surgery. The study has been criticized for taking more than 4 years to accrue just 100 patients from six institutions in Japan. Slow accrual, low patient numbers, and the relative scarcity of prostate cancer in Japan raise questions regarding treating physicians experience and patient selection. Results are, therefore, probably unreliable. Other trials of surgery, radiation, or watchful waiting have not accrued enough patients and have been closed prematurely without reporting results. A new study, SPIRIT,8 just begun in North America, is a randomized comparison of radical prostatectomy and brachytherapy in 1980 men with low-risk cancer. Results are not expected until at least 2010. With few good-quality randomized studies comparing treatments, evidence of benefit must be drawn from elsewhere. Single-institution reports are particularly prone to bias, which can be minimized by using nomograms. Nomograms are based on results from several thousand patients, typically from several series. To date, there are at least 42 nomograms, of which 17 have been validated.9 A comparison between clinicians and 22 nomograms showed that nomograms predicted outcome better than clinicians in 13 cases. Modification of a nomograms output by a urologist worsened its predictive ability.10 The most widely used nomogram is the Prostogram.11 It is freely available at www.nomograms.org. Typical output from this nomogram is shown in Figure 1 and can be used to indicate the likely relative success of treatments. A criticism of the Prostogram is that it does not model the effect of adjuvant hormone therapy, which substantially improves outcomes with higher-risk tumours. >> > Posters have the right to be anonymous. >> [quoted text clipped - 3 lines] >> claims, >> or at the very least provide their own credentials. The dilemma: We all attach a little weight to opinions based on anonymity vs openness. If one posts with a fake email address and fake name, he/she is least credible, out of the box, of all. Next comes those with actual email addresses and alias names. Then with real email and real names. Then with real emails, names and titles. But then you can Google them and find they have been investigated by the Securities Administration and that they hail from Nigeria.  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 > "J" <studras@anon.inv> wrote in message > > [quoted text clipped - 9 lines] > > We all attach a little weight to opinions based on anonymity vs openness. That's a mistake. I know of a number of doctors who post anonymously. And I have their credentials. And I don't just take their word for it. I double check what they tell me a number of ways. But I do not contact their homes, relatives, nor place (or ex-places) of work. It's not fair to the original poster (the doctor who is "bad-mouthing" other doctors). They have to be able to speak out without fear of retaliation or shunning by colleagues in other medical professions.. > If one posts with a fake email address and fake name, he/she is least > credible, out of the box, of all. [quoted text clipped - 7 lines] > they hail from Nigeria. > [..] or on slick web pages selling garbage theories (or products) and they aren't even doctors at all. Here's just one example http://www.newtimesbpb.com/Issues/2005-12-22/news/news.html Another had two names - it's posted about on sci.med.dieseases.cancer under subject "Caveat Emptor:" Unfortunately he is a doctor and was injecting weed killer into patients and is associated with other quack cure web pages. So shutting down one doctor or having him pay fines barely touches the tip of the problem. His clinic continues with two doctors. He has two sons who are doctors. (* I don't know if they are or not associated with his scams*) J >> "J" <studras@anon.inv> wrote in message >> > [quoted text clipped - 15 lines] > But I do not contact their homes, relatives, nor place (or ex-places) of > work. It was a joke, J. The punch line was Nigeria. I guess it was an inside joke. We had a guy on a couple of months ago that was going to make us millions of dollars. For all intents and purposes, I am anonymous. No one on this NG, except Robert Young, lives(d) within 100 miles of me. No one on this net gives me any credence at all based on my email address or name. I am just one of a dozen Steve Kramer's in Cincinnati with no medical expertise at all other than I have PCa. > The dilemma: > > We all attach a little weight to opinions based on anonymity vs openness. Opinions, schmopinions; I'm talking about facts. Only if peer-reviewed facts (including large-scale statistics, and at some point non-reviewed claims such as some of Strum's) fail to resolve an issue should we resort to opinions to form life-affecting decisions, and those opinions should be THE PATIENT'S, not someone ELSE'S. How my own blood brother's hypothetical PC tx came out is of zero decision-making value to me (or certainly you) compared to how 10,000 VA PA cases turned out. > If one posts with a fake email address and fake name, he/she is least > credible, out of the box, of all. Which is why I reference recognized sources to support any PC claims I make. I would never ask or expect anyone to make any decisions based on any opinions or "facts" I originate, just as I would make no significant decisions based on any "facts" generated by anyone in this forum or spouted by any urologist without support. For that reason my identity is of zero importance to any of you; its primary significance is to three fully-identified, specific internet stalkers who can't stand the fact that my politics are right of center. If they found me here they would be in YOUR faces as well as mine. I wouldn't care if all of you knew my name; it's those three fanatical left-wingers who have created the problem. > Then with real email and real names. I don't care if posters have real names, addresses, and verified M.D.s from Johns-Hopkins; before I make decisions based on their claims I'd want broader, peer-reviewed support for their claims. We mustn't forget that we're trying to cure or at least ameliorate our CANCER and its impacts here, not pick a dog from the pound. If I lived my life by others' -- including a team of uro oncs -- OPINIONS, I'd be on ADT right now. But my research of the FACTS and their application to my personal PREFERENCES not only persuaded me otherwise, but changed that whole team's opinions OF MY CASE. Yet I wouldn't advise anyone else to eschew ADT just because *I*M*O* its use as a first adjunct after primary treatment in asymptomatic active people is highly debatable (or even because it is debatable and debated by the top minds in the field.) No one here should give a damn about my OPINIONS. Mt opinions' only value should be as motivation to dig into the FACTS I formed them from, followed by application of those facts to their own PREFERENCES to reach their own treatment CHOICES. I.P. and that's all you need to know ... IMO >> The dilemma: >> >> We all attach a little weight to opinions based on anonymity vs openness. > > Opinions, schmopinions; I'm talking about facts. Sometimes I'm funny. And sometimes I aint. I thought the Nigeria (though not as good as a smiley) was a dead giveaway. Truthfully? There is no expert, in my opinion, until he has convinced me that he is an expert. It don't matter if he is anonymous or has 40 diplomas on the wall. > No one here should give a damn about my OPINIONS. Well, that's true enough. ;-) 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 > Truthfully? There is no expert, in my opinion, until he has convinced me > that he is an expert. It don't matter if he is anonymous or has 40 > diplomas on the wall. And he -- whether it's Walsh or Scardino or Strum or a flawless trial based on 20,000 patients -- is STILL is not an expert in our PERSONAL PRIORITIES. With, say, 20 main and side effects on the menu, there's room for millions of different rankings. (I think the simplistic, theoretical number is 20 x 19 x 18 x ... x 2, if I recall correctly.) I.P. "Steve Kramer" wrote> > Sometimes I'm funny. And sometimes I aint. I thought the Nigeria (though > not as good as a smiley) was a dead giveaway. I got ... and smiled at ... the joke; the Nigerian problem has been widely known for nearly a decade. But my credibility comments referred to other, more meaty, paragraphs. I.P. J wrote...snip... > SEER stops year 1975 - 2000 > http://seer.cancer.gov/csr/1975_2000/results_figure/sect_22_zfig.02.pdf > unless you can find something more recent in their statistics. > Doesn't look like a 30% drop in deaths (to me) in Caucasians under age 65. > What would it be (there) for the over 65'ers? > J J...Last I checked (spring '05) the SEER data went through 2002 http://seer.cancer.gov/csr/1975_2002/results_merged/sect_23_prostate.pdf The high water mark was in '91 and again in '93, when there were 39.3 deaths due to PCa in the US per 100,000. In 2002, this number had fallen to 28.1. I calculate a 28.5% decrease in mortality...Ron > J wrote...snip... > > SEER stops year 1975 - 2000 [quoted text clipped - 11 lines] > deaths due to PCa in the US per 100,000. In 2002, this number had > fallen to 28.1. I calculate a 28.5% decrease in mortality...Ron Thanks Ron, in which populations (split them out, caucasians, blacks, hispanics) and age groups? J > J wrote...snip... > > SEER stops year 1975 - 2000 [quoted text clipped - 11 lines] > deaths due to PCa in the US per 100,000. In 2002, this number had > fallen to 28.1. I calculate a 28.5% decrease in mortality...Ron There are two important points about this that I should have made earlier but didn't think of. 1. We don't know for certain that early detection is the cause of this drop. Another possible explanation is that hormone therapy has reduced the number of deaths from advanced PCa. I don't know the facts here, but if a man ordinarily lives, say, 4 years after cancer metastasis, but HT extends that to 7 years (these numbers are made up), then some percentage of men may die of other causes in the three years they gain from HT, thus reducing the PCa death rate. If HT were to increase other death rates, e.g., make heart attacks more likely (I'm making that up too), then the difference would be even more significant. LHRH agonists were developed in the 1980s. IF (and I don't know if this is true or not), treatment by HT increased dramatically in the 90's, and if HT extends life, it could account for the difference in death rates. The first "if" may or may not obtain. Orchiectomy as a hormonal treatment for PCa was discovered in the 1940's and became a standard treatment. So I don't know if hormone deprivation really increased in the 1990s, or whether it just got more palatable for patients. 2. Not all men in the U.S. get PSA tests. If early detection and treatment IS the cause of dropping death rates, then increasing the number of men who get PSA testing will decrease the death rate even further. In other words, if early detection is involved in the lowered death rate, then the drop in overall death rates significantly _understates_ the value of early detection because the death rate also includes many men who never got PSA tests until it was too late. Alan (snipped) > The death rate from prostate cancer is at an all-time low for both white > and > black Americans - and a new study suggests that a primary reason may be > increased use of the PSA blood test (prostate specific antigen test) to > find > prostate cancer early. (snipped) > The drop in death rates for local, regional, and advanced cancers combined > was [quoted text clipped - 5 lines] > colleagues say the PSA test was finding prostate cancer in earlier stages, > when treatments are more successful. Claims for increased longevity for those diagnosed with PCa seem problematic to me. Here's a purely hypothetical example that demonstrates what I find confusing. Let's say100 guys were diagnosed with PCa in 1985. Back then it's likely that most would have been in their 70s or older. And let's say, hypothetically, that 10 eventually die of prostate cancer over the intervening 20 years. Now, let's suppose the PSA test had been around way back in 1945, and those same 100 guys were tested at that time, but (just for the sake of my example) absolutely NOTHING else was done to them until 1985. Then they got the same treatment as above. Again, in this second situation 10 would die -- but the medical profession would, quite logically, claim that it had extended the life expectancy of those diagnosed by 40 years. Yet the only thing we've actually altered is the men's age at initial diagnosis. The success (or failure) of the actual treatment was unchanged. Those of us diagnosed with PCa have at least three variables to juggle in our brains: (1) A lot of new treatment options have become available. But many of these are so new there is no long-term success data available for them. Do we choose a promising new treatment, wait for more information, or reject innovative approaches in favor of "gold standard" methods? All are gambles. (2) The advent of the PSA test and wider use of DREs have resulted in a large number of men being diagnosed with PCa at much younger ages than in the past, often with much earlier-stage PCa. They are confronted with the need to make decisions about life-changing treatments for a cancer which, for some, may have remained indolent for the rest of their lives -- but for others would have been deadly. (3) Younger men are likely to be in better physical shape, and better able to recover from any treatment they receive for PCa. So it's not entirely clear whether the doctors treating them are better than in the past, or it's just that today's doctors are working on less riskly patients. All of us want to see continuing innovation in ways to treat PCa, whether that's chewing on stinkweed root or having R2 D2 and CP 30 take over the surgical suite. But we also need help from the scientific and medical experts in better ways to determine whether our specific cancer is active or indolent, and which of the wide range of treatments available to us is the best choice for our individual case. Alex While logically stated, I do not think the hypothetical holds. I think a better hypothetical would be something like; Robert is diagnosed with PCa in 1974 at 42 years old. Since there is no PSA test, he probably had it two years before, so let's say 1972. He gets an RPP, cobalt radiation, estrogen ADT, and chemo before he dies an escrutiatingly painful death in 1982. Stephen is diagnosed with PCa in 2000 at 46 years old. Since his PSA was 16, he probably had it two years before, so let's say 1998. He gets an RPP, EBRT, Lupron ADT and, one can predict, chemo. Oh, and one helix of his DNA is identical to Robert's. If I am still able to type in this NG during 2010, treatments have gotten better. 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 > (snipped) >> The death rate from prostate cancer is at an all-time low for both white [quoted text clipped - 67 lines] > > Alex > Claims for increased longevity for those diagnosed with PCa seem problematic > to me. [quoted text clipped - 15 lines] > the men's age at initial diagnosis. The success (or failure) of the actual > treatment was unchanged. This is good thinking Alex, but I don't think that's what the "death rate" means. I don't think it's the percentage of men diagnosed with PCa who die. I think it's the percentage of men in the general population who die of PCa. If one year 50,000 men die of PCa, and ten years later only 40,000 die of PCa, that's a 20% decline in the death rate (assuming constant size population). Age at diagnosis has nothing to do with that. Alan "c palmer" criticised these quotes: > Most men with a positive biopsy within days or a > few weeks are having a radical prostatectomy If true, that is scary. I can't imagine educating myself sufficiently in days or weeks to choose any radical treatment. > which means they will never ever ejaculate again; > they will never ever have a normal erection without using intra-penile > injections. More than 50% will be incontinent of urine and have to wear > diapers for the rest of their lives, and perhaps 20% will have fecal > incontinence. Oh, yeah? I've never seen a picture anywhere near that dire across the board of RP. > In fact the majority of men I see who have profound sexual dysfunction > from prostate cancer had no symptoms and the only reason they had the > biopsy was because of a minor increase in their PSA. Huh? How does "profound sexual dysfunction" equate to "no symptoms "? > If you elect to > have a biopsy remember if it is positive you will imediately have the > quality of your life profundly changed in a very short period of time! Only if you educate yourself, study your cancer case, and CHOOSE to alter your QOL immediately (to improve is long term). > it is the > tests and procedures such as cystoscopies, biopsies and > TURPS/prostatectomies done by urologists that damage the penis that are > going to ruin your sex life Sooooo, how does that explain all the long-faced guys (and frustrated wives) who have never had any of those tests? > All patients need to be fully informed before they can make an informed > choice about the choices of treatment offered to them. Finally, I agree. I.P. Fecal Incontinence??? What the s**** is he talking about? I'm sending this guy a note. A friend of mine just lost his kidneys after his prostate cancer spread there less than a year after a RRP. He is 60. His PSA was 4.5 (up from 1.5 in a year) when he was diagnosed. (Normal DRE). Let's wait till people like this lose a few more organs before they act. Biopsy/Ultrasound does not equal RRP. That decision comes afterward in and informed way. More and more evidence suggests that it's not the PSA#, but how it is behaving over time that is indicative of the existence of PCa. I'm not a doctor, but I keep preaching that PSA testing can only help. There is no downside! The next step; biopsy does include some risk OF NOT FINDING AN EXISTING CANCER, but no way can it misdiagnose existence of the disease (assuming competent pathology). The next step is the big one. You've got cancer. What do you do about it? The answer to that question comes from an evaluation, consideration, and determination unique to each and every one of us.Watchful waiting is ALWAYS an option (while it may not be recommended). I have another friend who is 82. Gone through non-prostate cancer treatment 5 years ago. Radiation, chemo, the whole nine yards. This year he was diagnosed with PCa. 1 of 8 cores, low Gleason. He's going nuts about having his prostate removed (he wants it done NOW). His doctors are against it for several reason - the primary one is that he will, in all probability, not die of this cancer. Like so many people this guy has an immortallity complex - thinks he can and is gonna live forever. Actually, I think he knows better but is just pertified fo dying and unwilling to face the inevitablility. I know a lot of people like that. They need help. Dying can be a peaceful, even comfortng event. There is no need for "old age" end of life to be traumatic, if you and yours simply face and understand it's inevitabilty and its promises. My mother in law died just last August at 81. I was there. We had all faced, with her, this inevitability. We were all at peace. She said goodbye, plainly and with a smile, moments before she passed. Seconds before she passed she pointed up toward the ceiling and made a circling motion. There were no words. There was also no doubt. She saw that infamous light! Doctors/scientists say this is probably due to oxygen starvation of the brain. I wonder. Actually I don't wonder - 'cause I've been there - nearly died from a reaction to anesthetics during a rotator cuff operation 30 years (probably closer to 40 now) ago. I saw the light.... remember it clear as a bell! It's not the light that impressed me, it's what I experienced inside it. Sounds melodramatic? Just the truth! This guy is obviously retired. He specialty suggests that he has dealt with an older demographic for the most part. His dialog may have been slanted from this perspective. I don't think many of us would worry allot about a guy having a PSA near but under 10 if he was 75-80. |
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