No, not at all.  I remember Gordy talking about those rare nodules.  For
some reason I thought it was early 2007.  I'm glad Les is doing relatively
well.

My colon cancer CTs show long nodules, too. But everyone says they're
expected at our age, and that while we might not win the Tour de France
with them, we'll never notice them otherwise.

That, or course, may mean any of several things, including:
1. Your docs are smarter than mine.
2. My docs are smarter than yours.
3. Both sets of docs are right, and my nodules are just different from
yours.

Sounds like you may know in June. If yours are mutated mets, what does
one do about THAT, given that even garden variety mets present treatment
 dilemmas?

I.P.

You're right.  I've had anxiety attacks/issues regarding other things.
Not this.  Not yet anyway.  I'm trying to face it squarely.  It's just
some of the unknown stuff right now.  And I'm over-reacting to some
things, since in know my own probabilities are low right now.

.

First, there are various risks associated with transplants, and the
drugs needed to suppress rejection have serious side effects.  But a
more basic question is "why bother?"  It is possible that a prostate
might be implanted in such a way to improve continence, but that seems
rather unlikely to me.  In any case, there are already surgical
techniques to do that.   It might also restore some ejaculation, but
that hardly seems worth the effort.  Since the new prostate might
develop BPH or prostate cancer itself, it seems better not to replace it.

Erections are controlled by nerves outside the prostate, and those
nerves can and often are transplanted.

Given all the disadvantages of having a prostate, one might better argue
for routinely removing it from men past the age when they may want to
produce offspring, at least for men with a high likelihood of getting
prostate cancer.  Even fertility could be preserved without a prostate
by storing sperm.

[snip]

Of course you are right that the Quality of Life (QOL) costs are not
intuitively quantifiable in the same sense that the economic costs are.  But
I believe one could do better than just winging it.  But before addressing
that, let me answer the question of why bother.

Just as we are often fooled by our senses, I think we can be fooled by our
emotions:  we can make choices which are inconsistent with our actual
priorities because of what we _wish_ were true.  The object of a decision
analysis for say, the initial treatment, would not be to make the decision
per se but to check the consistency of our assumptions and explore which are
the key variables.  The best analogy I can think of is the mathematical model
in a Business Plan.  It is well known that you can make the result come out
pretty much any way you want by choosing your assumptions.  I know I have
done so :-).  But the real value of the model is to see how the outcome
changes as you change the assumptions;  in identifying those variables and
assumptions which change the outcome by 100% when they change by 10% and the
other way around.  The structure of the model itself, if done correctly,
helps you to understand the fundamental dynamics of the business and can be
agreed upon by everyone even if the specific assumptions are subjective.

Some examples: how would my treatment selection change if my Gleason score
were off by 1 (and what is the probability of that?); what is the probability
that one more biopsy needle would have found a worse sample?;  what is the
probability that the cancer has already escaped the prostate?; etc., etc.  
You implicitly evaluate these probabilities when you you make a treatment
choice anyway.  Why not make the evaluations explicit and see how your choice
would change if you varied the probabilities?  And are your probability
estimates reasonable or driven by emotion? (Example: people are usually more
afraid of dying in an airplane crash than in a car crash even though the
later is orders of magnitude more likely.)

That's the first part of a decision analysis, estimating the contingent
probabilities, and there are good data out there to help you get a handle on
it.  The other part is the payoffs: years of survival and the QOL of that
survival.  I don't know how to do this but I have some ideas.  The hint that
it can be done, or at least approximated, can be found in the frequently
heard comment that "I'd rather have three good years than four bad ones".  It
should also be possible to factor in the "time value of life" (to coin a
phrase) similar to the "time value of money":  another year now is probably
worth more than another year ten years from now.

These payoffs will be different for each individual and different for the
same individual at different points in his life.  One approach for developing
an individualized "payoff matrix" might be a series of preferences.  For
example: "Would you rather live with incontinence or impotence?"; "Would you
accept a 5% risk of incontinence to achieve a zero risk of impotence?";
"Would you exchange a life span shortened by three years but additional
unimpaired year now for a five year life span where you were tired all the
time?".  These are only examples meant to illustrate the technique and would
certainly not be the final questions.  An analogy here might be the many
different "pop psychology" personality tests which help you gain insight into
your character (although they are frequently misused and assumed to have a
greater validity than they do).

Thus I see the decision tree and it's contingent probabilities to be about
the same for everyone and open to collaborative development while the payoffs
in terms of length and Quality of Life would be subjective and different for
every individual _but_ consistent for that individual.  The object would be
to help understand the different variables and to expose any inconsistencies
in the logic, not to dictate the decision or reduce the unquantifiable to
three decimal places.

Of course such a model would not eliminate "worry" which, I guess, was the
original issue, but I think it would be helpful in choosing the initial
treatment and any follow up treatments as well as evaluating whether or not
it would pay get additional information, eg biopsies, scans, etc.  It also
might be a good way of thinking through potential side effects.

Anyway, I have rambled on too long about this already.

Sometimes life hands us distasteful but easily resolved dilemmas. This
was one of them.

Where did you find a three-sided coin?  ;-)
(That's one decision I don't have to make this time around; I may as
well flip a marble. But if I were locked into your side of the aisle,
I'd have a really tough decision to make.)

I.P.

[snip]

Leonard, I believe I have addressed your issues in a lengthy reply to Mr.
Freely and don't want to repeat it here.  Please see that response and
comment if you wish.