It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board

  • When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

  • Post New Thread   Reply Reply
    Thread Tools Search this Thread
    Old 01-23-2020, 03:25 PM   #1
    IADT3since2000
    Senior Veteran
    (male)
     
    Join Date: Nov 2007
    Location: Annandale, VA, USA
    Posts: 2,389
    IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
    Smile When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    It’s when the evening and night before you took the preparation for a colonoscopy, performed the ensuing toilet duty, had the colonoscopy, and your gastroenterologist gave you an excellent report!

    I did all that yesterday and this morning! I am so delighted that it is today in the afternoon and not yesterday, which I had watched slowly approaching with increasing dread.

    Colonoscopies and other health checks are really important for us prostate cancer patients because the vast majority of us will eventually die from something else, with colon cancer fairly prominent without colonoscopies or other screening, and sometimes we focus so heavily on prostate cancer that we miss the bigger picture. Also, some of us don’t do the screening colonoscopy because we figure we will soon be dead due to prostate cancer, so what’s the point? That was me for a few years after diagnosis and two urologists giving me a prognosis of five years in late 1999 and early 2000, but then, after a few years, I began to realize I might make it or at least live quite a lot longer, so I had my first colonoscopy in 2003.

    In the past until today, I have dreaded these things. This was my fourth. The procedures have always been fine, but as most of us know, the preparation is the hard part; the prep dose was not so fun to take in the past, and the toilet time was miserable (plus the reduced sleep). I almost passed out when doing a one-big-dose prep in 2003; I recall that it was delivered via suppository. Yuck! The oral prep single dose was better but still awful in 2012 – not so much the not-so-great taste and texture, but the awful intended effect and toilet time. I was given a split-prep dose in 2016, and that was a lot better, but still rough.

    I had a different oral split dose this time, taken at 5 PM and 3:45 AM, and a different prep solution called SUPREP (sodium sulfate, potassium sulfate and magnesium sulfate oral solution). You mix the 6 ounce solution with 10 ounces of water for each dose, and then drink two 16 ounce additional containers of water within the next hour. The results weren’t fun, but I’ve got to say this was a lot better than in the past; I spent at least as much time on the toilet, but it was milder and not explosive. Now that I know this stuff is available I won’t dread the next colonoscopy. I am also delighted to be able to get back to my regular Mediterranean diet.

    There’s a great and very funny film that features a colonoscopy gone somewhat wrong after the patient blew off the questions that give the anesthesiologist the information he needed. It’s “Ghost Town” from 2008, starring Ricky Gervais, Tea Leoni, and Greg Kinear, and the “ghost town” is New York City. Now that I’m past my procedure, I think I’ll watch it again.

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    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 remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

    Last edited by IADT3since2000; 01-23-2020 at 03:28 PM. Reason: edited title

     
    Reply With Quote
    Sponsors Lightbulb
       
    Old 01-24-2020, 08:27 AM   #2
    JohnR41
    Senior Veteran
    (male)
     
    Join Date: Sep 2008
    Location: Florida, U.S.A.
    Posts: 2,455
    JohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    Hi IADT3,

    None of my grandparents ever had a colonoscopy and my parents didn't either. Same goes for aunts and uncles, and none of them ever had colon cancer. I'm going to be 79 soon and have never had a colonoscopy, and I don't plan on ever having one in the future.

    According to some quick research, I see that the colon cancer rate in the U.S. is 29.2 per 100,000 people. For those who eat a diet that's high in animal protein and low in fiber, which is what most Americans do, they should definitely be concerned. Others not so much.

    Of course everyone should be informed and decide for themselves based on family history, age, lifestyle, and overall health status.

    Oops, I just remembered my mother did have one colonoscopy at age 79. And that's because she got a false positive on a fecal test. Fecal tests are well known for that. So she was put through a terrible experience because of that. After it was all over she said, "never again!"

    My brother-in-law's father died from colon cancer. He was a butcher and had the habit of occasionally nibbling on raw ground beef. Little did he know that it would put him at high risk for colon cancer.

     
    Reply With Quote
    The following user gives a hug of support to JohnR41:
    IADT3since2000 (01-24-2020)
    Old 01-24-2020, 10:15 AM   #3
    Prostatefree
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Posts: 125
    Prostatefree HB UserProstatefree HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    Personally, I appreciate the cleanse, and never found anything difficult or terrible about it.

    Happy to have three of them behind me and being responsible for my health.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    12-8-19 PSA less than 0.02, zero club 3.5 yrs

     
    Reply With Quote
    The following user gives a hug of support to Prostatefree:
    IADT3since2000 (01-24-2020)
    Old 01-24-2020, 02:38 PM   #4
    IADT3since2000
    Senior Veteran
    (male)
     
    Join Date: Nov 2007
    Location: Annandale, VA, USA
    Posts: 2,389
    IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    Here's a little more about the role colonoscopies are playing for me.

    My first, in 2003 as I noted earlier, was partly motivated by being shocked by my first-ever PSA results and subsequent diagnosis of a then life-threatening case. Also, my beloved mother-in-law had died of colon cancer a number of years earlier after a battle over half a dozen years, and in 1998, a year before my diagnosis of prostate cancer, Katie Curic's husband Jay Monahan had died of colon cancer, which spurred his wife to vigorously advocate for colonoscopy screening; I'm sure most of us remember her inspired campaign, including her own colonoscopy on live TV. Like prostate cancer, colon cancer typically has no tell-tale symptoms until it is well advanced, and I did not want to have that kind of shock again.

    My first results in 2003 were quite good, and the doctor said I could wait for ten years for the next one. That would have been in 2013, the year my radiation was planned, which would rule out the colonoscopy; therefore, I had my second a year earlier in 2012. Again, the result was good, as expected (but not guaranteed).

    My oncologists advised another colonoscopy three years after my 2013 radiation as there is apparently an increased but still extremely low risk of colon and colorectal cancer due to the radiation. Because of my own high-risk case, my oncologist and I were also tracking my CEA level (carcinoembryonic antigen), as that had been slightly elevated while PAP, NSE, and CGA were all normal (a panel of biomarkers for advanced cancer that does not depend much or at all on androgens as fuel). While CEA is not typically tracked for prostate cancer patients, it is a fairly good risk marker for colon cancer. Therefore, I was glad when that 2016 procedure resulted in a negative biopsy; apparently that CEA anomaly was just due to my particular individual biology ("ideosyncratic"); we stopped tracking CEA.

    Due to previous findings and my history of radiation, the next colonoscopy was also set for 3 years, and that is the one I just had. My gastroenterologist was very encouraging about what he saw; pending good biopsy findings, fully expected based on what he saw, I won't need my next one until five years from now. I'm thinking I have graduated to the the next, better class of patients. He did see evidence of mild radiation proctitis, which is not causing any problems, and which he considered inconsequential. I was reassured that he saw no evidence of colorectal cancer, which I had specifically asked him to check, and which he said he does routinely check as part of the procedure.

    My wife and I have been thinking TGIF and not Wednesday!

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    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 remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
    Reply With Quote
    The Following 2 Users Say Thank You to IADT3since2000 For This Useful Post:
    JohnR41 (01-25-2020)
    Old 01-25-2020, 07:41 AM   #5
    JohnR41
    Senior Veteran
    (male)
     
    Join Date: Sep 2008
    Location: Florida, U.S.A.
    Posts: 2,455
    JohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    Thanks, I understand why you would need to be tested and it seems your doctors are doing a good job of caring for you.

    I also understand that there are many doctors who might not tell their patients the whole story about testing. For example, there's no guarantee that there won't be cancer developing during the interval between tests. As you said the interval could be 10 years, 5 years, or 3 years. All of those intervals leave plenty of time for a fast growing cancer to do plenty of damage. They even have a name for it, it's called "Interval cancer". And one doctor, who did a lot of research and writing on this subject, said that interval cancers tend to be aggressive whereas they mostly find benign growths and/or slow growing cancers during a colonoscopy.

    Of course, if you need testing, some testing might be better than no testing. I'm just pointing out that some people get a false sense of security.

    People might say: If Jay Monahan had been tested he wouldn't have died from colon cancer. But there's no evidence of that being true because the intervals between tests are so long. The interval at first would be 10 years and later in life it might be five years. Even 5 years is a long time.

     
    Reply With Quote
    Old 01-25-2020, 08:02 AM   #6
    DjinTonic
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Location: NC
    Posts: 177
    DjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    Quote:
    Originally Posted by JohnR41 View Post
    Thanks, I understand why you would need to be tested and it seems your doctors are a good job in caring for you.

    I also understand that there are many doctors who might not tell their patients the whole story about testing. For example, there's no guarantee of there not being cancer in the interval between tests. As you said the interval could be 10 years, 5 years, or 3 years. All of those intervals leave plenty of time for a fast growing cancer to do plenty of damage. They even have a name for it, it's called "Interval cancer". And one doctor, who did a lot of research and writing on this subject, said that interval cancers tend to be aggressive. And often what they mostly find during a test are benign growths and/or slow growing cancers.

    Of course, if you need testing, some testing might be better than no testing. I'm just pointing out that some people get a false sense of security.
    I have colon cancer on both parent's sides and have been followed carefully. The interval between my scopes is either 3 or 5 years, depending on the path report of any polyps removed. If there are any of the type that can become malignant, next test will be in 3 years. No polyps or only sessile ones means a 5-year interval.

    Note that PCa can mean you might have an increased risk of other cancers, like colon cancer. Ask your doc if germline genetic testing might be smart for you.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
    Reply With Quote
    Old 01-25-2020, 08:52 AM   #7
    JohnR41
    Senior Veteran
    (male)
     
    Join Date: Sep 2008
    Location: Florida, U.S.A.
    Posts: 2,455
    JohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    Quote:
    Originally Posted by DjinTonic View Post
    I have colon cancer on both parent's sides and have been followed carefully. The interval between my scopes is either 3 or 5 years, depending on the path report of any polyps removed. If there are any of the type that can become malignant, next test will be in 3 years. No polyps or only sessile ones means a 5-year interval.

    Note that PCa can mean you might have an increased risk of other cancers, like colon cancer. Ask your doc if germline genetic testing might be smart for you.

    Djin
    Hi, I got a reply faster than I expected, so you missed my last paragraph.

    Thanks for the information but I believe it's really too late for me to be tested even if I wanted to, and I'm not sure I would want to.

    The U.S. Preventive Services Task Force guidelines state that folks 75 and older should not receive screening colonoscopies.

    As we age, our colon-wall tends to become thinner and more fragile and susceptible to being perforated. Indeed, I knew of three elderly women in my community who had their colons perforated by colonoscopy testing. It was very life threatening and they had to be operated on to repair the damage.

    Also, there have been older people who died from a heart attack as a result of a colonoscopy procedure. I suppose that means having a stroke is also possible.

     
    Reply With Quote
    Old 01-25-2020, 10:22 AM   #8
    IADT3since2000
    Senior Veteran
    (male)
     
    Join Date: Nov 2007
    Location: Annandale, VA, USA
    Posts: 2,389
    IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    US Preventive Services Task Force and Screening for Prostate and Colon Cancer

    Hi John, you just wrote in part:

    Quote:
    Originally Posted by JohnR41 View Post
    ...
    The U.S. Preventive Services Task Force guidelines state that folks 75 and older should not receive screening colonoscopies.
    The Task Force advice may be wise, but based on their past history I put no trust at all in their recommendation!!! These are the amateurs who advised against prostate cancer screening for years , though the current recommendation, from a new group of voting Task Force members, is more favorable to screening, though not for men aged 70 and older, where they believe the harms outweigh the benefits. Bluntly, in the past they badly botched their interpretation of the science (They were not alone!), and the failed to connect key dots in coming to their conclusions. The current Task Force has done a considerably better job but still falls well short of the mark. As someone with a heavy background in statistics and experimental design, much heavier than for the vast majority of doctors, I have been appalled at the Task Force's inability to sort through and interpret the evidence. I call them "amateurs" because they are not experienced in specialties such as urology and oncology; in fact, past boards, and perhaps the current board, have had NO voting urologists or oncologists, just doctors and other health professionals mainly from the primary care world; however expert in the primary care world, I have seen ample evidence that the Task Force as a whole, at least in the past, has a profoundly inadequate understanding of prostate cancer. (Regarding that negative recommendation after age 70, the Task Force notes that research does not support it; the key truth is that the research has not been done; the age cut-off for populations in trials was up to age 69. Therefore, while hard evidence is lacking, our understanding of prostate cancer, which is frequently diagnosed in men in their 70s, suggests strongly that screening would benefit many such men. No Sherlock Holmes badges for the Task Force on this issue!)

    This is not new to me; I've expressed my thoughts more fully in post #1 of https://www.healthboards.com/boards/cancer-prostate/713149-national-conference-prostate-cancer-2009-last-weekend-la-awesome.html. My own views on screening, opposed to the inadequate analysis in the key 2009 issue of the New England Journal of Medicine which first reviewed results from the Prostate, Lung, Colorectal and Ovarian cancer trial and the European Randomized Screening for Prostate Cancer trial, were expressed in https://www.healthboards.com/boards/cancer-prostate/676597-screening-prostate-cancer-why-its-wise.html back in early 2009 (and haven't significantly changed). I also submitted four maximum-length comments to the Task Force during the public comments period prior to their work on the recent guideline; perhaps I and others got through to an extent, as some of those salient points were addressed in the detailed discussion section, though they failed to fully grasp what should have been the impact on their final guideline. Still, they at least tried and were well-intended (the road to hell ...).


    Quote:
    Originally Posted by JohnR41 View Post
    As we age, our colon-wall tends to become thinner and more fragile and susceptible to being perforated. Indeed, I knew of three elderly women in my community who had their colons perforated by colonoscopy testing. It was very life threatening and they had to be operated on to repair the damage.

    Also, there have been older people who died from a heart attack as a result of a colonoscopy procedure. I suppose that means having a stroke is also possible.
    John, it could be that you had an unskilled gastroenterologist practicing in your community; for you to know of three such patients suggests that. I am aware that colonoscopies are often not done after certain ages, depending on the patient, probably related to their life expectancies, their overall health and lifestyle, and the nature of colon cancer. Are you aware of research regarding these matters? I am not, except for the generally findings that strongly favor the value of assessing colon health, particularly with colonoscopies and sigmoidoscopies, and more recently with less invasive approaches such as Cologuard.

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    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 remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

    Last edited by IADT3since2000; 01-25-2020 at 10:28 AM. Reason: Added exclamation points and other emphasis. Added a couple more sentences.

     
    Reply With Quote
    Old 01-26-2020, 08:54 AM   #9
    JohnR41
    Senior Veteran
    (male)
     
    Join Date: Sep 2008
    Location: Florida, U.S.A.
    Posts: 2,455
    JohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    Hi Jim,

    I just checked with the CDC to see what their current recommendations are and it seems they follow the same recommendation as the Task Force. However, after reading the information, it doesn't seem all that bad to me because they don't say absolutely no testing after age 70. It's just that they should not be tested routinely because it's a complex and personal decision. It's something that should be discussed with their doctor because it depends on the patients overall health status.

    If they had more urologists and oncologists on the task force, it's likely they would call for routine testing up to age 80 or 85. And then they might say, "unless the patient's ill health makes it a poor choice." So you can see how it might go from one extreme to the other because of their personal bias.

    Of course, screening after age seventy might benefit many men. But what they're saying is it may also cause harm to many men. So depending on the individual, you need to weigh the potential benefit against the potential for harm.



    https://www.cdc.gov/cancer/prostate/basic_info/benefits-harms.htm


    As far as screening for colon cancer, I have a different outlook from that of most other people. But I don't recommend it for everyone because I believe it depends largely on a lifestyle that most people won't follow. My outlook is that you would have to do something to cause colon cancer. And in our culture people tend to do all the wrong things, and that's what contributes to the high rate of colon cancer in the U.S. Do all the right things and your risk of colon cancer will be so small that the risks associated with getting a colonoscopy will be greater.

     
    Reply With Quote
    Old 01-26-2020, 09:35 AM   #10
    DjinTonic
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Location: NC
    Posts: 177
    DjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    I'd like to point out that we're discussing a procedure with very real risks for folks with no risk factors (or age as a risk factor for complications) --a very legit topic.

    What about the phony argument of overtreatment to justify not screening for PCa with PSA? I'm not saying PCa overtreatment isn't an issue, but rather it's an illogical reason for limiting screening. As I've said before, you can't distinguish those G6 men who need treatment from those who can do AS without first identifying all men with G6 PCa. And in doing so, you automatically ensure early diagnose the appox. 15% of PCa with high-grade disease.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
    Reply With Quote
    Old 01-26-2020, 10:29 AM   #11
    JohnR41
    Senior Veteran
    (male)
     
    Join Date: Sep 2008
    Location: Florida, U.S.A.
    Posts: 2,455
    JohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    As far as I know, no one is denying screening. For example, if you get PSA testing regularly and your doctor stops ordering the test at age 70, you can ask him to continue the testing. I believe the last time I got tested was around age 75 or 76. After it stopped I was okay with it so I never said anything. But I'm sure if I were to ask for it, they would do it.

     
    Reply With Quote
    Old 01-26-2020, 01:09 PM   #12
    DjinTonic
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Location: NC
    Posts: 177
    DjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    Quote:
    Originally Posted by JohnR41 View Post
    As far as I know, no one is denying screening. For example, if you get PSA testing regularly and your doctor stops ordering the test at age 70, you can ask him to continue the testing. I believe the last time I got tested was around age 75 or 76. After it stopped I was okay with it so I never said anything. But I'm sure if I were to ask for it, they would do it.

    John, I agree that guys here would be the very last to argue against PSA screening. I am more concerned about the younger end-- whatever the stating age for PSA screening is, the the no harm in asking to start X years earlier. Men are generally not tested for familial mutations that increase PSA risk.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
    Reply With Quote
    Old 01-26-2020, 02:04 PM   #13
    IADT3since2000
    Senior Veteran
    (male)
     
    Join Date: Nov 2007
    Location: Annandale, VA, USA
    Posts: 2,389
    IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    A Major Flaw in the US Preventive Services Task Force Approach to PC Screening

    Hi John,

    At 10:54 am today you wrote in part:
    Quote:
    Originally Posted by JohnR41 View Post
    ... Of course, screening [for prostate cancer] after age seventy might benefit many men. But what they're saying is it may also cause harm to many men. So depending on the individual, you need to weigh the potential benefit against the potential for harm. ...
    The US Preventive Services Task Force view of potential "harm to many men" from PSA screening for prostate cancer is where previous Task Forces bungled the science and understanding of medicine so badly, likely leading to several thousand unnecessary deaths in the US because men with life-threatening disease did not get timely screening because of the USPSTF guidelines! One of them was nearly me, which is no doubt one of the reasons this makes me so angry.

    A critical factor the USPSTF in the past failed to understand was that Active Surveillance (AS) for "low-risk" cases, the cases where there is real risk that treatment is unnecessary, solves the potential risk of unnecessary harm. When you get right down to it, AS is an extension of the diagnostic/assessment process. The prior recommendation was produced by a voting panel that barely understood AS, in fact confusing it at least once with "watchful waiting", and failing to understand that it can prevent ove rtreatment and therefore unnecessary harm.

    Therefore, today, provided you are a patient who will not be panicked into unnecessary treatment for a mild case, AS prevents over treatment! The current USPSTF panel is considerably more savvy and does at least partially appreciate the key role of AS. They rightly state that AS is still under utilized, which leads to unnecessary harm for some patients, but they are also aware that the rate of use of AS is rapidly increasing and is now in fact used by a large proportion of appropriate patients.

    I am also mostly opposed to briefing men on "risks and benefits" of PSA screening. The problem is that most of us are too ignorant to assess the information given to us (at my first PSA test I thought 10 was the maximum score and had never heard of a DRE), and a second key problem is that the information provided, especially the number of screenings to save a life, has been highly misleading in the past, underestimating the value of screening by a lot! Frankly, I have been amazed how badly doctors and researchers bungled the science here, including an extremely unfortunate, premature and misleading pair of publications (on PLCO and the ERSPC) in 2009 on the revered New England Journal of Medicine. (That's when I realized that august publication was not exactly a bible.) I could give a whole lecture or course on this bungling, but I'll get down from my soapbox.

    That CDC phony graphic about 1 death being prevented for every 1,000 screenings is also out of date. (Shame on the CDC! ) It stems from the initial 2009 report on the ERSPC (the European trial). The rate plummeted with the first update with only two more years of follow-up, and decreased substantially again with a second update. Moreover, it does not address the fact that many patients who do not die suffer from metastatic disease, which would have been mostly prevented with timely screening and treatment; death isn't the only adverse impact of prostate cancer.

    Also, note that the CDC page totally omits mention of active surveillance. That is highly misleading to the average patient and shameful! Additionally, note the listing of harms. Yes, 1 of 5 (or even more than 1 in 5) surgery patients has a degree of urinary incontinence, but for many it is very mild and can be countered and not a "problem", which makes the phrase "loses bladder control", though true, highly misleading and daunting to the average patient. Likewise for their other statements on harms.

    As for patients 70 and older, if life expectancy is short, screening is probably unnecessary. But if not, and if the patient can appreciate the role of AS should he be diagnosed with a appropriate lower-risk case, then unnecessary harm will be avoided, leaving only benefit. Right?

    One more pet peeve: the CDC site you cite has this description of the USPSTF: "The U.S. Preventive Services Task Force (USPSTF) is an organization made up of doctors and disease experts who look at research on the best way to prevent diseases and make recommendations on how doctors can help patients avoid diseases or find them early." I have seen similar descriptions in many media articles, and these descriptions are, in a word, false! Many of the voting panel members ARE highly experienced primary care type doctors and health professionals, but the are NOT experts in prostate cancer, and likely not in many of the other diseases and conditions for which they make recommendations. Worse yet, some of them think they are such experts. It is crystal clear that many of these panel members have had a severely limited understanding of prostate cancer. These false descriptions of USPSTF expertise need to be debunked.

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    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 remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
    Reply With Quote
    Old 01-26-2020, 02:17 PM   #14
    IADT3since2000
    Senior Veteran
    (male)
     
    Join Date: Nov 2007
    Location: Annandale, VA, USA
    Posts: 2,389
    IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    Lifestyle, Risk of Colon Cancer, and Need for Screening

    Hi again John, I'm responding to your post of 10:54 today, 1/26:

    Quote:
    Originally Posted by JohnR41 View Post
    Hi Jim, ... As far as screening for colon cancer, I have a different outlook from that of most other people. But I don't recommend it for everyone because I believe it depends largely on a lifestyle that most people won't follow. My outlook is that you would have to do something to cause colon cancer. And in our culture people tend to do all the wrong things, and that's what contributes to the high rate of colon cancer in the U.S. Do all the right things and your risk of colon cancer will be so small that the risks associated with getting a colonoscopy will be greater.
    Do you have citations for research that backs up your belief that you can safely avoid colon cancer screening if you have a healthy lifestyle?

    You wrote earlier: "For those who eat a diet that's high in animal protein and low in fiber, which is what most Americans do, they should definitely be concerned. Others not so much."

    I was one of the "others" and have been since 2000, and somewhat before that. Since 2000 I have been on a high-fiber, Mediterranean diet with no red meat, limited poultry, very limited dairy, but a lot of seafood. Yet at least one and I think two of my previous colonoscopies found and removed "pre-cancerous polyps", in other words, the kind of tissue that develops, unchecked, into deadly colon cancer. I'm thinking I would probably now have colon cancer if I had not had those colonoscopies.

    You may know a lot more about colon cancer than I do. I really know the prostate cancer territory, but I pretty much follow my doctor's advice when it comes to preventing colon cancer.

    Jim

    Last edited by IADT3since2000; 01-26-2020 at 02:18 PM. Reason: Separated paragraph right after posting.

     
    Reply With Quote
    Old 01-27-2020, 09:28 AM   #15
    JohnR41
    Senior Veteran
    (male)
     
    Join Date: Sep 2008
    Location: Florida, U.S.A.
    Posts: 2,455
    JohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB UserJohnR41 HB User
    Re: When Does the Day After A Night of Severe Rectal Incontinence Feel So Good?

    Hi Jim,

    This is a reply to your "PC screening" post of Jan. 26. I found it difficult to follow your train of thought so I went online to find an explanation of Active Surveillance versus Watchful waiting. Now I understand.

    This is difficult for me because I tend to view these issues from a perspective of nutrition, just as I do with colon cancer. Of course, if you ask a urologist what the best approach is, he will answer from a medical perspective. He can be an expert in his field but that's as far as it goes. In my opinion, no urologist is going to venture into something else for which he has not been trained and licensed for. And most patients will be even less able to deal with it from a standpoint of their diet and lifestyle in general.

    As far as the Mediterranean diet goes, it's definitely better than the standard American diet. But that's not saying much when there are other diets that are far better. Dr. Dean Ornish was the first to do a study demonstrating the benefit of lifestyle changes on prostate cancer. Elderly men with high PSA readings, who didn't want any medical treatment, volunteered for the study. After a certain length of time on his regimen, all but one of them had significant reductions in their PSA test results.

    Right now what I'm wondering is if you have heard anything about the potential for prostate biopsies to spread cancer. Biopsies cause bleeding and cancer cells can bleed-out and spread into other areas of the body. This has been written about by a urologist whose name I don't have handy at this time. Just wondering if you've heard anything about it.

    About colon cancer: There are lots of studies, however, as far as I recall, none of them give a 100% guarantee. Just as one would expect from
    various medical approaches. There are no guarantees either way. However, I will review some of the literature I have to see what might be helpful to pass along. I do a lot of reading and can't recall all the various studies - there are so many. Some can be found online but are not always up-to-date.

    John

     
    Reply With Quote
    Reply Reply




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 08:49 AM.





    © 2020 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!