A Different Nomogram!

This nomogram is somewhat different from others I have seen. It
results in a more optimistic projection for many of us, however, so I
am not really sure how useful it is. The nomogram creators admit: "The
calibration plots suggest that the predictions of the nomogram may be
too optimistic for patients with calculated 10-year PFP less than
90%."

But - as the creators point out: "Unique to predictive models, the
nomogram predictions can be adjusted for the disease-free interval
that a patient has achieved after RP."

They make two assertions which took a lot of mental processing for me
to understand because, initially, they seem to conflict (and I still
don't think I really understand):
1. "Given that a patient’s prognosis improves with the disease-free
interval maintained after RP, we have also enabled the 10-year PFP to
be adjusted to reflect this changing prognosis." I did not know this!
I assumed that because nomograms generally show that the more time
which goes by, the risk of progression increases - that is the way to
think about it. And they say that also:
2. "For model validation, we assessed both discrimination and
calibration. Discrimination refers to the ability of the nomogram to
rank patients by their risk, such that patients with a higher
predicted risk of treatment failure should be more likely to recur."

If anyone can help me understand these two items as both being
applicable, I would appreciate it!

The paper and nomogram can be seen here
http://jco.ascopubs.org/cgi/content/full/23/28/7005

> 1. "Given that a patient’s prognosis improves with the disease-free
> interval maintained after RP, we have also enabled the 10-year PFP to
> be adjusted to reflect this changing prognosis." I did not know this!
> I assumed that because nomograms generally show that the more time
> which goes by, the risk of progression increases - that is the way to
> think about it.

I think they are simply saying that the longer YOU go without
recurrence, the less likely it is that YOU will recur. (As time goes
by, obviously, more people recur cumulatively; but the longer each
individual goes without recurrence, the less likely it is that that
individual will recur)

So based on the data from your post-op biopsy, the nomogram predicts
likelihood of recurrence (by reading off the horizontal axis at the
bottom of the chart) immediately post-op.

The longer you go post-operatively with no recurrence, the more likely
it becomes that you will never recur; so you take your score from the
horizontal axis at the bottom of the chart, then trace up vertically
until you reach the number of months (vertical axis) post-op that you
have been undetectable (defined as under 0.4); that's why the
probability line slants from left to right. So if you have had no
recurrence after 4 years, for example, your probability of remaining
recurrence-free is now greater than it was on the day after your op.

Hope that helps.

I have no idea what your number 2 para means. Leonard Evans, who is a
mathematician and a frequenter contributor here will probably be able
to explain it.

Fred

On May 21, 10:13 am, H F <p...@gtek.biz> wrote:
> This nomogram is somewhat different from others I have seen. It
> results in a more optimistic projection for many of us, however, so I
> am not really sure how useful it is. The nomogram creators admit: "The
> calibration plots suggest that the predictions of the nomogram may be
> too optimistic for patients with calculated 10-year PFP less than
> 90%."
>
> But - as the creators point out: "Unique to predictive models, the
> nomogram predictions can be adjusted for the disease-free interval
> that a patient has achieved after RP."
>
> They make two assertions which took a lot of mental processing for me
> to understand because, initially, they seem to conflict (and I still
> don't think I really understand):
> 1. "Given that a patient’s prognosis improves with the disease-free
> interval maintained after RP, we have also enabled the 10-year PFP to
> be adjusted to reflect this changing prognosis." I did not know this!
> I assumed that because nomograms generally show that the more time
> which goes by, the risk of progression increases - that is the way to
> think about it. And they say that also:
> 2. "For model validation, we assessed both discrimination and
> calibration. Discrimination refers to the ability of the nomogram to
> rank patients by their risk, such that patients with a higher
> predicted risk of treatment failure should be more likely to recur."
>
> If anyone can help me understand these two items as both being
> applicable, I would appreciate it!
>
> The paper and nomogram can be seen herehttp://jco.ascopubs.org/cgi/content/full/23/28/7005

This is the nomogram that is currently used by the calculator at the
Sloan Kettering web site. They give you the choice of using the older
"Historical Model" or the "Current Model". The original model had
some defects and the newer model is an attempt to resolve them.

Although in principle I have the background to understand the
statistical models and techniques that are used, I have to admit that
I've never tried to understand them in depth. That would require an
investment in time that I don't feel it worth my while to make. But
I think I understand enough of it to get the general flavor of what
they are saying. So, with that caveat, let me try to address your
questions.

1. I think that previous results have not made it clear whether
prospects improved with time. It was definitely true for high risk
patients: the longer they went without a recurrence the less likely
they were to recur. But the data I saw was not very clear about what
happened for moderate to low risk patients. What was clear in those
cases was that the risk stayed low and didn't increase
significantly. What the current authors report does suggest,
however, is that even for moderate to low risk patients, the longer
they go without recurrence, the less likely the are to recur, at least
up to a point. That is encouraging..

I' m not sure which nomograms you are referring to which show an
increased risk over time. I haven't seen any that I believe.

The results they report here are roughly consistent with those from
Walsh and his coresearchers, but perhaps a bit more optimistic. It
is my impression that Scardino, Kattan, as well as Walsh, are leaders
in this field, so one should take seriously what they say. The only
other predictive model I've seen people refer to is one supposedly
based on neural network methods, which was done at a VA hospital,
which gives much more pessimistic predictions. In fact they are so
far off from what Scardino-Kattan and Walsh predict that either their
method is wrong or they are describing and entirely different
population. When predictions diverge so much, it is usually the
outlier that is questionable.

Could you give a reference to a nomogram which predicts increased risk
over time?

Be that as it may, there is one point that is confusing here, and I'm
not sure what to make of it. If all the nomogram is predicting is the
likelihood of your remaining recurrence free at 10 years from RP, then
of course, if you have gone 7 years without recurrence, your
likelihood of still being recurrence free at 10 years is very high.
But what you are interested in is how likely you are to remain
recurrence free in after another 10 years. It is not clear to me
just what they are saying about that. They do say in the article
that they estimate the overall recurrence rate after 10 years, for men
who have gotten that far , as being about 3 percent. But they don't
say how this varies with the post surgical pathology.

Let me use my case an an example. I was last tested 89 months
following RP, and I was recurrence free. According to the nomogram,
with my PSA and post surgial results, the likelihood of my remaining
recurrence free at 10 years ( a bit less than three years from now) is
over 99 percent. And according to their data, the likelihood of my
remaining recurrence free after that is at least 97 percent, but it
might be even higher given the good post-surgical pathology report.
Their study doesn't really address that point. I am willing to accept
such odds.

So, if I understand the article properly, the nomogram is mostly
useful for men who are only a few years beyond RP. It certainly
doesn't help to know the likelihood of your being recurrence free at
10 years if you have already got to 11 years, for example.

2. Here they are discussing the validation. The original study
applied to a specific study population. The validation then tried to
see how well it worked on a different population. In testing that
they asked first if it at least ranked patients correctly with respect
to greater and lower risk, and they found it did. The secon dpart, if
I understand them correctly, refers to whether the actual predictions
were at the same level. They discovered that their predictions were a
bit optimistic when applied to the validations population, but
apparently not greatly so.

There are of course several caveats that need to be considered. It
is fairly clear that if Scardino is your surgeon, then your chances of
recurrence are going to be lower than if you pick a random surgeon in
your community. The question is how much less. The validation
gave a partial answer to this: not very much for the other surgeons
whose patients were in the validation study. But otherwise it doesn't
really give you a good answer.

It is my impression, perhaps it is just my hope, that while things
like avoiding impotence are highly dependent on the skill of the
surgeons, the likelihood of a cure, after the surgeon reaches a
certain level of competence, is not so dependent. You don't really
need a "star" to be cured. I certainly hope that I am right about
that since my surgeon, while quite good, is not a star. Also, I think
the skill of the surgeon already shows up in the post surgical data,
such as positive margins, used in the nomogram.

On May 21, 9:44*pm, len <l...@math.northwestern.edu> wrote:
> On May 21, 10:13 am, H F <p...@gtek.biz> wrote:


Len and Fred - thanks for your help. You are, indeed, addressing my
interest. My undergraduate degree was in math, completed 46 years ago
and never used, so I have forgotten twice what I ever knew! My
nomograms clearly show that risk of progression increases with time -
unless I am not understanding them correctly. For example:
Johns Hopkins: Recurrence Probability @ 3 years 51%; @ 10 years 89%
Vanguard Urologic: Progression Free Probability: @ 2 years 21%; @ 7
years 2%
Sloan Kettering Historical: Progression Free Probability @ 2 years
28%; @ 7 years 3% (Historical Model)
@ 2 years 61%; @ 7 years 25%
(Current Model)
Prostate Center: Biochemical Progression Probability: @ 1 year 14.21%;
@ 5 years 42.68%
They way I interpret all of these is that my risk increases with time.

This nomogram I have referred to suggests that my 10 year progression
free probability is 60%. If I am still free at 3 1/3 years, 70 % and @
5 years free, 80%.

So these are quite different from the others. Because the authors say
the results are too optimistic for patients with calculated 10 year
<90%, I am inclined to completely discount this nomogram - as much as
I would prefer to adopt its viewpoint! I am not inclined to place a
lot of stock in any of them - except the do all seem to suggest that I
am a high risk case, so I should seek agressive
treatment.............please correct me if you think that is an
inappropriate conclusion.

HF....I looked up your stats from previous posts:

RP 14 months ago; T3a, nerve invasion, Gleason = 9, lymph node
invasion (4); PSA since <0.007

Right?

Now this is my untrained non-medical opinion which is worth exactly
what you are paying for it. No question that the G9 and the lymph node
invasion make you high risk, but the post-op PSA of <0.007 for 14
months is wonderful! I think I would choose to watch the PSA like a
hawk, getting tested using the ultrasensitive tests every 3 months,
and then treat fairly aggressively if you see at least 3 consecutive
significant rises. But for goodness sakes, with a 0.007, celebrate the
moment!

A couple of general comments:

1. There is no RIGHT decision; you'll get those who, in your situation
would treat aggressively now, those who would treat conservatively, or
not at all even in the face of persistently rising PSA. Each of these
positions has merit, and facts/arguments to support each position. You
make your treatment decision based on what seems right to you at the
time, after doing whatever research you wish, and listening to the drs
in whom you have the most confidence. But you will never know for sure
whether you are making the right decision, because there is no such
thing based on our knowledge to date. We are all stumbling along
making imperfect decisions; that's how it is.

2. Remember, the nomograms are based on treatments which were done
many years ago. Therefore, in many respects they don't apply to you.
For example, I feel reasonably confident that due to technical
advances, salvage radiation (SRT) performed in 2008 is likely be more
effective than salvage radiation performed in 1998. But a 10 year
nomogram available today to assess probability of recurrence after SRT
will, by definition, be based on the results of salvage radiation
performed in 1998 or earlier. So the nomogram really has limited
predictive value for SRT performed in 2008. Therefore, I would be
cautious in basing individual treatment decisions on nomograms.
Elizabeth Edwards made that point very clearly re her breast cancer;
she said straight out that the statistics based on past treatment
regimens don't apply to her because the current treatment technology
has improved so much; IMHO, that's a very fair point.

3. With all respect, I think you are still misunderstanding when you
say the risk of recurrence increases with time. To the best of my
knowledge, all of the nomograms show that the risk of recurrence
DECREASES as time goes on. For example, using your numbers from the
Hopkins nomogram, 51 men out of a hundred recur after 3 years (average
recurrence rate of 17% per year), leaving 49 men who have not
recurred. After 10 years, 89 of the original sample of 100 have
recurred, which means that between 3 and 10 years, 38 more men
recurred out of the 49 remaining after 3 years (average recurrence
rate of 38/7 years = 5.5 per year, equals roughly 11% per year of the
group who did not recur). So using that example, the Hopkins nomogram
shows a decrease in the annual recurrence rate from 17% average in the
first 3 years, to 11% average in the last 7 years. As time goes on,
certainly more men will recur cumulatively; but as each year goes by
and you remain free of recurrence, the less likely it is that you will
recur in the future. So the longer you keep your 0.007, the less
likely it is that you will recur.

Again, all of the above are the ramblings of someone not trained in
either math or medicine; so take it FWIW.

With best wishes

Fred

On May 22, 6:53 am, H F <p...@gtek.biz> wrote:
> On May 21, 9:44 pm, len <l...@math.northwestern.edu> wrote:
>
> > On May 21, 10:13 am, H F <p...@gtek.biz> wrote:
>
> Len and Fred - thanks for your help. You are, indeed, addressing my
> interest. My undergraduate degree was in math, completed 46 years ago
> and never used, so I have forgotten twice what I ever knew!

Don't feel so bad about that.

A general undergrdaute degree in math isn't a whole lot of help in
these matters. Even a Ph D such as mine in some other area than
statistics is most likely not going to be helpful. I happen to have
studied some statistics, so I have a general idea of what is going on,
but I know little or nothing about the specific statistical tests
used by biomedical researchers.

> My
> nomograms clearly show that risk of progression increases with time -
> unless I am not understanding them correctly.

You have to distinguish between the risk AT RP of recurring in a
specified period of time from the risk of recurrence in the future
AFTER the specified period of time.
Naturally the former goes up as you increase the time period. The
question you are interested in, I believe, is what happens to the
second kind of risk. As I noted previously, I think the figures
usually refer to the former, but I can't tell without looking
directly at the references.

Let me try to given an example. Suppose one study shows the risk at
RP of recurrence within 5 years is 40 percent. Suppose also, you
know that the ultimate risk at RP of recurrence any time in the future
is 70 percent. Suppose you start with 1000 men at RP. Ultimately,
700 will recur, but at 5 years only 400 have recurred. That means
that of the 600 men who got to 5 years without recurring, another
700-400 = 300 will recur. That means the ultimate recurrence
likelihood at 5 years would be 300/600 = 0.5 = 50 percent. On the
other hand, at RP it would have been 70 percent. So that means it
would have decreased for those men who got to 5 years recurrence free.

Since a vew if any studies follow men indefinitely, the statistics of
any given study don't usually allow a good way to estimate the
ultimate recurrence probability starting at RP. So the kind of
calculation I just did is usually impossible.

> For example:
> Johns Hopkins: Recurrence Probability @ 3 years 51%; @ 10 years 89%

I think they are referring here to the likelihood of recurrence within
3 years and 10 years respectively, not the ultimate recurrence
likelihood after 3 and 5 years respectively.

> Vanguard Urologic: Progression Free Probability: @ 2 years 21%; @ 7
> years 2%

I don't know anything about this estimator, but I bet it is telling
you the likelihood of remaining recurrence free within the specified
period starting at RP.

> Sloan Kettering Historical: Progression Free Probability @ 2 years
> 28%; @ 7 years 3% (Historical Model)
> @ 2 years 61%; @ 7 years 25%> (Current Model)

The Sloan Kettering models.definitely give the likelihood of being
recurrence free within the specified period of time, not the
recurrence after that period. I addressed that in some detail in my
previous response. The only information they give about ultimate
recurrence rates is that the overall likelihood of recurring after 10
years seems to be about 3 percent. But they don't distinguish on the
basis of the severity of the case. Higher risk cases, as shown by
post-surgical pathology would presumably face a higher risk after 10
years, but they provide no guidance about how much higher.

It is my impression that the risk of ultimate recurrence does drop
faster with time recurrence free for more aggressive cases than for
others. It is plausible that after 10 years it gets pretty close to
that of non-aggressive cases,


> Prostate Center: Biochemical Progression Probability: @ 1 year 14.21%;
> @ 5 years 42.68%

I would bet these are for recurrence likelihood within the specified
period, not the ultimate risk of recurrence after the period has
passed.

> They way I interpret all of these is that my risk increases with time.

I hope I've explained the likely meaning of the figures.


For example, let's consider the Sloan Kettering Historical
Progression Free Probabilities. Suppose it were known that the
likelihood of ever recurring were 30 percent. Consider 1000 men.
After two years
>
> This nomogram I have referred to suggests that my 10 year progression
> free probability is 60%. If I am still free at 3 1/3 years, 70 % and @
> 5 years free, 80%.
>
> So these are quite different from the others. Because the authors say
> the results are too optimistic for patients with calculated 10 year

Let me try to explain that again. What they said was the following.
They came up with their predictors from a study on a database of a
large number of men. When they applied it to another large group of
men at other institutions, they found the predictions to be generally
consistent, but a "bit optimistic" although they didn't quantify
that.. They don't tell you, from their study, the risk at 10 years
of ultimately recurring. The only information they offer about that
is the 3 percent overall figure, which didn't come from this study.

> <90%, I am inclined to completely discount this nomogram - as much as
> I would prefer to adopt its viewpoint!

I agree that this nomogram won't be particularly helpful. I don't
know all the details of your case, but I went to the Sloan Kettering
site and put in the figures Fred came up with. I had to guess at
what to put in. In particular, I presumed there was no seminal node
involvement because if there were it would have been classified as
3b. The nomogram gives the following: the likelihood of remaining
recurrence free within two years from RP is 83 percent and within 10
years from RP is 36 percent. So if 1000 men like you started at RP
830 would still be recurrence free after 2 years, meaning 170
recurred, By 10 years, the number which would have recurred is 640,
so at two years 640 - 170 = 470 remain to recur by 10 years. That
means that at 2 years, the likelihood of your recurring within the
next 7 years would be 470/830 ~ 57 percent., and of not recurring
would be 43 percent. That would still be quite high, but not as bad
as the 36 percent figure would suggest. If you get to 5 years being
recurrence free, I believe the same sort of calculation would say the
likelihood of remaining recurrence free for the next five years would
be about 69 percent.

One thing to remember in allof this is that the number of high risk
cases in any of these studies is probably relatively small. So the
reliability of the predictions may not be as great as it is for lower
risk cases which were better represented. That may explain the great
divergence in the different predictions.


> I am not inclined to place a
> lot of stock in any of them - except the do all seem to suggest that I
> am a high risk case, so I should seek agressive
> treatment.............please correct me if you think that is an
> inappropriate conclusion.

I am not in a position to judge what you should do. I don't think the
nomograms help. What you have to decide is whether additional
treatment would improve your chances at this date, still pretty early
in the process. The only thing I know about that is that both
Scardino and Walsh remark that you are better off if you go at least
10 months without recurrence, which you have. It is my impresion
that the research is somewhat mixed about whther or not treatments
such as ADT is likely to be helpful for a man like you and whether it
is risky to wait for the PSA to start rising. You should talk to
your doctor to that and also see at least one oncologist, preferably
more than one.

But it does seem true that the longer you go without recurring, the
less likely you are to recur in the future. Of course, if you started
ADT, that would upset any such calculations. Presumably you wouldn't
be any worse off with respect to the progression of the disease, but I
don't know enough even to be sure of that.

>
> But it does seem true that the longer you go without recurring, the
> less likely you are to recur in the future. *Of course, if you started
> ADT, that would upset any such calculations. *Presumably you wouldn't
> be any worse off with respect to the progression of the disease, but I
> don't know enough even to be sure of that.

Len and Fred - thanks for your help and support. I have just skimmed
your responses and can see that I am going to have to study them. I am
trying to get ready to hit the road in about an hour, so I am saving
your responses for when I can devote some time to them.

My current plan is to begin treatment: Eligard + Taxotere. It will
start when PSA hits 0.4. This is per my clinical trial.

On Thu, 22 May 2008 04:53:49 -0700 (PDT), H F <pete@gtek.biz> wrote:

>My undergraduate degree was in math, completed 46 years ago
>and never used, so I have forgotten twice what I ever knew!

Same here, same degree, about 40 years ago, barely used and similar
level of atrophy. Still, I bet your mathematical instincts are
intact.

That's an interesting nomogram - thanks for the link. What struck me
immediately is how fierce the points tally is in its response to
higher PSA values and seemingly gentle for higher gleasons and
non-confined tumours. That said, some of these conditions are
inter-dependent so if the drought doesn't get you the floods will.

> My
>nomograms clearly show that risk of progression increases with time -
>unless I am not understanding them correctly.

Well the nomogram clearly shows that the longer you go
progression-free the better are your prospects and this is what I've
always been led to understand, although perhaps a little more clearly
now.

I picture this based on the analogy of repeated attempts at carelessly
crossing a road. Supposing the probability of being run over by a bus
is 5% for each careless crossing, then 10 such crossings will increase
the probability of being run over at least once to around 40%. If each
time the pedestrian crosses the road he becomes marginally more
skilled - say 20% improvement - then the risk is a diminishing series
(5%, 4%, 3.2%....) and the cumulative 10-crossing total is halved.
Those figures are simple and not representative of PCa but I think
this is the nature of the position we're in; a reducing year-on-year
risk (one road-crossing, always getting better at doing it) but with
increased exposure to the possibility of the single event when
observed over the longer time span. It's the fact of being alive which
puts us at risk and this seems to loom large when we are only just
post-treatment and have so many years ahead.

There's an encouraging footnote at the end of fig2 - "...progression
after 10 years is extremely rare". That sharply reduced risk shows on
the upper part of the graph where all the lines sweep off quickly to
the right.

My current plan is to begin treatment: Eligard + Taxotere. It will
start when PSA hits 0.4. This is per my clinical trial.


==> I obviously missed something. I thought your last PSA was 13.1.

On May 24, 9:31*am, "Steve Kramer" <skra...@cinci.rr.com> wrote:
> My current plan is to begin treatment: Eligard + Taxotere. It will
> start when PSA hits 0.4. This is per my clinical trial.
>
> ==> *I obviously missed something. *I thought your last PSA was 13..1.

Steve - it was 13.1 prior to RP. Since RP it has been <0.007!

Oh. Good! That's a relief.

"H F" <pete@gtek.biz> wrote in message
news:52810b09-7394-4a03-b93f-58133d90405a@c65g2000hsa.googlegroups.com...
On May 24, 9:31 am, "Steve Kramer" <skra...@cinci.rr.com> wrote:
> My current plan is to begin treatment: Eligard + Taxotere. It will
> start when PSA hits 0.4. This is per my clinical trial.
>
> ==> I obviously missed something. I thought your last PSA was 13.1.

Steve - it was 13.1 prior to RP. Since RP it has been <0.007!

> "H F" <pete@gtek.biz> wrote in message
> news:52810b09-7394-4a03-b93f-58133d90405a@c65g2000hsa.googlegroups.com...
> On May 24, 9:31 am, "Steve Kramer" <skra...@cinci.rr.com> wrote:
>> My current plan is to begin treatment: Eligard + Taxotere. It will
>> start when PSA hits 0.4. This is per my clinical trial.
>>
>> ==> I obviously missed something. I thought your last PSA was 13.1.
>
> Steve - it was 13.1 prior to RP. Since RP it has been <0.007!


I was just rethinking this -- or should I say understanding this for what it
is. You are taking a refreshingly pragmatic view of your Gleason 9, T3,
nerve and node involved cancer. Most people with a PSA of 0.007 PSA would
praise God for the cure. But, you are not fooled and are already making
plans for a PSA 0.40. That's a very healthy approach, I think -- physically
and mentally.

--
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 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08
Non Illegitimi Carborundum

On Mon, 26 May 2008 07:15:01 -0400, "Steve Kramer"
<skramer@cinci.rr.com> wrote:

>> "H F" <pete@gtek.biz> wrote in message
>> news:52810b09-7394-4a03-b93f-58133d90405a@c65g2000hsa.googlegroups.com...
>> On May 24, 9:31 am, "Steve Kramer" <skra...@cinci.rr.com> wrote:
>>> My current plan is to begin treatment: Eligard + Taxotere. It will
>>> start when PSA hits 0.4. This is per my clinical trial.
>>>
>>> ==> I obviously missed something. I thought your last PSA was 13.1.
>>
>> Steve - it was 13.1 prior to RP. Since RP it has been <0.007!
>
>
>I was just rethinking this -- or should I say understanding this for what it
>is. You are taking a refreshingly pragmatic view of your Gleason 9, T3,
>nerve and node involved cancer. Most people with a PSA of 0.007 PSA would
>praise God for the cure. But, you are not fooled and are already making
>plans for a PSA 0.40. That's a very healthy approach, I think -- physically
>and mentally.

Most of us paying any kind of attention to this forum - either
discussing or just reading - will have developed an edgy realism about
the 'cure'. In my case the drive to prepare mentally is fired more by
slightly corrosive pessimism, I think. Still, as you say, far better
then being doe-eyed about it.

H F - I wanted to ask if you'd completely ruled out SRT when embarking
on your RP? Unless I've misunderstood, you seem to imply that your
trial has determined the next stage (if any!).
I'd be interested in knowing your thinking on this.

On Mon, 26 May 2008 12:56:52 +0100, rosbif wrote:

>On Mon, 26 May 2008 07:15:01 -0400, "Steve Kramer"
><skramer@cinci.rr.com> wrote:
>
>>> "H F" <pete@gtek.biz> wrote in message
>>> news:52810b09-7394-4a03-b93f-58133d90405a@c65g2000hsa.googlegroups.com...
>>> On May 24, 9:31 am, "Steve Kramer" <skra...@cinci.rr.com> wrote:
>>>> My current plan is to begin treatment: Eligard + Taxotere. It will
>>>> start when PSA hits 0.4. This is per my clinical trial.
>>>>
>>>> ==> I obviously missed something. I thought your last PSA was 13.1.
>>>
>>> Steve - it was 13.1 prior to RP. Since RP it has been <0.007!
>>
>>
>>I was just rethinking this -- or should I say understanding this for what it
>>is. You are taking a refreshingly pragmatic view of your Gleason 9, T3,
>>nerve and node involved cancer. Most people with a PSA of 0.007 PSA would
>>praise God for the cure. But, you are not fooled and are already making
>>plans for a PSA 0.40. That's a very healthy approach, I think -- physically
>>and mentally.
>
>Most of us paying any kind of attention to this forum - either
>discussing or just reading - will have developed an edgy realism about
>the 'cure'. In my case the drive to prepare mentally is fired more by
>slightly corrosive pessimism, I think. Still, as you say, far better
>then being doe-eyed about it.

Don't know how healthy an approach it is, but since my T2B Gleason 7 was
removed along with the seminal vesicles and vans defrans (sp?) last Tuesday,
I've adopted the attitude that I'm never going to see this particular cancer
again, something the doctor says I have a 3-1 shot at achieving.

And, if I do see it again, hopefully it will be late enough for some really
rockin' medical advancements like the RF / nanoparticle "cure" to be on the
market that will allow me and others to be beating it 100%, or at least keep me
alive 'til I die of something else.

But my possible self-deception that everything is going to be fine will be less
stessful for me, I think, which I also think is best since I manifest a lot of
stress routinely anyway.

DM

On Mon, 26 May 2008 14:16:11 GMT, Danger Mouse <danger_mouse@att.net>
wrote:

>Don't know how healthy an approach it is, but since my T2B Gleason 7 was
>removed along with the seminal vesicles and vans defrans (sp?) last Tuesday,
>I've adopted the attitude that I'm never going to see this particular cancer
>again, something the doctor says I have a 3-1 shot at achieving.

Now you mention it, I can see there's no best mindset. If he ends up
cured, the pessimist has worried needlessy - if not cured, the
optimist has at least enjoyed a period free of anxiety.

>And, if I do see it again, hopefully it will be late enough for some really
>rockin' medical advancements like the RF / nanoparticle "cure" to be on the
>market that will allow me and others to be beating it 100%, or at least keep me
>alive 'til I die of something else.

I raise my glass of Lidl Corbiere to that prospect...

"Danger Mouse" <danger_mouse@att.net> wrote in message
news:tchl341g76c6ho920bqaf1ejvhlmbbn3dd@4ax.com...

> Don't know how healthy an approach it is, but since my T2B Gleason 7 was
> removed along with the seminal vesicles and vans defrans (sp?) last
> Tuesday,
> I've adopted the attitude that I'm never going to see this particular
> cancer
> again, something the doctor says I have a 3-1 shot at achieving.

While I am suspicious of the "3:1" estimate (only because initially my uro
lied to me using the same ratio), I agree that if your T2b and Gleason 7
came from a post-op biopsy, you're doing well and have every reason for
anticipation of a good life.