Discussion Topic |
|
This thread has been locked |
cornel
climber
Lake Tahoe, Nevada
|
|
Have another cocktail another nickname you got it goin on... now..
|
|
jstan
climber
|
|
|
Apr 11, 2017 - 11:57am PT
|
From the cases with which I happen to be familiar in radical surgery the surgeon walks a fine line. Take too much and there is increased risk of incontinence. Take too little and risk of relapse increases. During the operation stain tests of the margin are made looking for missed cancerous tissue. Waiting till PSA gets into the twenties may not be a good idea.
Better radiation procedures and much more precise radiation targeting have allowed improvement of outcomes for that option during the last twenty years. We are waiting Jim's post when he reaches thirty years post op. That treatment used to be a little
sketchy.
Would be useful to hear what got Andy Grove. He was ahead of the curve in the mid nineties. On the other hand in the mid nineties John's Hopkins was developing a surgical process that allowed retention of a quite different male function. One that is, after all, not generally used late in life.
|
|
Gimp
Trad climber
Missoula, MT & "Pourland", OR
|
|
My life changed irrevocably on Feb 7, 2018 when my PSA came back at 173. I am a 66 year old lifelong weekender and physician/hand surgeon (which makes my errors in my own care all the more unforgivable in my mind). I am nothing special as a climber or skier but have done both for over 40 years with varying intensity. Climbing and backpacking has taken me to South American, Alaska, Tibet, Nepal, Greenland, Iceland, and Tasmania plus many areas in the US and Canada. 10 days before my blood work came back I had climbed 6 separate waterfall ice routes in Hyalite by 3 after a late start, that morning I had skied (only wish the conditions had been more memorable), and was supposed to climb the next day with my son. I had not had my PSA checked in almost 6 years and had not had a digital rectal exam in 3-4 years. My changes in urination had been going on for a year or two.
I have non-surgically treatable extracapsular disease with distant lymph node metastasis. The most impressive thing to me was how bad my CT scan looks in the face of how I felt and my activity level. (Bottom line is you don’t have a clue what is going on inside) I am currently being treated with androgen deprivation and chemotherapy. Later I will receive maximal dose external beam radiation. Given my staging my 5 year survival is projected at 29%.
I got my own PSA at a free standing lab because of my symptoms.
My sole purpose in writing this is not for sympathy but to advocate for annual PSA test for all men over 50 (maybe earlier if you have a bad family history). The current rhetoric about PSA is driven by application of herd health principles which increasingly are becoming the driving force in how medicine is practiced largely for cost containment. I would argue that it is fine for you to accept this a how you want to be cared for if you are willing to accept paying the cost for being in the tail area of the bell shaped curve. Some overtreatment IMO is far better than being the outlier that will not be caught by the algorithm. The price of a PSA test is trivial in the big picture and one that you should readily be willing to pay for on your own. Hell I would have paid for it every 6 months after 60 in retrospect!
Some stats worth knowing are:
AVERAGE age at diagnosis 66 years (so no quite the “old man” disease the cost containment propaganda likes to state)
1 in 9 men will be diagnosed with prostate cancer in their lifetime, many will be low grade amendable to monitoring or less drastic treatment.
29,430 men die of prostate cancer annually in the United States
170,000 new cases annually.
My final thought is that three of my brother-in-laws are major executives in multi-national corporations (all with C!! something or other titles) who have had corporate ordered annual physicals since there 40’s when they moved up to the higher levels of management. A PSA has always been part of their annual exam as I am sure it is for all our congressmen etc. If this is part of the annual exam for “important” people then is should be part of your annual health evaluation because even though the elites may consider you a serf you should consider yourself important.
Don’t make the same mistake I made.
Steve
|
|
jstan
climber
|
|
Zip:
Been a year since your last post. We are due an update.
|
|
ms55401
Trad climber
minneapolis, mn
|
|
If this is part of the annual exam for “important” people then is should be part of your annual health evaluation because even though the elites may consider you a serf you should consider yourself important.
Well said. Best of luck going forward.
|
|
Mighty Hiker
climber
Outside the Asylum
|
|
Mostly from experience: A relatively young urologist who I know believes that the science and practice of treating prostate cancer may change considerably over the next few decades. We're over-diagnosing and over-treating it.
1. Virtually all older men have 'abnormal' cells in their prostate. The older you are, the more likely. If you're over 60, likely, over 80, very likely. (Bearing in mind that our bodies are full of abnormal cells, most of which get dealt with by internal mechanisms.) The older you are, the more likely that you are to have an enlarged prostate, and abnormal cells therein, and the cells to be multiplying if not spreading.
2. There's a lot of different types of abnormal cells. Whether they will become a problem depends partly but not entirely on just how abnormal they are. It also depends on how long you live, and factors that aren't well understood.
3. The prostate specific antigen (PSA) test is still useful information, albeit indicative rather than conclusive. The higher the number, the more likely it is that you have an enlarged prostate, or prostate cancer of some kind.
4. Prostate biopsies are a necessary part of diagnosis. Again, they're not conclusive - they take tiny samples from ten different zones in something that's larger.
5. The digital rectal exam is a necessary indignity for men over 50, as part of their annual physical. Again, indicative rather than conclusive, but if you have a large and/or firm prostate, not good.
6. The lab or scientist who invents a test that more accurately diagnoses prostate cancer is going to make a lot of money.
7. Active surveillance is one treatment option those afflicted should discuss with their physician.
As I saw with a friend this spring, who was otherwise in fine health, dying of prostate cancer is not a good way to go. If it spreads, it probably spreads to your bones, and hurts like hell.
|
|
jstan
climber
|
|
I and my two siblings had an issue with PC, as did an uncle who succumbed to this malady. In making my decision I said to myself. "I know this is not serious and it will all turn out OK, But what will I say to myself if it does not?" I decided to let the deil take the hindmost and went all out, so to speak. Now 22 years post op with undetectable PSA I still have to recognize cancer is not something that ever goes away entirely. Medical technology for this disease is advancing apace so one's long term strategy has to be to try and be around to benefit.
|
|
zBrown
Ice climber
|
|
Abstract
The process of programmed cell death, or apoptosis, is generally characterized by distinct morphological characteristics and energy-dependent biochemical mechanisms. Apoptosis is considered a vital component of various processes including normal cell turnover, proper development and functioning of the immune system, hormone-dependent atrophy, embryonic development and chemical-induced cell death. Inappropriate apoptosis (either too little or too much) is a factor in many human conditions including neurodegenerative diseases, ischemic damage, autoimmune disorders and many types of cancer.
|
|
Jeff Gorris
climber
Not from Portlandia
|
|
I hear they needle the sh#t out of yours before they diagnois you... Three biopsies, one MRI, + one MDx ConfirmMDx later, still negative for now.
|
|
Reilly
Mountain climber
The Other Monrovia- CA
|
|
Prostate biopsies are a necessary part of diagnosis
And 1-2% result in infections! A friend just went septic overnight from his!
He has been discharged but the ER doc told him he came in none too soon.
|
|
Gimp
Trad climber
Missoula, MT & "Pourland", OR
|
|
|
Dec 11, 2018 - 01:35pm PT
|
Good bone health may help control/delay metastasis.
Lots of controversy however in this regard.
Steve
|
|
jstan
climber
|
|
|
Dec 11, 2018 - 06:16pm PT
|
Not an MD but I am using a concoction of Ca and vitamin D called "Bone-up". Had read Ca supplements with no Vit D can allow Ca decoration in the circulatory system. Another 50 years before we know better.
|
|
|
SuperTopo on the Web
|
Let us know!