Prostate Cancer “Quote-of-the-Day”

"When your Ed finally clears up, your in for a rough time!"

The Wife!

---

Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
Psa at surgery 49.8
RRP on 01/25/11
PT3a
margin involved-Left anterior
lymph nodes clear
1st PO Psa 0.26 03/16/11
2nd PO Psa 0.08-05/19/11
3rd PO Psa 0.05-08/22/11,4th-01/25/12 0.09.
Lots of ED

Casey, I don't really have a quote of the day, but I feel compelled to ask about your quote #76. "One million men may have been unnecessarily treated for clinically insignificant prostate cancer." To use the currently ubiquitous response: "Seriously"?

If my math is correct, that's 50,000 men per year over 20 years. I note the use of the passive voice ("It has been estimated"). Use of the passive voice eliminates the need to specify who is making the claim.

Then it says "may have," which is not a very definitive kind of statement.

Then the quote uses the term "clinically insignificant prostate cancer" without defining the term. What's insignificant to whoever wrote the editorial may be quite significant to the individual diagnosed with cancer.

Nor does the quote explain what is meant by the term "treated." Was it a simple blood draw? Was it a biopsy? Was it a DRE? Was it surgery? Who knows.

I realize I don't work at Sloan-Kettering and I don't have a medical degree, but if I must include a quote in this post, it would be this: "I'm sure as hell glad I was screened, DRE'd, biopsied, and robotocized, and I'd do it all again in a heartbeat."

I get really antsy when it seems as if we're trying to trivialize this disease.

---

Age 66
Dx June 2010.
PSA rose for 3 years to 6.2
Bx shows cancer in 6 of 12 cores, all left side
Gleason 7 (3 + 4)
Bone scan, CT scan, rib x-rays negative.
DaVinci 8/20/10
Negative margins; negative seminal vesicles
5 brothers, ages 52-67 ; I'm only one with PCa
Continence after 7 weeks. ED continues.
PSA 1/3/10: <0.01; 6/12/11: <0.01, 1/26/12: <0.01

#79

[greetings from Barcelona]

Patients hear the word ‘cancer’ and want definitive treatment.  The word ‘cancer’ evokes a response which is disproportionate to the natural history [of prostate cancer].  It is a communication challenge [for urologists] to overcome this.”

-          Dr Michael A Carducci, Kimmel Cancer Center at Johns Hopkins

"Why have I done so well with Cancer?   I believe it is because 7 years ago I decided that I wanted to live."

 - Living1963

Happiness is like peeing in your pants. Everyone can see it, but only you can feel its warmth.

(A birthday card from my Ex on my last birthday.)

---

enlarged prostate at age 25-dx'd 51
3/2000 psa=.08
4/2002 psa = 1.4
4/2011 psa= 49.2
5/2011 Prostate Biopsy-3 of 12 cores Positive
Gleason 4+4=8
T2c n0m0
Bone&CT=neg
MRI-1 nerve bundle involved
open RRP 8/5/11,home 8/6/11,cath out 8/16/11
Post Op Path
71g-1 NERVE spared
Gleason upgraded 5+4=9
13 lymph nodes,SVI neg
Margin-indeterminate,PNI-pos
pT3aN0Mx
10/18/11 PSA <0.1
12/31/11 PSA <0.1

Insanity: Saying the same thing over and over again and expecting different results. (modified)

Albert Einstein

"Here's a last bequest:  I don't want that guy sayin' my last urology."

-- Archie Bunker

There is not point in worrying because if something (bad) does happen then you have lived it twice.

Micheal J Fox (actually about his life wife Parkinsons - but it seems so appropriate for all of life)

---

64 as of April 2012
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
12 Jul 2011 - PSA 1447 (It's just a number! )
Scans showed active prostate cancer widespread in bones
Started HT treatments Casodex, Zoladex and Zometa for bone
Last Casodex - 29 August
31 Oct 11 - PSA 46.6
25 Jan 12 - PSA 75
22 Feb 12 - PSA 99 - Restarted Casodex
22 Mar 12 - PSA 149 - Start Zytiga

#91

 

from the book, Anticancer:  A New Way of Life, by Dr David Servan-Schreiber:

 

"Other recent studies—from the University of San Francisco—found that such simple life-style changes in men with prostate cancer, completely change the way genes behave, including the genes of cancer cells. This research shows that life-style choices play on our genes like a pianist's fingers play on a keyboard ... transforming the body's ability to resist cancer growth."

#93

 

Quote from Dr Jonathan Oppenheimer, board-certified pathologist (fellowship in Urologic Pathology at Johns Hopkins), Medical Director and Chief Pathologist at Urologic Reference Lab (leading service provider of 2nd opinions of prostate biopsy pathology):

 

"The me-first imperative of professional trade organizations and healthcare entities run as businesses by external investors most interested in ROI with “skin in the game” — this is what perverts our present healthcare system and does a disservice to patients.

 

The transparency of the Internet will put an end to all these games. I’m looking forward to the return of medicine as a respected and suitably compensated honorable profession rather than its present meat-market (with patients as unsuspecting commodities, their body parts and “treatments” being marketed, bought and sold like widgets at a bazaar).

 

From my perspective, the first thing is to stop the creation of all these new prostate “cancer” patients. The medical industry can make a lot more money off someone if he has that label. (Please, please don’t misinterpret this. I am not saying that the diagnosis of “cancer” is not appropriate when it has a good chance of leading to treatment that benefits the patient.) The term just shouldn’t be used as widely as it currently is to describe a natural aging process that may not have significant potential to harm.

 

If taxpayer money is being spent, let it serve the interests of those who pay the taxes or society at large .  If private money is spent, a transparent marketplace will enable an informed consumer to make reasonable decisions using their own values."

 

 

Clock,
I see that no one has answered your questions so I'll try.
50,000 is 23% of those DXed annually. Conservatively 40% of all those treated have low or very low risk PC so the 50,000 number is really conservative, more like 90,000.
Clinically insignificant cancer is defined as a cancer that will never cause symptoms during one's lifetime. Prostate cancer is very prevelent in the majority of older men as is well documented by autopsies. Your age after 50 pretty well corrolates with your probability of finding PC on an autopsy. Since PC deaths account for only 3% of deaths in men and most men over 50 have PC then there has to be a very high amount of PC that is clinically insignificant. Most men having PC die without knowing they have it.
Treatment is defined as having a treatment with a curative attempt; not a diagonosis procedure like a biopsy or psa test.
Clinically insignificant or very low risk PC is defined as <G7; psa density <1.5;
<30% cores positive; psa<10; no nodule; no core>50%.
Hope this answers you questions.

---

66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Regarding ED:

"The well man wears an invisible crown that only the ill man can see."

I believe this is from one of either Walsh's or Scardino's books, but I could not find the direct quote.

---

Gleason,3+4;PSA 7.9,Nerve-sparing RRP,03/2008(Age 48 then),pT2c, 60g, neg margins; perineural & lymphatic invasion;3 lymph nodes removed,clear; seminal vesicle invasion:absent;Gleason 4 was 5-10%; PSA <0.1 until Oct 09:0.1; retest <0.1; scans clear;monthly results from Jan 2010:0.2,.2,.17,.17,.24,.31,.29,.41, IGRT SRT started 8/4/2010, PSA@5 weeks in: .17,after:.12,.10,.06, .05 since