i got final pathology report on my lrp today

the path report is worse than the biopsy.
the cancer was 4% of the prostate.
the gleason was 3+4=7 biopsy was 3+3=6
the cancer penetrated the capsule but was not found in the margin.
the margin was negative.
T3A biopsy was T1C.
surgeons comment was risk of recurrence is 35%.
how can there be 35% risk since there is no cancer in the margin?

gary

gary.miller12@comcast.net wrote:

> surgeons comment was risk of recurrence is 35%.
> how can there be 35% risk since there is no cancer in the margin?

I've been wondering about this. Best I can figure, no one knows the
exact mechanism that the cancer uses to get loose.

I've seen two descriptions. Both remind me of weeds.

The cancer creeps out, cell by cell, kinda like kudzu. The docs talk
about margins, micro-tendrals, getting to the seminal vesicles. That
speaks for slash (surgery) and burn (radiation) as a treatment.

They don't like to talk about distance metastasis, where colonies of
the cancer take up in distant bones or lymph nodes. The docs send us
for radioactive bone scans, which usually do not show cancer.
Apparently, there's a speading mechanism that's like dandelion seeds.

Given that blood flows in and out of the prostate, these dandelion
seeds are always spreading.

I guess that's the 35%. Maybe the seeds don't usually take root but in
35% of guys,over a long period of time, they do.

This suggests that environmental changes and good gardening techniques
should help over the long term. By that I mean, the vitamin-D, the
soy, tomatoes, the juices, and other supplements.

If that lets me skew the 35% to 20%, then it's worth trying.

-kh

<gary.miller12@comcast.net> wrote in message
news:1162883814.250436.68000@e3g2000cwe.googlegrou ps.com...
> the path report is worse than the biopsy.
> the cancer was 4% of the prostate.
> the gleason was 3+4=7 biopsy was 3+3=6
> the cancer penetrated the capsule but was not found in the margin.
> the margin was negative.
> T3A biopsy was T1C.
> surgeons comment was risk of recurrence is 35%.
> how can there be 35% risk since there is no cancer in the margin?
>
> gary

I had similar results in May of 2002 when I had my RP. 3+3 on biopsy, PSA
in the 5's (my age then was 64), and a competent uro who felt that
prospects looked good. After surgery (with one nerve spared), Gleason was
3+4, possible penetration of the capsule, and some cancer cells found in
adipose tissue outside the prostate. I was really down.

A veterenarian whose SO had similar results used to post in this forum. She
was really helpful to me. Not only did she assure me that escaped cancer
cells are not a death sentence, especially when our immune system is good.
What sticks in my mind was her saying that probably every time our skin is
exposed to the sun for any length of time, some cancer cells may be
produced, but our body usually takes care of them. But what was particular
helpful is that she wrote that even with the alarming results in her SO's
post surgical report, several years later his PSA was still undetectable,
and everything was going well.

I am now 4 1/2 years post RP. PSA is still undetectable (<0.05), I am
basically continent, and have erectile function normal, I believe, for my
age. I still get nervous at PSA check time (and given the positive margins,
I will have to go 10 years before I am declared "cured"), but really don't
worry about it much anymore. I don't know if this is helpful to you, but the
good lady's encouragement to me after my post-surgical bad news, helped me
get through a difficult stretch. Don't let the negative statistics dominate
your thoughts.

tchtic@yahoo.com wrote:
> gary.miller12@comcast.net wrote:
>
>> surgeons comment was risk of recurrence is 35%.
>> how can there be 35% risk since there is no cancer in the margin?
>
> I've been wondering about this. Best I can figure, no one knows the
> exact mechanism that the cancer uses to get loose.
> I've seen two descriptions. Both remind me of weeds.
> Given that blood flows in and out of the prostate, these dandelion
> seeds are always spreading.
> I guess that's the 35%. Maybe the seeds don't usually take root but in
> 35% of guys,over a long period of time, they do.

That's the primary mechanism in Gary's case, and the Gleason 7 raises
the odds. But there's no point worrying about it. My Gleason 8 raises my
negative-margins recurrence likelihood, even further, but until it
happens, it ain't happened.

> This suggests that environmental changes and good gardening techniques
> should help over the long term. By that I mean, the vitamin-D, the
> soy, tomatoes, the juices, and other supplements.
> If that lets me skew the 35% to 20%, then it's worth trying.

*IF*. Remember, their benefit is pure speculation, and many such
speculations don't pass rigorous studies. Don't get obsessed by it.

I.P.

gary.miller12@comcast.net wrote:...snip...
> surgeons comment was risk of recurrence is 35%.
> how can there be 35% risk since there is no cancer in the margin?
>
> gary

Part of the prostate is just "hanging out" there in space in side your
body, it is not physically attached to any other anatomical structures
(other than the rest of the prostate). The remainder of the prostate
is physically attached to other parts of your anatomy. When the
surgeon removes the prostate he/she need only cut through the part that
is physically attached to other structures. That area where the
surgeon cut is called the margin. If cancer cells are found at the
margin, then there is the possibility that some cancer cells remain in
your body on the other side of the margin or excision, the part that
remains in your body.

The part of the prostate that is not physically attached to your body,
the part that is just "hanging out" is covered with a thin membrane,
the capsule. Cancer can also grow through this membrane and exist on
the outer surface of the prostate (extra-capsular extension). From the
prostate surface it can then migrate to the seminal vesicles and so on.


So there are at least two pathways for the escape of cancerous cells,
1) through the physically attached portion of the prostate and 2) from
the surface of the prostate. The best pathological prognosis would be
negative margins and no ECE. This would indicate that both of these
pathways were not operative...Best wishes and good health, ron

gary.miller12@comcast.net wrote:
> the path report is worse than the biopsy.
> the cancer was 4% of the prostate.

That sounds pretty good to me.

> the gleason was 3+4=7 biopsy was 3+3=6

You would feel better if that hadn't happened, but it is not at all unusual.

> the cancer penetrated the capsule but was not found in the margin.
> the margin was negative.

That is good.

> T3A biopsy was T1C.

T1c is a diagnosis before surgery based primarily on what the doctor can
feel under DRE. After surgery, presuming any cancer at all is found in
the prostate that was removed, you can't have T1c anymore. It has to be
at least T2-something. The T3 in your case means it penetrated the
capusule, which you already knew.

> surgeons comment was risk of recurrence is 35%.

The Sloan Kettering nomogram puts it a bit lower at around 28 percent,
but that seems the right ballpark.

> how can there be 35% risk since there is no cancer in the margin?

I think others have addressed this issue. The pathology report after
surgery only tells you what the pathologist found when examining the
prostate. He can't be sure some small amount of cancer hasn't managed
to escape, and clearly he can't say anything definite about parts of
your body he can't examine. Estimates of this kind are based on follow
up studies of other patients with similar post-surgical pathology.

The most likely prognosis is that you will never have a recurrence.
After all, the odds seem to be at least 2 to 1 against it. But even if
you do, most likely it won't be for a while, and it will first show up
as an increase in PSA. At that point, if the recurrence is local, it
still may be possible to destroy the remaining cancer through radiation.
Even if the cancer has escaped to distant sites, it often takes many
years before a PSA rise is followed by clinical symptoms. At that
point, hormone therapy is still available, or perhaps some miracle cure
developed in the next several years.

I know it is difficult, but for the moment assume the best, not the
worst, and concentrate on recovering from the surgery. Most likely, you
will do fine, and worrying about what will happen otherwise won't do any
good.

>
> gary
>

<gary.miller12@comcast.net> wrote in message
news:1162883814.250436.68000@e3g2000cwe.googlegrou ps.com...
> the path report is worse than the biopsy.
> the cancer was 4% of the prostate.
> the gleason was 3+4=7 biopsy was 3+3=6
> the cancer penetrated the capsule but was not found in the margin.
> the margin was negative.
> T3A biopsy was T1C.
> surgeons comment was risk of recurrence is 35%.
> how can there be 35% risk since there is no cancer in the margin?

Sorry to hear about your urinating problem, but it is quite common and
should fix itself quickly.

T3a means that it penetrated the wall of the prostate or is in the seminal
vesicles. That's where I started my journey.



--
PSA 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,
2/06, 6/06
PSA .07 .05 .06 .09 .08 .132 .145
Casodex added daily 07/06
PSA <0.04
Non Illegitimi Carborundum

gary.miller12@comcast.net wrote:
> the path report is worse than the biopsy.
> the cancer was 4% of the prostate.
> the gleason was 3+4=7 biopsy was 3+3=6
> the cancer penetrated the capsule but was not found in the margin.
> the margin was negative.
> T3A biopsy was T1C.
> surgeons comment was risk of recurrence is 35%.
> how can there be 35% risk since there is no cancer in the margin?
>
> gary


Hello Gary--


This will probably make me an outcast here but I have concluded that in
terms of QOL after pca treatment it is the "overexamined life that is
"not worth living". (Socrates: "the unexamined life is not worth
living"). You need to review the information that you must know in
terms of your treatment but with everything you come across here you
could drown in info and also become more depressed and nervous. That's
what happened to me initially.

I have to say I love this group but some here are so obsessed with data
relating to this illness that in order to remain here I have to skip
through most of the specific stats and numbers because if not I would
go crazy. And anyway, after J's surgery, I didn't really care about
knowing every particular detail of his tumor and what his prospects
were in aggravated detail. Some of thatinfo was too late to be of any
use, anyway.. What really chills my bones is the nomogram, just the
idea that somebody would actually want to sit down and placidly try to
predict their own life expectancy to a T. It makes me freak out just
to think about it.

This relates to the stat you mentioned: the 35% recurrence rate. It
had been somewhere in my consciousness before I read it here (time and
again) but none of the doctors had mentioned it explicitly and as far
as my husband was concerned, I had discouraged him from to reading too
much about future outcomes, at least not until after his RP.

I wanted to bring up some issues with Jon and so I mentioned this 35%
stat to him the other day and he was like a deer staring into the
headlights. He just had had no idea. If you must know I felt like a
murderer afterwards, he was so down for a couple of days and I thought
maybe telling him had served no purpose.

I suggested to J.that there were a couple of things that he might
want to try in terms of diet. Hence, why i had been urging him to
drink pom juice. He was very eager to comply and we also decided he
would eat 3 tbs of tomato sauce a day and also have a V-8. (Thank you,
Alan for that). A can of V-8 juice has a day's MDR of vegetables and
it comes in bought the low- sodium. You can only help yourself by
eating more fruits and vegetables and, as a matter of fact, I am going
to have a v-8 myself every day.And I thought there was some reliable
evidence in existgence about the pom juice.

Afterwards we talked about him doing other things that can always help
with illness such as trying to lead a less stressful life, going to the
gym and doing more enjoyable things. And, In his case, J. already prays
every day so I told him to do it double-hard! (BTW I think prayer is
a healing exercise and you don't even have to be relig. to get
something out of it. For example: I enjoy reading Psalm book even
though my religious practice is now mostly vestigial).

You know there are some people in this group who are clearly obsessive.
In your case, the worst thing you can do for yourself is to dwell on
this statistic (and others) in my opinion. It is already bad enough
that you have that 3-mo psa test to cope with.

I would add that there are some types who might want to know
everything but this is not the right approach for a lot of people.
Personalities vary.

Also, even if every bit of info were valuable some people are just not
capable of acquiring it before or during illness. For ex. after my
husband was initially dx he was so paralyzed by fear and depression
that it was enough work for me just to keep him going. And there
wasn't any time to waste in treating him, acc. to the docs, so I
simply did not time to read the whole encyclopedia britannica Some
people don't have a research ass't (like J. has me) and there are
limits to what they themselves can do.

Hope this helps.

Best of luck,



Leah

callalily wrote:
> I have to say I love this group but some here are so obsessed with data
> relating to this illness that in order to remain here I have to skip
> through most of the specific stats and numbers because if not I would
> go crazy. And anyway, after J's surgery, I didn't really care about
> knowing every particular detail of his tumor and what his prospects
> were in aggravated detail. Some of thatinfo was too late to be of any
> use, anyway.. What really chills my bones is the nomogram, just the
> idea that somebody would actually want to sit down and placidly try to
> predict their own life expectancy to a T.

Hear, hear. I didn't like what I saw in my nomograms, but that's SO easy
to fix: I STOPPED LOOKING AT THEM. They were interesting after my
post-op pathology results came in, and provided one data point in
researching the expected benefits of adjuvant treatment, but are not
only useless but needlessly alarming beyond that. I've gone two years
now with virtually zero PSA, but have I gone back to the nomograms or
studies? For what purpose? I'll have plenty of time -- years -- to visit
Paris and climb some frigging mountain, and may even pay somebody else
to mow my lawn, after my PSA starts to climb, and an early bone met will
just have to get in line with all my other aches and pains anyway -- at
which point any nomogram just got REALLY useless. Besides, the same
nomograms that give me 8 years to live also give me narrow but finite
odds of living two years or 20 years. Guess what? My CANCER will tell me
where I'm heading, and no news is great news once that data point has
expended its planning usefulness.

> I wanted to bring up some issues with Jon and so I mentioned this 35%
> stat to him the other day and he was like a deer staring into the
> headlights. He just had had no idea. If you must know I felt like a
> murderer afterwards, he was so down for a couple of days and I thought
> maybe telling him had served no purpose.

That's GREAT news. A 65% chance of being completely cured of CANCER?
Many cancer victims would love those odds.

> V-8 juice has a day's MDR of vegetables and it comes in low-sodium.

Mmm, hmmmm. And it tastes great . . . as long as you add about a day's
MDR of salt to it.

> there are some people in this group who are clearly obsessive.
> there are some types who might want to know
> everything but this is not the right approach for a lot of people.

PC data's primary contribution is to making decisions. Beyond that it's
primarily a source of worry, or maybe encouragement if it's good, but in
either case it's arguably just a conversation piece once tx decisions
are made.

I.P.

All it takes is for one cancerous microfiber to enter the bloodstream and at
some point there is a re-occurrence.\ And how many blood networks are within
the prostate capsule?

gourd dancer

<gary.miller12@comcast.net> wrote in message
news:1162883814.250436.68000@e3g2000cwe.googlegrou ps.com...
> the path report is worse than the biopsy.
> the cancer was 4% of the prostate.
> the gleason was 3+4=7 biopsy was 3+3=6
> the cancer penetrated the capsule but was not found in the margin.
> the margin was negative.
> T3A biopsy was T1C.
> surgeons comment was risk of recurrence is 35%.
> how can there be 35% risk since there is no cancer in the margin?
>
> gary
>

MAS wrote:
> All it takes is for one cancerous microfiber to enter the bloodstream and at
> some point there is a re-occurrence.\ And how many blood networks are within
> the prostate capsule?

Tumor DNA can be detected in the serum of all men with PCa (at least in
the study that was conducted). Men with more aggresive PCa have higher
serum tumor DNA loads then men with less aggresive disease. My guess
is that it takes more than circulating tumor cells to cause a
recurrence. I suspect that a strong immune system can help reduce the
post-treatment level of circulating tumor DNA. Also, studies have
shown that other biological factors are required to be present to
enable the circulating tumor cells to survive at a remote location. So
again, any thing your body can do to lessen the concentration of these
factors will also serve to stave off recurrence...Best wishes and good
health, ron

"callalily" <lfcjjk@aol.com> wrote in message
news:1163023161.465416.106950@h54g2000cwb.googlegr oups.com...
>
> gary.miller12@comcast.net wrote:
>> the path report is worse than the biopsy.
>> the cancer was 4% of the prostate.
>> the gleason was 3+4=7 biopsy was 3+3=6
>> the cancer penetrated the capsule but was not found in the margin.
>> the margin was negative.
>> T3A biopsy was T1C.
>> surgeons comment was risk of recurrence is 35%.
>> how can there be 35% risk since there is no cancer in the margin?
>>
>> gary
>
>
> Hello Gary--
>
>
> This will probably make me an outcast here but I have concluded that in
> terms of QOL after pca treatment it is the "overexamined life that is
> "not worth living". (Socrates: "the unexamined life is not worth
> living").

I couldn't agree more!

> I have to say I love this group but some here are so obsessed with data
> relating to this illness that in order to remain here I have to skip
> through most of the specific stats and numbers because if not I would
> go crazy.

Same here.

> And anyway, after J's surgery, I didn't really care about
> knowing every particular detail of his tumor and what his prospects
> were in aggravated detail. Some of thatinfo was too late to be of any
> use, anyway.. What really chills my bones is the nomogram, just the
> idea that somebody would actually want to sit down and placidly try to
> predict their own life expectancy to a T. It makes me freak out just
> to think about it.

Yes. It doesn't take buses into account either :-)
>
> I would add that there are some types who might want to know
> everything but this is not the right approach for a lot of people.
> Personalities vary.

Indeed they do.
>
> Also, even if every bit of info were valuable some people are just not
> capable of acquiring it before or during illness. For ex. after my
> husband was initially dx he was so paralyzed by fear and depression
> that it was enough work for me just to keep him going.

Spouse wasn't, but as I've said before we've gone the cancer road before. We
accept what happens.

I think that some people might be confused between 'recurrence' and
'secondaries' (mets). They are different in character and implications. It
might be just my reading of posts of course!

Mary

"I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote in message
news:Met4h.46$X97.31@newsfe02.lga...
> callalily wrote:
>> I have to say I love this group but some here are so obsessed with data
>> relating to this illness that in order to remain here I have to skip
>> through most of the specific stats and numbers because if not I would
>> go crazy. And anyway, after J's surgery, I didn't really care about
>> knowing every particular detail of his tumor and what his prospects
>> were in aggravated detail. Some of thatinfo was too late to be of any
>> use, anyway.. What really chills my bones is the nomogram, just the
>> idea that somebody would actually want to sit down and placidly try to
>> predict their own life expectancy to a T.
>
> Hear, hear. I didn't like what I saw in my nomograms,

I don't even know what a nonogram is. Do I need to?

We're always being sent catalogues full of essential things for the 'home'
(we don't live in a home) or how to be healthier. We always say that we
don't know how we've got so far in life without them ...

Mary

"ron" <oitbso@yahoo.com> wrote in message
news:1163043704.308086.185180@e3g2000cwe.googlegro ups.com...
> MAS wrote:
>> All it takes is for one cancerous microfiber to enter the bloodstream and
>> at
>> some point there is a re-occurrence.\ And how many blood networks are
>> within
>> the prostate capsule?
>
> Tumor DNA can be detected in the serum of all men with PCa (at least in
> the study that was conducted). Men with more aggresive PCa have higher
> serum tumor DNA loads then men with less aggresive disease.

Not always.

Mary

> "ron" <oitbso@yahoo.com> wrote in message
> > Tumor DNA can be detected in the serum of all men with PCa (at least in
> > the study that was conducted). Men with more aggresive PCa have higher
> > serum tumor DNA loads then men with less aggresive disease.

Mary Fisher responded
> Not always.

The detection of tumor DNA in serum that I am referring to was done in
a research study, it is not a common or widely available test. What
are you referring to, more information please...ron

Mary Fisher wrote:

>
> I don't even know what a nonogram is. Do I need to?

They are interactive charts based on huge statistical bases, which
"tell" us how long we have to live based on our numbers -- Gleason
grade, stage of advancement, treatments, etc. They're Partin tables on
steroids. They sound morbid, and give worrywarts something tangible to
worry about. What's most "fun" -- i.e., useful -- about them is playing
war games with them. I entered the nomograms with my pre-op PSA, Gleason
8, SVI, negative-margin surgery, and whatever the heck else it covered
(e.g., age?, political bent?, number of people filtering me?, number of
people *I* filter?, diet?) and came out with a statistical death
sentence in X years.

Duly noted (but soon forgotten).

Then when my oncs recommended early adjuvant (i.e., Just In Case) ADT, I
fed that additional hypothetical data into the nomograms to get their
opinion on how that would change X, to get one more ADT benefit
"data" (opinion) point. One could play similar war games with any
mainstream treatment combo they were considering, producing a fairly
useful and fairly meaningful set of decision fodder.

There are several nomograms out there, such as Sloan-Kettering online
and, I think, Strum's book. Google 'em here, or stand by and wait for
others to link you to them. I forget where they are, partly because my
Windows computer had one hell of a time accessing the online ones
(haven't tried them since switching to Mac) and partly because my
decisions are made until and unless my PSA takes off again. My attitude
towards X at present is something like, "Let me know when X counts down
to a couple of years, when it might actually affect my activities. OH,
WAIT . . . my PSA will tell me that, won't it? Then who needs to "know"
X unless they're still making decisions?" Well, one person needing X is
the guy or S.O. considering retiring to enjoy what's left. (Did that, 18
years ago, when it dawned on me I may not live forever due to disease or
WMD proliferation into radical terrorist Islam.) Or the guy has to see
his yet-hypothetical grandkids at any cost. (I'd have to wait too long,
given that I have no kids yet.) Or the guy whose dreams require years to
achieve, such as paying off his home for his SO (think insurance.) (My
top goal is to catch some big wind and waves tomorrow, followed closely
by visiting Alaska and AU/NZ, none of which X threatens.)

There's the thought process. Whether nomograms are useful to you depends
on where you fit in the scenarios. I'm going windsurfing, because winter
looms FAR closer than X does.

I.P.

I agree with pretty much everything in Leah's post.

We should not allow fear of death to keep us from enjoying
life. All of us know from the time we are 6 years old that
one day we will die. As children, and often as adults, we
cope with that fact by putting it out of our minds. Cancer
and other serious diseases make it much more difficult
to put it out of our minds. Cancer brings our mortality
very clearly into focus.

But very little has really changed for us. With or without
cancer, we still have just a finite amount of time left. The
challenge that we face is to make the most of that time,
to enjoy it to the fullest, to achieve what we want to
achieve, to care for our loved ones as best we can, and
to contribute to the world we will leave behind as best
we can.

While we're alive, let's truly live.

Alan

"I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote in message
news:enJ4h.26$h56.6@newsfe07.lga...
> Mary Fisher wrote:
>
>>
>> I don't even know what a nonogram is. Do I need to?
>
> They are interactive charts based on huge statistical bases,

Ah - we call it actuarial statistics.
>
> There's the thought process. Whether nomograms are useful to you depends
> on where you fit in the scenarios. I'm going windsurfing, because winter
> looms FAR closer than X does.

I'd say that most people in Britain aren't too bothered.

I'm certainly not. When I kept bees I sometimes had a general reaction to a
sting, which could kill me. But I always thought that driving to the apiary
was a greater risk than death by anaphylaxis.

I still drive and so does Spouse.

I'm reminded thought that until he had it explained to him he was worried
about the <1% risk of dying because of anaethesia.

Perhaps it's right that doctors give such risk information but I'm not at
all sure that it helps a patient to take a pragmatic view of his/her
condition.

Mary

"nomogram" is apparently a mathematical term (I had to
look this up) for a way to graph variables so that you can
use the values of two or more variables to find the value
of an unknown variable.

Nowadays I assume nobody actually draws graphs any
more. The computer calculates the result and gives it
to us.

Here's a link to definitions:

http://dictionary.reference.com/browse/nomogram

Or better still, and with a gorgeous diagram of a real,
graphic, nomogram:

http://en.wikipedia.org/wiki/Nomogram

Alan

That's nomogram, not nonogram (which is a kind of puzzle).

See: http://www.mskcc.org/mskcc/html/10088.cfm

You fill in what you know about a series of risk factors and it uses a
statistical database to predict the probability of extra-prostatic disease
etc.,


"Mary Fisher" <mary.fisher@zetnet.co.uk> wrote in message
news:4553914d$0$29546$4c56ba96@master.news.zetnet. net...
>
> "I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote in message
> news:enJ4h.26$h56.6@newsfe07.lga...
>> Mary Fisher wrote:
>>
>>>
>>> I don't even know what a nonogram is. Do I need to?
>>
>> They are interactive charts based on huge statistical bases,
>
> Ah - we call it actuarial statistics.

Mary Fisher wrote:

> Ah - we call it actuarial statistics.

Same here. The PC nomograms just address specifically the PC factors and
mortalities.

> I'm reminded thought that until he had it explained to him he was worried
> about the <1% risk of dying because of anaethesia.

Then he should love the current risk with modern anaesthesia drugs: 1 in
250,000.

> Perhaps it's right that doctors give such risk information but I'm not at
> all sure that it helps a patient to take a pragmatic view of his/her
> condition.

Actually I think it is quite pragmatic. Hypothetically it removes
emotion (and reliance on anecdotal "evidence") from the decision
altogether, for better or worse. And even if for no other reason,
doctors would get sued constantly if they didn't tell us of the more
serious risks and their likelihoods. (I'm surprised not more of us sue
after not being told about some of the SEs we face unexpectedly; I guess
it's because most of them are ADT-related and subside after tx.)

I.P.

Alan Meyer wrote:

> Or better still, and with a gorgeous diagram of a real,
> graphic, nomogram:
>
> http://en.wikipedia.org/wiki/Nomogram

HAH! Haven't seen a Smith chart since my junior year in college.


I.P.

Alan Meyer wrote:

> All of us know from the time we are 6 years old that
> one day we will die.

I wish more of today's teenage drivers, urban skateboarders, etc. AND
THEIR PARENTS realized that.

> While we're alive, let's truly live.

A valid motto for those who elect to avoid early adjuvant (i.e.,
preemptive, asymptomatic) ADT.

I.P.

Mary Fisher wrote:

> I'm reminded thought that until he had it explained to him he was worried
> about the <1% risk of dying because of anaethesia.
> Perhaps it's right that doctors give such risk information but I'm not at
> all sure that it helps a patient to take a pragmatic view of his/her
> condition.

I began seeing my former rheumatologist (RD) in 1991. She continued
to tell me to wait (for a hip replacement) until I couldn't stand it
(pain)
any longer.

In August 1999, I told her I was ready.

Her reply was, "Welllllllllllllllllll, it may be too late. The way
your neck
is fused, the anesthetist could paralize you when you're intubated.
But I'll talk to them and see if it could be done."

Next appointment, Novermber 1999, she had not talked to anyone.
I had collected some notes from the arthritis support group and
began asking questions.

The bitch's reply was, "I KNOW WHAT'S BEST FOR YOU!"

Goodbye to the whore.

I found a new RD by February 2000 who took one look at my
X-rays and sent me to a surgeon. I had the hip replacement
in July. Told I would be in the hospital 2 weeks and in rehab
4 to 6 weeks.

I was home in 12 days. Drove the nurses nuts, walking up
and down the halls, strengthening the new hip, 8 to 12 hours
a day. I was supposed to have been out of bed only for PT
and OT - perhaps an hour a day - but I never saw them after
day #2. So I took up walking...and walking...and walking. <g>

"Alan Meyer" <ameyer2@yahoo.com> wrote in message
news:1163112966.612787.49110@m7g2000cwm.googlegrou ps.com...
> "nomogram" is apparently a mathematical term (I had to
> look this up) for a way to graph variables so that you can
> use the values of two or more variables to find the value
> of an unknown variable.
>
> Nowadays I assume nobody actually draws graphs any
> more. The computer calculates the result and gives it
> to us.
>
> Here's a link to definitions:
>
> http://dictionary.reference.com/browse/nomogram
>
> Or better still, and with a gorgeous diagram of a real,
> graphic, nomogram:
>
> http://en.wikipedia.org/wiki/Nomogram
>
> Alan
>
Thank you.

Mary

"I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote in message
news:X5T4h.1924$kv7.441@newsfe04.lga...
> Mary Fisher wrote:
>
>> Ah - we call it actuarial statistics.
>
> Same here. The PC nomograms just address specifically the PC factors and
> mortalities.
>
>> I'm reminded thought that until he had it explained to him he was worried
>> about the <1% risk of dying because of anaethesia.
>
> Then he should love the current risk with modern anaesthesia drugs: 1 in
> 250,000.

That's what the "<" is about! And it can happen during dentistry or other
minor surgeries. He hadn't understood that it wasn't pecular to
prostatectomy - we were given a huge amount of information and nobody can
take everything in.
>
>> Perhaps it's right that doctors give such risk information but I'm not at
>> all sure that it helps a patient to take a pragmatic view of his/her
>> condition.
>
> Actually I think it is quite pragmatic. Hypothetically it removes emotion

Not if it's taken literally.

> (and reliance on anecdotal "evidence") from the decision altogether, for
> better or worse. And even if for no other reason, doctors would get sued
> constantly if they didn't tell us of the more serious risks and their
> likelihoods.

That's the reason the information is given.

Mary

"Joe Price" <joeprice@shaw.ca> wrote in message
news:bHO4h.292369$R63.190978@pd7urf1no...
> That's nomogram, not nonogram (which is a kind of puzzle).
>
> See: http://www.mskcc.org/mskcc/html/10088.cfm
>
> You fill in what you know about a series of risk factors and it uses a
> statistical database to predict the probability of extra-prostatic disease
> etc.,

It's not peculiar to prostate diseases is it?

Mary

"I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote in message
news:0tT4h.788$h56.439@newsfe07.lga...
> Alan Meyer wrote:
>
>> All of us know from the time we are 6 years old that
>> one day we will die.
>
> I wish more of today's teenage drivers, urban skateboarders, etc. AND
> THEIR PARENTS realized that.
>
>> While we're alive, let's truly live.

That's why the urban skateboarders do what they do. I'm full of admiration
for them (as well as scared).
>
Mary

"callalily" <lfcjjk@aol.com> wrote in message
news:1163023161.465416.106950@h54g2000cwb.googlegr oups.com...

> This will probably make me an outcast here but I have concluded that in
> terms of QOL after pca treatment it is the "overexamined life that is
> "not worth living".

> use, anyway.. What really chills my bones is the nomogram, just the
> idea that somebody would actually want to sit down and placidly try to
> predict their own life expectancy to a T. It makes me freak out just
> to think about it.

Ha!! That doesn't make you an outcast. That makes you a woman! Actually,
more than that -- Jon's woman. You don't want to know his chances or is
time. You are wrapped up, as you should be, in the emotion of his
mortality.

He, on the other hand, when he sidles up to his mortality (which will likely
be awhile) will want to know exactly when so that he can prepare for it --
in most cases so he can prepare for your well-being.

> I wanted to bring up some issues with Jon and so I mentioned this 35%
> stat to him the other day and he was like a deer staring into the
> headlights. He just had had no idea. If you must know I felt like a
> murderer afterwards, he was so down for a couple of days and I thought
> maybe telling him had served no purpose.

He is just not ready yet. It didn't hurt to put it out there. It gives him
something to wrap his arms around. But, I would not push it further for
awhile.

> I suggested to J.that there were a couple of things that he might
> want to try in terms of diet.

Take him out walking too. I cannot tell you how many benefits that has
afforded me. I am sure it is helping me fight the cancer (and ruptured
disk). It helps me sleep, digest, ward off colds, heal when I have medical
procedures, etc. But, it also gives me time to think and, when I'm with
someone, time to talk. It provides me a view of God's gifts (or the natural
consequence of the Big Bang) on a daily basis that I've seen sparingly
before.

> And, In his case, J. already prays
> every day so I told him to do it double-hard! (BTW I think prayer is
> a healing exercise and you don't even have to be relig. to get
> something out of it. For example: I enjoy reading Psalm book even
> though my religious practice is now mostly vestigial).

Ugh! I hate the psalms. But, I have to admit that I've typed a few out for
my bulletin board in my office. Psalm 108 (some list it as 109) for my
boss, but the rest for me.


> Also, even if every bit of info were valuable some people are just not
> capable of acquiring it before or during illness. For ex. after my
> husband was initially dx he was so paralyzed by fear and depression
> that it was enough work for me just to keep him going.

Check the archives, m'lady. I think you will find that the initial posts by
almost everyone here, if it occurred at or near dx, were marked by fear,
depression and paralization.



--
PSA 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,
2/06, 6/06
PSA .07 .05 .06 .09 .08 .132 .145
Casodex added daily 07/06
PSA <0.04
Non Illegitimi Carborundum

"Steve Kramer" <skramer@cinci.rr.com> wrote in message
news:RL_4h.26525$Cq3.5603@tornado.ohiordc.rr.com.. .
>
> "callalily" <lfcjjk@aol.com> wrote in message
> news:1163023161.465416.106950@h54g2000cwb.googlegr oups.com...
>
>> This will probably make me an outcast here but I have concluded that in
>> terms of QOL after pca treatment it is the "overexamined life that is
>> "not worth living".
>
>> use, anyway.. What really chills my bones is the nomogram, just the
>> idea that somebody would actually want to sit down and placidly try to
>> predict their own life expectancy to a T. It makes me freak out just
>> to think about it.
>
> Ha!! That doesn't make you an outcast. That makes you a woman!
> Actually, more than that -- Jon's woman. You don't want to know his
> chances or is time. You are wrapped up, as you should be, in the emotion
> of his mortality.
>
> He, on the other hand, when he sidles up to his mortality (which will
> likely be awhile) will want to know exactly when so that he can prepare
> for it -- in most cases so he can prepare for your well-being.

How do you know what he will want, just becasue yo're another man?

Not all men are the same.

Nor are all women.
>
>
>> And, In his case, J. already prays
>> every day so I told him to do it double-hard! (BTW I think prayer is
>> a healing exercise and you don't even have to be relig. to get
>> something out of it.

According to research women with breast cancer who are prayed for have a
better rate of survival than those who aren't prayed for. And the first
category includes those who don't know they're being prayed for.

I'll pray for your husband.

....
>
> Check the archives, m'lady. I think you will find that the initial posts
> by almost everyone here, if it occurred at or near dx, were marked by
> fear, depression and paralization.

"Almost". That's not everyone, my man.

My husband's diagnosis wasn't marked by fear or depression, I've no idea
what "paralization" is.

Mary Fisher wrote:
> It's not peculiar to prostate diseases is it?

100% prostate cancer specific.

I.P.

Mary Fisher wrote:

>> Alan Meyer wrote:
>> We should not allow fear of death to keep us from enjoying
>> life. All of us know from the time we are 6 years old that
>> one day we will die.
>>> While we're alive, let's truly live.
>
> That's why the urban skateboarders do what they do. I'm full of admiration
> for them (as well as scared).

Take it from someone who has done that and much more along those lines:
they would have far MORE fun if they wore protective gear, and even more
yet if they chose more forgiving (i.e., softer) venues. The first
thought in my head when I see these absolute FOOLS flying skateboards
off rooftops into crowded asphalt parking lots, schussing several
flights of concrete and steel staircases, and street lugeing down city
streets at night HOPING they correctly timed the traffic light at the
bottom of the hill, wearing no more than shorts and tees, is, "Where the
hell are/were their parents?" These kids swamp ERs by the tens of
thousands, and many of them drive the same way, putting everyone ELSE at
risk.

I doubt Alan meant "forget physics and try to maim and/or kill one's
self". I suspect he meant something more like, "enjoy sunsets or skiing
or a great career rather than spending that time slumped in a chair
worrying about a cancer we can do nothing more about."

I.P.

"I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote in message
news:ZG25h.15$2l3.10@newsfe04.lga...
> Mary Fisher wrote:
>> It's not peculiar to prostate diseases is it?
>
> 100% prostate cancer specific.

Since you snipped the relevant words I've no idea what your're reffering to.

Your loss.
>
> I.P.