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CentralPaDude 02-25-2022 01:33 PM

Re: Newly Diagnosed
 
[QUOTE=dewayneb;5515555]all lymph nodes and margins are clear. In regards to side effects, so far so good.[/QUOTE]
Great to hear, and here’s to a rapid recovery and PCa in the rear view mirror!

Prostatefree 03-03-2022 08:09 AM

Re: Newly Diagnosed
 
[U][/U] [QUOTE=IADT3since2000;5514681]Hi Prostatefree. Here are some more thoughts on what you wrote in post #10 about how radiation affects healthy cells.

[QUOTE=Prostatefree;5514603]Radiation damages healthy cell DNA. No dispute, imo. The question is does it do so to a measurable extent and effect the quality of your life, [I]over time[/I].

Indeed, it is well known and widely accepted that radiation does damage healthy cell DNA, but for our decision making that is usually irrelevant. It is usually irrelevant because it is also well known and widely accepted that healthy cells fully and rapidly recover from safe doses of radiation, and this means there is [I]no impact on quality of life[/I] over time for tissue that received [I]safe[/I] doses.

On the other hand, in line with your point, it is also recognized that some patients will need dosing high enough to kill the cancer in certain areas that will also injure some healthy tissue enough so that they cannot fully recover; this may indeed result in some side effects. One of the best-known side effects is development of scar tissue, and that can be a gradual process, as you noted. Usually, per my layman's impression, most late developing side effects will have shown up by the five-year point, though they can appear later. For us patients, the key questions are: what are the odds generally and specifically for us personally of developing side effects, especially those that are bothersome?

Fortunately, many studies have been published that show the odds of mild side effects are low, and the risks of more bothersome side effects are very low. Many radiation patients, even those who had pelvic doses, have experienced no long-term side effects despite very long-term survival after radiation. That's a good indicator that radiated healthy tissue is able to recover and function well long term. I myself am now approaching the nine-year benchmark since completing radiation that included a pelvic dose as well as a higher dose to the prostate, and I have no long-term bothersome side effects from it. Doctors can and should advise patients of the general risks of side effects based on the odds, and especially when the odds of substantial side effects are higher, due to the patient's special circumstances.

Jim[/QUOTE]

Very interesting. When I read this I hear a case made for surgery in younger men. In short, no need to concern yourself with the side effects of radiation because they don't show up until later (5 years or more), if at all.

Developing scar tissue over time is the ongoing dying off of radiated "healthy" cells.

A radiated cell never fully recovers. At best, it does not die. Think of a cell as having an end of life timeclock (DNA). Radiation shaves time off that clock. True, you may never need the extra time if you die sooner of something else. There in lies the seed of the original prostate cancer myth for all those who suffer and die of it.

IADT3since2000 03-03-2022 11:37 AM

Re: Newly Diagnosed
 
Hi Prostatefree. I'm glad this Board has different points of view so that readers can form their own viewpoints. Mine is clearly different from yours. You recently posted:

[QUOTE=Prostatefree;5515646][U][/U] [QUOTE=IADT3since2000;5514681]Hi Prostatefree. Here are some more thoughts on what you wrote in post #10 about how radiation affects healthy cells.
...[/QUOTE]


Very interesting. When I read this I hear a case made for surgery in younger men. In short, no need to concern yourself with the side effects of radiation because they don't show up until later (5 years or more), if at all.[/QUOTE]

I just have great difficulty understanding how [I][U]the claims and viewpoint in your post[/U][/I] make a case [I]for[/I] surgery for men of [I]any age[/I]! It's not just that the acute effects of modern radiation during treatment are milder and far shorter than for surgery. And it's not just that the long-lasting effects of modern radiation, if they show up at all, [I][I]ever[/I][/I], typically will show up a couple of years to usually not more than five years later in contrast to long-term surgery effects that show up at the start and never go away unless decreased with further treatment. It's also that [I][U]the odds[/U] of long-term effects of modern radiation [U] are so much lower[/U][/I], while effectiveness is at least equal for lower-risk men and markedly superior for higher-risk men!

I'm trying to see what you are seeing. I suppose some of us are more comfortable with a fairly certain up-front outcome we know has strong odds of some discomfort, possibly great discomfort, than an extremely likely much milder outcome that yet has some low possibility of an increase in discomfort in the future. Maybe an argument can be made that patients who are naturally worriers would be more comfortable with surgery.

[QUOTE=Prostatefree;5515646]Developing scar tissue over time is the ongoing dying off of radiated "healthy" cells.[/QUOTE]

Is that your speculation, or do you have credible sources for that? I was under the impression that scar tissue was an up-front consequence that gradually becomes bothersome, but I have never really understood the source of scar tissue. Perhaps your explanation is right for [I]some[/I] healthy cells, but I doubt very much it is true for all healthy cells that have received radiation.

[QUOTE=Prostatefree;5515646]A radiated cell never fully recovers.[/QUOTE]

I understand that you believe this, but I believe it is not true, at least for most healthy cells that receive radiation. Cells have repair mechanisms, and they are generally effective. If you have credible sources to back your statement, I'm sure many of us would like to view what they have to say.

[QUOTE=Prostatefree;5515646]At best, it does not die. Think of a cell as having an end of life timeclock (DNA). Radiation shaves time off that clock. True, you may never need the extra time if you die sooner of something else. There in lies the seed of the original prostate cancer myth for all those who suffer and die of it.[/QUOTE]

Again, what you wrote is one possibility, but my impression is that this is not true. Cell time clocks are usually described in terms of telomeres, and I have never seen, read or heard that radiation affects those telomeres for all healthy cells it reaches. Again, if you have credible sources, please provide them.

The bottom line is that [I]modern[/I] radiation is safe and effective for patients young or old, and there are numerous published, long-term medical research studies that prove that!

….Jim[SIZE="1"]

- - - - - - - - - - - - - - - - - - - - - - - -
22 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.[/SIZE]

ASAdvocate 03-03-2022 12:31 PM

Re: Newly Diagnosed
 
Jim, It’s like politics. PF has very strong opinions, and you or I aren’t going to change him. He has been adamantly consistent that any man with the smallest amount of PCa should have an RP without delay.

He is entitled to his opinions, and I agree with his points about early detection. But, as with politics, I doubt that he can be convinced to change his convictions.

IADT3since2000 03-03-2022 02:29 PM

Re: Newly Diagnosed
 
Hi ASAdvocate,

Yes. Of course, I too am a staunch advocate of early detection.

Jim

Terry G 03-04-2022 10:20 AM

Re: Newly Diagnosed
 
I appreciate Prostatefree’s point of view especially with regard to early detection. Simply looking at my biopsy results suggests I’m a perfect candidate for AS and yet I elected early aggressive treatment and have no regrets. My urologist was ready to schedule surgery and what a terrible choice that could have been for me. I believe we can become biased in our treatment decision especially when we have great results with it. I try not to let my bias show.

With PCa it’s difficult to say what is the best decision for someone else. I think we all would prefer that each guy make a fully informed decision regarding what treatment is best for their particular circumstances. If the only treatment information comes from your urologist I don’t believe you’re making a very informed decision. My wish is that more recently diagnosed would fully investigate all their options. Terry


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