Posts Tagged ‘american urological association’


It is much more likely that there is only disease going on at a time.

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I pictured you walking backwards and that you were coming back home...I pictured you walking away from me and hoping you were not leaving me alone...

I pictured you walking backwards and that you were coming back home…I pictured you walking away from me and hoping you were not leaving me alone…

Chapter Two-A dog shows up at the lake
John and Karen had two other dogs, Oscar and Tootsie, both of whom they loved dearly, but there was an emptiness around their home without Meg. The couple felt her memory and presence everywhere in and about the house. The couch, the trampoline, the backyard, the bedroom, the children’s rooms, the porch, and years and years of pictures with members of the family framed throughout the house, served as a constant reminder of Meg. The two remaining dogs were dachshunds; Oscar was the grouchy father, and Tootsie, a high maintenance daughter. The female dachshund next door had been Oscar’s wife and Tootsie’s mother. It had been an “arranged” marriage.

“I miss having a big dog around here John,” Karen said.

“I miss having a dog that likes being in water,” John replied. He thought, “Dachshunds are like cats, they do not like water and don’t swim.”

John and Karen had a small piece of property on the lake near their home. They rarely spent the night at the small cabin on the site, but very much enjoyed going there for “day trips” and always got home before the time the street lights came on.

John and Meg could easily consume a Saturday at the lake with cutting grass, fishing, and working in their small garden there. They often visited the big box stores for stuff needed for whatever they would be doing that day. Meg loved riding in John’s truck, ambling around the property, and dipping into the lake for a swim from time to time as John worked.

“John, what on earth do you and Meg do all day out there?” Karen often asked.

John and Meg looked at Karen in unison and agreed that Karen just did not “get it.”
“Well Karen, Meg and me don’t have nothing to do out there, we got all day to do it, and we may not get but half of it done,” John answered. He wasn’t sharing any of their secrets.

With Meg gone there was a void on Saturdays, not only at home for the couple, but also for John at the lake. John attempted to make the dachshunds his “lake dogs,” but they did not like water and just made a mess out of his Saturdays. Oscar hated it at the lake preferring the warm and known confines of their home and being a lovable grouch on his turf. Tootsie loved riding in the truck to the lake and she loved to cuddle in the warmth of John’s jacket during the ride however, Tootsie was always doing something meddlesome. She explored to the extent that John spent the majority of his time looking for her or keeping Tootsie out of trouble.
On one occasion John lost Tootsie for about two hours though it seemed like an eternity. During the time she was missing, he frantically searched the shore of the lake, the cabin, and the surrounding area. He envisioned Karen chastising him for not “taking better care of Tootsie.” All of his worst fears as to her safety ran through his mind only to find her on top of the boat dock. Tootsie had no problem climbing the steps to the top of the deck, but once there, she would not come back down. He found her accidentally because he saw the silhouette of her small head on the horizon of the dock flooring. His fear of finding the more worrisome silhouette of her body floating in water hence relinquished, John commenced to chastise her under his breath. (Tootsie’s head is small for her body. John’s head is small and Karen often made fun of him for it. John’s mother said her first memory of John as a baby was that he could, “cover his whole face with his hand.” On his high school football team in LaGrange, Georgia, he wore the smallest helmet. It was a size 6 and 7/8, and was specially ordered for him. Karen told John, when she perceived he was gaining weight, “John, you need to be careful about gaining too much weight or you’ll start looking like Tootsie. Your head won’t match your body.”)
On another fateful day at the lake, Tootsie chased a mouse or some other rodent under the cabin, which had only a six-inch crawl space, and it took several hours to determine where she was. Once found, she would not come out and there was no obvious way to get to her or to get her out. Complicating the situation and intensifying the anxiety for John, it was not clear if Tootsie was trapped or just would not come out. Exasperated and about to give up, John found a neighbor with a skill saw to cut a hole in the cabin’s kitchen floor to “rescue” her. The sawed out square of flooring replaced the hole in a patch-like fashion serving as a constant reminder of that day’s three-hour ordeal to free Tootsie from the confines of the cabin crawlspace.
“Karen, I am not taking Tootsie out to the lake anymore. She is a good truck dog and likes to ride, but she is way too much trouble for me out there. I can’t get anything done with her. She gets into stuff. “Dachshunds have a Napoleon complex and that’s her problem,” John thought. He, however, did take her again. It would be a mistake to do so, and it would be the last trip to the lake for Tootsie.
The “last” time Tootsie went to the lake with John, she played the “Napoleon role” that only a foot-long dachshund can do with the great dane puppy which lived next door. She barked and taunted the dog until it grabbed her like a pillow, shook her, and then threw her about thirty feet. All of this transpired in a matter of seconds right in front of John to his amazement and chagrin while he was raking leaves and listening to a Georgia football game. Tootsie’s run in with the great dane resulted in a trip to the vet, a V-neck T-shirt soaked with Tootsie’s blood, ten holes in Tootsie’s abdomen (but no damage to her intestine), two hours of surgery in which John assisted the vet, fifty stitches, and another ruined Saturday at the lake. No Tootsie was not to be another Meg and she would not be going to the lake anymore, period. To make matters worse, on the day Tootsie came home from the hospital, John was holding her in his arms, and was about to give her cheek a kiss when she snapped up and bit him on the tip of his nose. He dropped her to the floor out of shock and a bit of anger, only to find her running to Karen. Karen now became the “good-guy” and Tootsie’s savior in this unprovoked attack, which further aggravated John. Karen then laughed uncontrollably at the situation and particularly at John clutching his nose. John’s nose was now bleeding profusely and when he checked it out in the mirror there was an inch long scratch which was deep and devoid of skin. The area subsequently scabbed over and for two weeks was a painful and visual reminder of the little ungrateful troublemaker that was Tootsie.
“Dr. McHugh, what happened to your nose?” John was asked a thousand times over the ensuing weeks.
“My dog bit me,” he answered. Having to respond to that question in light of the history of the event was “salt on the wound” to John. He did, however, forgive Tootsie.

Several months later after blowing leaves at the lake, John alone and without a lake dog, was resting on an old spring swing left at the lake by the original owner of the property Jessie Jewell. He saw a small puppy walking up the gravel driveway. The lake property is at the end of a road that has a cul de sac. His first thought was that someone had dropped off the dog and left it. As the puppy approached her gait and color made John think that the visitor was a golden retriever puppy and probably one of a neighbor’s dogs. She walked nonchalantly to where he was sitting and sat down right next to him. It was as if she was already his dog and that what she was doing now was what she was accustomed to doing naturally and often.

“Well, what’s your name, cutie pie?” John asked somewhat taken aback by the level of the “make yourself right at home” nature of this stranger.

The dog’s tail began wagging as it looked up at John contentedly. John confirmed that the dog was a female, and as best he could tell, she was a thoroughbred. He figured that someone was probably missing her pretty bad about now. She had no collar. It was unknown to John at the time that this was a foreboding sign. He picked her up, held her in his lap with her belly up, legs open and apart, and began to rub her. To John, a dog that will let you rub its belly is an “at peace” dog and a prerequisite characteristic of one you’d want to have. Oscar would not let you do that, but Tootsie would. This dog was as laid back as you please to be on her back and be rubbed, particularly behind her ears.

“I think I’ll keep you my little friend. Do you like the water?”

When John and the new dog arrived home that evening, he said as he entered the house, “Karen, guess what showed up at the lake today?”

Karen immediately said, “She’s pretty. Look at her tongue; it’s got a black spot on it. That means she has chow in her.”

“You don’t know that Karen. A black spot on the tongue? Are you kidding?”

“It means she has Chow in her. I bet she is a Golden-Chow.”
Karen was right about the puppy having Chow in her as evidenced by the way her bushy tail always was curled up over her back. None of the neighbors near the lake cabin reported losing a dog and so the family adopted the golden retriever looking puppy with the bushy tail and black spotted tongue as their own.

Bess, their middle child who was in sixth grade at the time, named the new pet Chloe. The new dog was the same color as Meg and since Meg was named after the spice, nutmeg, Bess wanted to name her after another brownish colored spice. She thought chloe was a spice as well. That chloe was not a spice was something that John and Karen did not note, but would not have corrected it even if they had noticed the error. John, a poor speller, the next day went to PetSmart to make a tag for her collar, but spelled her name “Clohe” much to the sarcastic delight of his family who never let him forget that he spelled her name incorrectly. Named for a spice that wasn’t, and having to wear a tag with the wrong name on it may have very well been a glimpse into Chloe’s unpredictable future.
The couple and their family fell instantly in love with the gentle intruder. As John’s mother would say, “One man’s loss is another one’s gain.”
The “gift” and the coming saga that was Chloe then commenced; the extent and complexity of which was unknown to John or Karen at the time. Chloe on the other hand, knew exactly what was to come and the role she’d play in the lives of John, Karen, their family, and more importantly, other lives.

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life is what happens while you're making other plans...j lennon


I have had an ongoing dialogue with a radiation therapist friend  of mine about ” what is the most aggressive therapy for prostate cancer?” What would you say? To me the most aggressive thing would be to  remove the prostate. In the diagram above, from “The Decision”, shows that if the prostate cancer is only in the gland and you remove the gland then you have removed all the cancer. If you do radiation of any type or cryosurgery, or  nanoknife, or hifu or whatever, there is the chance that whatever “energy” used it might not kill all the cancer. So to me, removal is the most aggressive thing to do. Am I missing something here?

“John, you are shooting an  arrow and the  moving the target to suit your preconceived outcome?” I have yet to understand that argument. I mean  it’s a great little saying, I just don’t think it applies to this.

Now to the article below….seems that they think that surgery  is the most aggressive form of therapy and that it works better than other modalities for aggressive prostate cancer. I make this point in the book. You need to know your cancer and then decide what you  feel is the  most aggressive form of therapy and if it applies to your disease.

Why is this important? Because if you feel  you  have an unfavorable cancer, i.e. high volume and high Gleason’s score, then you need to have in  your mind which treatment is the most aggressive. My radiotherapist friend actually  told me that combination  radiation was the most  aggressive. I don’t buy it.

What his point is that in the bad parameter cancers, the disease is most probably into the capsule of the prostate and that all the pain and suffering of surgery may not be of any benefit, i.e. the patient will  need post op radiation anyway. The  report below however finds that patients do better with  surgery first even if  further treatments become necessary.( The PSA rises after the prostate is removed.) From a purely common sense thinking, at least surgery will assure that all the cancer in the gland will be gone, albiet at the price of surgery and its attendant potential  complications. That is another “decision” point and one we  have to  make.

So….put that in your quiver or  pipe to shoot or  smoke  and use it to help formulate what is best for you. Not this article alone, or  my thoughts  alone,but what do you think.   You must decide for you what you feel is the most aggressive form of therapy and then decide if that is what you need for your cancer. If you have a very favorable cancer then you can go with active surveillance or one of the ” energy treatments.”  See my Decision Worksheet and the points that follow for assistance and understanding here.

One size does not fit all. Balancing cure with risks. Arrows in your quiver. Don’t be a one-dimensional prostate cancer patient. Don’t kill a fly with a shot gun…and bla bla bla blah……

Surgery For Aggressive Prostate Cancer Gives 92% 10-year Survival Rate

28 Sep 2010

Patients with the most aggressive form of prostate cancer who have surgery – radical prostatectomy – were found to have a 10-year cancer-specific survival rate of 92%, which is high, and a 77% overall survival rate, according to researchers from the Fox Chase Cancer Center and the Mayo Clinic, USA. This compares to an 88% 10-year cancer specific survival rate and 52% overall survival rate for those who underwent radiotherapy without surgery. The findings were presented at the American Urological Association’s 84th Annual Meeting, Chicago.

Stephen Boorjian, M.D., a urologist at the Mayo Clinic, said:

It’s long been believed that patients with aggressive prostate cancer are not candidates for surgery. We found that surgery does provide excellent long-term cancer control for this type of prostate cancer. In addition, by allowing the targeted use of secondary therapies such as androgen deprivation, surgery offers the opportunity to avoid or at least delay the potentially adverse health consequences of these treatments.

Their study included 1,847 individuals with aggressive prostate cancer. Between 1988 and 2004 1,238 of them underwent a surgical procedure to have their prostate taken out (radical prostatectomy) at the Mayo Clinic, while 609 received radiotherapy at the Fox Chase Cancer Center. 344 of the patients who received radiotherapy were also given androgen deprivation therapy.

The investigators worked out their overall and cancer-specific survival rates:

Patients who underwent surgery had a 92% cancer-specific survival rate, as did those who received radiotherapy plus androgen deprivation therapy (hormone therapy)

77% of those who had surgery had a 77% overall survival rate

Those who received radiotherapy plus hormone therapy had an overall survival rate of 67%

Patients who had just received radiation therapy (radiotherapy) had an overall survival rate of just 52%

Dr. Boorjian said:

Patients with radiation and hormone therapy were 50 percent more likely to die than patients who had surgery. This was true even after controlling for patient age, comorbidities and features of the tumors. These results suggest that use of hormone therapy in patients who received radiation therapy may have had adverse health consequences.

We want to stress that surgery provides excellent long-term control for high-risk prostate cancer patients. Limiting the need for hormones may avoid adverse health consequences. Further studies evaluating the differing impacts of treatments on quality of life and non-cancer mortality are necessary before we can determine the best approach for patients with aggressive prostate cancer.

What is prostate cancer?

Prostate cancer only affects men. Cancer begins to develop in the prostate – a gland in a man’s reproductive system. The word “prostate” comes from Medieval Latin prostate and Medieval French prostate. The ancient Greek word prostates means “one standing in front”, from proistanai meaning “set before”. The prostate is so called because of where it is – at the base of the bladder.

The prostate is an exocrine gland of the male reproductive system, and exists directly under the bladder, in front of the rectum. An exocrine gland is one whose secretions end up outside the body e.g. prostate gland and sweat glands. It is approximately the size of a walnut.

The urethra – a tube that goes from the bladder to the end of the penis and carries urine and semen out of the body – goes through the prostate.

There are thousands of very small glands in the prostate – they all produce a fluid that forms part of the semen. This fluid also protects and nourishes the sperm. When a male has an orgasm the seminal-vesicles secrete a milky liquid in which the semen travels. The liquid is produced in the prostate gland, while the sperm is kept and produced in the testicles. When a male climaxes (has an orgasm) contractions force the prostate to secrete this fluid into the urethra and leave the body through the penis.

The epithelial cells in the prostate gland produce a protein called PSA (prostate-specific antigen). The PSA helps keep the semen in its liquid state. Some of the PSA escapes into the bloodstream. We can measure a man’s PSA levels by checking his blood. If a man’s levels of PSA are high, it might be an indication of either prostate cancer or some kind of prostate condition.

It is a myth to think that a high blood-PSA level is harmful to you – it is not. High blood PSA levels are however an indication that something may be wrong in the prostate.

Male hormones affect the growth of the prostate, and also how much PSA the prostate produces. Medications aimed at altering male hormone levels may affect PSA blood levels. If male hormones are low during a male’s growth and during his adulthood, his prostate gland will not grow to full size.

In some older men the prostate may continue to grow, especially the part that is around the urethra. This can make it more difficult for the man to pass urine as the growing prostate gland may be causing the urethra to collapse. When the prostate gland becomes too big in this way, the condition is called Benign Prostatic Hyperplasia (BPH). BPH is not cancer, but must be treated.

In the vast majority of cases, the prostate cancer starts in the gland cells – this is called adenocarcinoma.

In the majority of cases, prostate cancer is a very slow progressing disease. In fact, many men die of old age, without ever knowing they had prostate cancer – it is only when an autopsy is done that doctors know it was there. Several studies have indicated that perhaps about 80% of all men in their eighties had prostate cancer when they died, but nobody knew, not even the doctor.

Prostate cancer can, however, be aggressive and progress much more rapidly.

Click here to read about prostate cancer in more detail.

Source: Mayo Clinic

Written by Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today


Article URL: http://www.medicalnewstoday.com/articles/202732.php

Main News Category: Prostate / Prostate Cancer

Also Appears In: Cancer / Oncology, Urology / Nephrology,


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Pepe the prostate


Interview with Mr. PSA- Part Two 

Dr. McHugh: “Welcome back. I am with Mr. PSA and his pseudonym Pepe the prostate. How are you tonight and again thanks for being here with us to shed some light on the dilemma that is PSA and prostate cancer.” 

Mr. PSA: “Thank you, again it is good to be here. There has been a lot of misguided press since I was here just 24 hours ago. I think my thoughts and insight into this issue will be helpful.” 

Dr. McHugh: “This logo of yours. What is that about?  It looks like a child did it. Some sort of Zeus character? Are those lightning bolts coming from your head? I’m sorry. Is this really sending the message you want to get out there?” 

Mr. PSA:  “Okay, the lightning bolts are the seminal vesicles. They represent my ears. The little things that look like legs are the vas deferens, and the shoes are well… they are testicles. Clever huh? I am very pleased with my logo. You have to be somewhat into prostate cancer and the prostate to get it. The fact that you did not get it speaks volumes about you and your inadequacy to do this interview. Just kidding, kinda. Now what else do you have for me?” 

Dr. McHugh: “I am a urologist my friend. I get it. I am talking about the public. The guy that has been recently diagnosed with prostate cancer. Are you over his head with your little interpretation of a prostate? And anyway, what is the prostate cancer connection?” 

Mr. PSA: “You remember Pepe le Pew don’t you. The romantic skunk with a French voice and high libido? The prostate  has testosterone in it, it converts testosterone. That’s how proscar works. Anyway it all ties in, it puts a face on the PSA so that folks will be more sensitive about putting me down.” 

Dr. McHugh: “What are your ,thoughts on the AUA response to the ACS remarks about you? You align yourself politically more with the AUA than with the ACS don’t you? Is that a fair statement?” 

Mr. PSA: “Of course I lean more toward the AUA, this is an organization that represents practicing urologists, the guys out in the field actually doing the day to day work in prostate cancer. What I found interesting about their response was that they said in one paragraph that they appreciated and supported (not agreed) the ACS statement, then in the next made the point that proceeding to a biopsy was a multifactorial process that included the patient, me, my density as it applies to the size of the prostate, my free value,the age of the patient, the health of the patient, the change over time of me and on and on. What came to mind is your book, “The Decision,” you address the relevant factors that go into making the “decision.” Its a complicated situation. 

Dr. McHugh: “Thanks for plug. I personally have been a big fan of yours and I feel that everybody needs to remember, hey, “don’t just throw the baby out with the bath water.” I think you are still relevant. I really do.”  You mentioned that one of the factors mentioned by the AUA was a free PSA. Have you gone generic? What is the free about?” 

To be continued….

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