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  • Treatment Options for an Insufferable Horndog

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    Old 10-01-2020, 04:33 AM   #16
    Insanus
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    Re: Treatment Options for an Insufferable Horndog

    The no side effects claim for AS is not entirely accurate. There can be anxiety over if they made the correct decision and knowing they are walking around with untreated cancer.

     
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    Old 10-04-2020, 12:22 PM   #17
    IADT3since2000
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    Re: Treatment Options for an Insufferable Horndog

    Hi again Smasher. Insanus recently wrote the following:

    Quote:
    Originally Posted by Insanus View Post
    The no side effects claim for AS is not entirely accurate. There can be anxiety over if they made the correct decision and knowing they are walking around with untreated cancer.
    Evidence established by medical research has demonstrated that the degree of anxiety, which was substantial in the early 2000s when AS was just emerging, is now, nearly twenty years and a mountain of research later, low. Sure there is some anxiety, but I suspect it is lower than the anxiety and possible "treatment regret" a man who was eligible for AS with with a low-risk case, feels as he bears the side effects of surgery after deciding against AS.

    It is so important for patients with low-risk cases to understand that the degree of danger from prostate cancer ranges from the "danger" from a case of dandruff to the danger from pancreatic cancer, as the renowned medical oncologist, now retired, Dr. Charles "Snuffy" Myers, MD, used to put it. No one would agree to be scalped to deal with a case of dandruff, but the equivalent is what some men are doing who choose surgery for a mild case where active surveillance is appropriate.

    Yes, low-risk prostate cancer is still cancer. But some experts have argued that we really need to call it something else to take away the word that scares Insanus, and others. Take 20%, one out of five, of patients in Dr. Laurence Klotz's very large group of patients on AS: as of several years ago, their cancer doubling time was OVER A CENTURY!. Think about that: if those patients had a prostate cancer at diagnosis the size of a pin head, in a century it would have grown to the size of two pin heads - no threat at all. For the rest, the 80%, there were shorter doubling times, but still long enough to give a lot of confidence in the approach. Dr. Klotz has stated that many patients in the Toronto group feel a sense of delight, sort of like beating the system, beating the odds, and I suspect that delighted group is a lot larger than any group that feels more anxiety than delight.

    Moreover, in the case of prostate cancer that is truly limited to Gleason score 6 or lower, the chance of metastasis is vanishingly small, according to what is now a convincing body of research. That fact is coupled with the reality that good doctors are now able to do a much better job of reducing odds that a higher grade cancer has been missed, with the "surveillance" part of "active surveillance" taking care of the rest. (That said, AS needs to be diligent and active. Faking it with an assumption that an initial good start will put you on a reliable automatic pilot for a continued good outcome won't hack it and is dangerous.)

    .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 and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) 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.

     
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    Old 10-04-2020, 01:55 PM   #18
    Southsider170
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    Re: Treatment Options for an Insufferable Horndog

    Quote:
    Originally Posted by Insanus View Post
    The no side effects claim for AS is not entirely accurate. There can be anxiety over if they made the correct decision and knowing they are walking around with untreated cancer.

    Men can also have anxiety with treatment as well- "did they get it all, was treatment necessary, etc."

    Anxiety is more of a universal possibility, not just something with AS patients.

     
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    Old 10-09-2020, 06:00 AM   #19
    redbelly7
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    Re: Treatment Options for an Insufferable Horndog

    If I had to do over, I'd go for radiation only. I had prostectomy after turp. Complete inctoninence, plus since in seminal vesicles, had radiation and Lupron. at 57, and hot wife, I should have chosen a diff path. Plus all surgeries and radiation has caused lymphatic issues. Working on that now. Good luck to you!

     
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    SmasherOfAjumma (10-09-2020)
    Old 10-09-2020, 06:03 AM   #20
    Sw1218
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    Re: Treatment Options for an Insufferable Horndog

    Quote:
    Originally Posted by Insanus View Post
    ... and knowing they are walking around with untreated cancer.
    Not to be disrespectful, but that would only be because they weren't properly educated on the true benefits of AS.
    __________________

    D.O.B. | 12/18/1973
    02.28.2019 | Dx 45
    Elev. PSA | 11.9
    GS | 4+3 = 7
    Treatment | HDR Brachytherapy & 6 mths of Casodex 50mg

     
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    Old 10-15-2020, 10:11 AM   #21
    GuyBMeredith
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    Re: Treatment Options for an Insufferable Horndog

    Comments from a 75 year old horn dog to a junior member of the club: do some research. You can see my stats in the signature. The options I was given were AS, surgery and IMRT with ADT or IMRT alone.

    With surgery for early localized PCa, there is immediate impotence and incontinence for most men. Depending on age, health and how the surgery goes many/most men may recover over time. With IMRT impotence and some urinary issues "might" develop over three or more years. Supposedly ADT would add to possibility of impotence.

    For early treatment, there is no proven difference in success between surgery and IMRT.

    MRI showed my cancer in an area that precluded nerve sparing surgery and I preferred to worry about impotence and incontinence being a "maybe" in the future so opted for IMRT with the dreaded ADT.

    I have been and am sexually fully functional through the entire treatment and expect to continue to be so until I am too old and ugly to attract women. I have gained at least 5 years sexual function over what I could expect with surgery. I just starting to recover from the effects of lupron so am still (hopefully temporarily) chemically castrate. Castrate sex is an interesting experience that I could easily live with. Ladies might find it interesting, too.

    Keep in mind, though, that every man is different and you need to make sure your urologist and others tell you what you as a unique individual at your age and health condition can expect as an outcome for each option. Doctors will tend to generalize so push them to keep it specific to you.
    __________________
    Diagnosed at age 73 Feb 2019 DRE indicates nodule PSA 2.8 Aug 2019 PSA 3.1 Urologist suggests biopsy in Oct Results of biopsy: 2 of 12 cores positive. Low volume T2b, intermediate risk, GS 3+4, PSA 3.10, prostate cancer, perineural invasion. Followed up with MRI to help decide between surgery and IMRT. MRI shows suspicious PIRADS 5 lesion measuring 2.cm in diameter, with associated left neurovascular bundle involvement. Started 6 month lupron series Feb 2020, 28 sessions of high dose IMRT Apr 15, 2020. Sexual functions okay except ejaculate has changed. Without libido it is an academic process that requires much focus. July 27 first measure of PSA and total testosterone. PSA: .13 ng/dl Total testosterone is less than 12 ng/dl.

     
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    SmasherOfAjumma (10-15-2020)
    Old 10-15-2020, 11:20 AM   #22
    DjinTonic
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    Re: Treatment Options for an Insufferable Horndog

    I fail to see how the OP is a candidate for AS according to the entry criteria of the programs at any of the major institutions. Of course, that doesn't mean one can't do AS with one's uro, but I, for one, would not suggest it.

    Opting for AS when there is the likelihood of needing treatment in the future means you are playing the odds: a small chance of lifetime avoidance of treatment and a larger chance of missing the advantages that earlier treatment and treatment at a younger age afford.

    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, negative 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
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.013 (2 yr. 10 mo.)

     
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    SmasherOfAjumma (10-15-2020)
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