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Posts Tagged ‘sexual function after prostate cancer surgery’

wit and wisdom picture

No. 123
Doctors, Pigs, and Incrementalism

incrementalism (noun): A policy or advocacy of a policy of political or social change by degrees: gradualism.
I was thinking about all of the intrusions into the lives and the profession of physicians by the government, insurance companies and hospitals and this joke came to mind. Most everything reminds me of a joke.
An insurance salesman is approaching a house that he intends to call on and notices in the side yard a three legged pig.
He knocks on the door, introduces himself and after talking about insurance for a while, asks the man of the house about the pig.
“So, tell me about that pig you have in your yard. Why does it only have three legs?”
“Oh that pig is very special. Our house caught on fire one night about a year ago and we were all asleep when it happened. That pig realized it and ran through the house oinking real loud to wake everybody up and get them out of the house. He saved the lives of my entire family. That’s one smart pig he is,” says man.
“So, he has only three legs. Did he lose one in the fire saving y’all?” the salesman asks.
“Nooooo,” the man says, “a pig that special you don’t eat all at one time.”

Rule: Yeah, us doctors are real special too. They ain’t gonna eat us either. At least, not all at one time.

Will Rogers said one time: “Be glad you ain’t getting all the government you pay for.”
If he were alive today he’s say: “Be glad you ain’t getting all the government health care you pay for.”

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That mean ole conniving PSA...he's worse than Mr. Prostate Cancer!

Things a doctor would not do….have a prostate cancer test

PSA is a “simple” blood test to check for prostate cancer. Know what it stands for? Prostate Specific Antigen. Or rather, as many doctors will tell you, Persistent Stress and Anxiety.

Prostate cancer is far more common – and, usually, less serious – than most people realise. In elderly men, it’s virtually a state of normality. Most of these prostate cancers lie dormant and harmless, and are something men die with, not of. So having a PSA may end up giving you information you would have been better off not knowing. That’s if you can trust the result: it’s notorious for inaccuracies, with false positives, false negatives and an inability to distinguish between harmless pussycat prostate cancers and the less common aggressive tigers.

Which is why, when men ask for the test, they’re potentially opening Pandora’s box. We try to guide them through the maze of ifs, buts and maybes. Sure, in theory it could save your life. But in practice it could well lead to worry, unpleasant biopsies and unnecessary, traumatic surgery.
Tony Copperfield, GP and author of Sick Notes

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If you are young and making career decisions you have got to do as my mother advised, ” Choose long-term gain over short-term gratification John.”

Eugene, Oregon Prostate Cancer Survivor Story

For about 15 or so years in late August I’d go out west to hike and fish with the fellows pictured above. The above picture is from the Golden Trout Wilderness in California but I want to tell you a bit our trip to Eugene, Oregon home of the Umpqua River and not far from Crater Lake.

I’m telling you these trips were something else. They have formed a very vital part of my life and who I am. Silly you say. In the picture above we are camped by the Kern River (Google the Merle Haggard song) and rode pack horses for 8 hrs to get there and did it on the side of a steep mountain all the way into the gorge to camp, hike and fish.Seven days of hiking and fishing miles of it alone. City slickers of sorts.  The guy above on the first row and holding what looks like a Red Solo Cup is the guy that planned the trips. We went everywhere and if you could pick the most beautiful places in the world and at the same time was known for fly-fishing…well that is where he’d have us go. But today my story is not about the Kern, but the Umpqua in Eugene. I’ll come back to the Kern another day.

This time our planner did not quite get the full picture of how our trip would be until we got there.  Yes the Umpqua was a renowned Steelhead river, and yes Zane Grey fished there and it is close to the most beautiful sightseeing  area in America,Crater Lake and also home to the Umpqua Fishing Lure Company and on the surface yet another perfect place to hike and fish. Hell it was on the other side of the continent from Gainesville, Ga. My son Clay immediately requested a Oregon Duck Hat. I ‘d never heard of that school and who would name a mascot a duck anyway.

Well we do the usual and fly into Eugene and then rent a van and then off to our trailhead along the Umpqua River. Our plan was like so many trips we’d done before, fish and hike and camp along the river for a week in the solitude we all had paid for both in money and the time and effort it took to be away from our families and jobs.

I remember passing a small drive-in type restaurant in Eugene (in which I bought a T-shirt for my sons that had a funny name making the shirt a favorite of theirs for years), the “Umpqua National Forrest” and the obligatory group picture there, The Steamboat Inn and then all the signs pointing the way to Crater Lake which was on the same road as the supposed “trailhead.”

Well…as we go along we see the river to our right and what one notices quite blatantly are wide areas for cars to park called ” turnouts.” People are parking along the river and then going down the bank to fish. Beautiful water, beautiful large rocks and beautiful holes, but all so “public.” As we drive along taking all this in someone asks, ” Where’s the trail going to be?” In other words how in the hell can we hike on this river in a section not easily accessed by everybody in cars. You see that was our deal, our manifesto, our modus operandi we go where they ain’t. We fish what ain’t fished, we fish where it is hard to get to and then we camp tens of miles from anyone and we get further away as the week progresses.

We see a forest service road that matches what we have on our itinerary and we all sigh a sigh of relief. Okay, this is looking familiar a dirt road and it is heading away from the highway and into green. After about 30 seconds we come to a bridge over the river and then the sign connoting the trail and parking area for hikers. We park. We get out and look around. To this day and as I write what comes mind is the sounds of cars. Swooshing cars going hither and dither back and forth over the sounds of the water of the Umpqua.

“Is this it?” we ask of our planner.

“I think so,” he says. “The trail looks a lot further from the river on the maps.”

We all look at the maps wishing we’d looked at the maps in Gainesville months before. Small dotted red lines along the Umpqua river and … a road on the other side of the river. The road we were just on and a major thoroughfare to one of the most visited attractions in Oregon, Crater Lake.

To be continued…..

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came to the desert for my ship to come in, no jacks or queens nor kings will make this losing hand win…i’m leaving las vegas

A bald patient of mine a few weeks ago told me, ” I don’t waste my testosterone on hair!” 

 

Do bald men face higher risk of prostate cancer?

Updated: May 22, 2012 3:01 PM EDT

 

© iStockphoto.com© iStockphoto.com

By Barbara Bronson Gray
HealthDay ReporterTUESDAY, May 22 (HealthDay News) — Got hair? If you don’t, you might have a higher risk of prostate cancer, a preliminary study suggests.Researchers are reporting that bald men who underwent biopsies of the prostate were more likely to have cancer than were those with more hair on their heads.

“Bald men should be aware that they may benefit from being screened earlier and perhaps, if necessary, from being biopsied sooner,” said study author Dr. Neil Fleshner, a professor of surgical urology at the University of Toronto. “In the study, the more bald people were, the more likely they were to have prostate cancer. We’re 95 percent sure this is real.”

However, not all doctors are ready to embrace the study’s conclusions.

The possible association between male pattern baldness and prostate cancer has been considered in previous studies.

Although the precise mechanism isn’t understood, researchers think male hormones known as androgens may play a role in both baldness and prostate cancer. Androgens, which include testosterone, can inhibit hair growth and trigger the development of prostate cells.

It’s thought that the androgen dihydrotestosterone (DHT) increases in bald men, causing the hair follicles to shrink gradually. As the follicles get smaller, the hair weakens and eventually stops growing. DHT also has been implicated in the development of prostate cancer.

The U.S. National Cancer Institute estimates there will be more than 240,000 new cases of prostate cancer this year. The prevalence of baldness increases with age, and it affects about 40 million men in the United States.

The research was scheduled for presentation at a news conference Tuesday at the American Urological Association annual meeting in Atlanta.

The study involved 214 patients aged 59 to 70 years old with elevated prostate-specific antigen test numbers (averaging 5.8). The men had all been referred for a prostate biopsy. Baldness was assessed on a four-point scale — just in the front, just a little on the top, moderate top and sides and severe top and sides — before the biopsy was taken.

The more severe a man’s balding pattern, the more strongly it was associated with a positive biopsy.

Men with a normal PSA were not included in the study, which found an association between baldness and prostate cancer risk, but did not prove a cause-and-effect relationship.

The researchers also sought to determine whether there is a relationship between the relative length of a man’s index and ring fingers and the diagnosis of prostate cancer, a question raised by previous studies. Some researchers have thought that the level of sex hormones in the womb could prenatally affect both finger length and predisposition to prostate cancer. No association was found in this study, however.

Dr. Nelson Stone, a clinical professor of urology and radiation oncology at Mount Sinai School of Medicine in New York City, questioned the potential value of the baldness study.

Stone said the researchers should have tested for hormone levels to see what association, if any, the amount of testosterone and DHT had on the diagnosis of prostate cancer.

“The incidence of baldness goes up with age, and we know that testosterone levels fall with age, and we still don’t know why,” he said.

Complicating the issue is also the question of whether the men with a positive biopsy had predominantly aggressive or nonaggressive forms of prostate cancer, Stone said.

Dr. Tobias Kohler, public liaison to the American Urological Association, said that, with or without hair on their heads, men can’t relax about prostate cancer.

“There is a link between baldness and prostate cancer, but it could be due to some other factor — perhaps something in the environment or something genetic, ” he said. “I would approach this study with caution.”

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

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Newt Gingrich and team at Orange Beach's Cobalt just beyond the Perdido Pass bridge and before the World Famous FloraBama lounge.

I grew up in LaGrange, Georgia which is on the Alabama-Georgia line. West Georgia, Troup County, I went to LaGrange High School, the same school as my mother went to in the late 1930’s.

If you follow the Chattahoochee River (I once spent about 12 hours on an inner tube floating the river from Carrollton to LaGrange. I did not get out of the river until after dark and my mother had the State Patrol out looking for me thinking I had drown or something.) upstream for about 25 miles from LaGrange you come to a community very similar to Lagrange, Carrollton. I used to go there for Key Club meetings in high school and for swim meets. Carrollton is home to West Georgia College.

One of West Georgia’s claim to fame, other than one year being elected one of the biggest party schools in the U.S., is that Newt Gingrich was once a professor there ,ran for congress twice and losing, then left because not obtaining tenure. When I was in college the rivalry between West Georgia, North Georgia College (where I attended) and LaGrange College in basketball was huge. Tickets for these games were hard to come by. Something I did that I am a bit ashamed of involved tickets for a game between LaGrange and West Georgia in 1974, which again is about the time he was a professor there at West Ga College. An old high school football friend induced me to buy fifty tickets for the LaGrange-West Georgia game and when I went to purchase them I was flagged as a scalper and told to report to the coach of the team, Coach Williamson. I knew the coach because he was over the LaGrange city pool for which my brother Cooper was the head life-guard and that previous summer I had worked at the city pool as well as a life-guard under my brother. I owed the job to Coach Williamson and so having to report to him for attempting to “scalp” ticket and as a student at LaGrange College that quarter was embarrassing but more importantly intimidating and at the same feeling very guilty and stupid for having been used and not knowing it.

“Who were you buying these for John?” the coach asked. See to him he knew from the get go that non students trying to make money on the game would use “stooges” ( that would be me-although unbeknownst to me) to buy tickets and then my friend would then sell them at a profit. I told him who had asked me to buy the tickets and it  seemed to me at the time that he already knew the answer. He asked me what I had planned to make and I truthfully said that I was not to make anything that I knew of. He told me to stay away from that guy,I apologized, and went on my way.

Anyway back to why I ended up back at LaGrange College for the fall of my sophomore year of college. For some reason I did not feel well the entire spring quarter in college. I believe I contracted a fungal type infection from spelunking in the old gold caves, tunnels and mines that were all and about Crown Mountain behind my dorm.(I had a CT scan of my lungs before my prostate surgery and I found that I have all these calcified lymph notes and granulomas of my lungs consistent with having been exposed to a fungal infection.)  I wa in a mountaineering society, The Order of Columbo, and I had all the stuff I needed to reppel into these pits and caves that had been created from blasting water into the side of the mountain to reveal and then claim the gold. Dahlonega is home of the first major Gold Rush in America and North Ga College is right at the spot, Crown Mountain, where a bunch of gold was found. Anyway when Fall quarter came around I decided to go to LaGrange College with the thought of returning to North Ga if I felt better.

My time in LaGrange during this time was odd. I was living in my grandmother’s home with my mother and little brother Jeff. I was enrolled at LaGrange College and was taking three courses: Organic Chemistry, English Literature and a Biology class. Now this Biology class was something else because the professor was a little twerp of a man who had all of these rules, unrelated to knowing the lesson, that he demanded of the students. Well, I did not like the guy and I was determined to make an A without playing along with all the games of this character. If I was called to the chalk board or called upon in class I pretended I did not know the answer. I ignored him for the three months I was in his class. I had an A in both Organic Chemistry and English but an 89 in Biology. When there was any subjective opportunity to influence my grade, this immature (almost as immature as me, I know what you are thinking) Ph.D. gave me a lower grade. It all came down to the last requirement for the course which was to give a lecture on a subject approved by the teacher. All I needed was a 90 and I’d have an A for the class. The reason the A was so important is that I needed A’s to get in medical school and at the time that was the sole purpose of my life. So I prepare for the lecture and make a point to memorize the whole thing and also learned several graphs and tables that I was able to draw on the board to complement my discussion. I killed it. Other students in the class were amazed at my performance. Now you feel that I am writing this is a bit self-severing to my memory, but almost the entire class came up to me afterwards and told me I should go into teaching, that my talk was excellent. It was by far the best presentation of the class, there is no debate about this and the reason it was is that I made a point for it to be. Well what do you think the grade I got for my lecture? You guessed it, an 89! I was furious and went immediately to the dip-shit of a professor and made it clear that I knew exactly what he’d done.

“You know that my speech was the best by far in the class and you also know that it deserved an A. And that I should get an A for this class,” I said really restraining myself particularly since he was a tiny little man and bespectacled.

“You made a B on the final lecture and that gives you an 89 for the course. I am sorry. Maybe this will teach you to play by the rules and to understand that this is my class and I ultimately have the final say on grades,” he said with a smirk.

I said nothing. I made the most disgusting face, one that relayed my sentiments that he was a nothing of a person and that using his little position of power to push around a student trying to get into medical school was pitiful. (This was almost 40 years ago. Can you tell that I am still a bit peeved by it? As similar situation occurred with a urologic attending 15 years later and it was not until about a few years ago that I have gotten over my problem with, as my mother would say to me, “male authority figures.”

While I was at LaGrange College I got in a fight in front of Roses parking lot one morning at 1 am and as a result had a knife pulled on me and out of reflex hit the guy and his friend then him me on the head with a crow bar and after running the two guys off and taking their knife and crow bar realized I was bleeding. I was taken to the emergency room at West Ga. Medical Center and had 17 stitches put in my head. I was actually proud of myself. The friend and the two girls that were with me thought I was some sort of bad ass of sorts. I did not even feel the crow bar to head and I had knocked the guy with the knife about ten feet. The problem was that the local paper , “The LaGrange Daily Misprint” as my mother would say, printed on the front page “Man Beaten.” And the man was me! I thought to myself how in the hell am I going to get in medical school now. I was ruined…I thought. More on this story later…I have a very long version that I may link to, but for now I want this post out because the Alabama and Mississippi primaries are today and I hope things get shook up a bit by Gingrich resurrection and I want to have mentioned that possibility before it happens.

Literally about on fourth of a mile up from where we saw Mr. Ginrich is where my family rented a house each summer on Orange Beach. My brother Rushton played music at the FloraBama which is a bar on the beach that is on the Florida Alabama line and this is about a mile from where we saw Newt. One mile in the other direction is where our Orange Beach condo is and where we made the decision to go to Cobalt where Newt was instead of where we usually go Calypso Joe’s on Cotton Bayou.

Now about Newt. While we were waiting to be served, we sat at a table that was only about fifteen feet from him and his entourage. You see I am a political person. I see politics in everything and I am a student of politics. I love history and have read or listened to probably fifty books on biographies of famous people particularly military or political persuasion. I just finished the Napoleon Russian campaign of 1812 and before that the entire audiobook of the “The Rise and Fall of the Third Reich.” It was fascinating to me, the secret service types that I saw surrounding him and the one I met at the bar. The one at the bar had some sort of flesh-colored plastic thing coming out from the sleeve of his suit-a gun of some sort maybe? A local sheriff was sitting with him. The was a very young pretty girl at his table who we figured was the daughter of the mayor or other local official who was sitting to his immediate right.

Newt is a bit overweight and the way he sat was Churchillian in that he was hunkered over his meal lifting a big glass of iced tea. At a separate table near by were the young guys, one in a bow tie, who I figured were recently graduated college political science degrees and looking to gain experience and potentially a job with any Gingrich success. With time almost all the folks sitting at the table got up and began milling about and Newt took a call on his cell phone that lasted about fifteen minutes.

His demeanor was interesting as well. It was not a flamboyant or hail hearty and well met type  out-going personality that you’d assume a politician would have. He had a look of a mixture of very heady contemplation of his political strategy or prospects versus just being tired. He had on a black suit and had placed his jacket on the back of his chair. The majority of the men in the group wore about the same thing and most had taken their jacket off and placed it on the chair as well.

Obama and Hillary had a tough campaign and now she's Sec of State. Newt for Sec of State?

People began to mill about our table to see him or take a picture. As if he were an animal in a zoo, he stayed seated facing the water and talking on the phone oblivious to the folks trying to see him. When he got up and put his phone in his pocket he grasped his jacket and another man appeared to help he put it on and he was brushed away. As in a planned unison all of his staff at seeing him rise formed a channel of people interspersed with the secret service types.

“Mr. Gingrich I’d like you to me Mr. (You make it up) he is the owner of Cobalt.”

And then from that point until he was near his bus, Mr. Gingrich had his picture taken with anyone who wanted one. It was done however with absolutely no enthusiasm. It truly was ho-hum but pleasant maybe just tired I don’t know. It was odd he sort of just moped along between pictures with a well-worn picture smile until he got to the Newt 2012 bus.

We then heard sirens and then saw the bus disappear over the Perdido Pass Bridge. So he was gone. The waitress that served the group came along and took away the tableware. I looked at the spot where he’d been and wondered how it is that it was interesting to observe Gingrich all the while understanding that people in general don’t trust or like politicians but yet people get so excited in participating in “their guy’s” campaign.

Anyway I thought to myself that what if he wins Alabama and Mississippi and somehow he has his third resurrection in this year’s GOP nomination process. The true conservatives don’t buy into Romney, Santorium is a bit too conservative and has scarred some away with his Church and State comments, and there’s old Newt. He is overweight, he is sometimes negative, he has baggage from the past, but all agree that he’s the smartest candidate and the best to debate Obama. What if it goes to the convention and Gingrich is the nominee?

“When was the last time we had an overweight president John?” asked my wife as I pontificated last night after seeing the only somewhat famous person I’d ever seen. (I saw George Bush senior at a distance when he stopped on train during his last campaign in Gainesville.)

“Let’s see,” I thought. “It would have had to been before Calvin Coolidge and that would have been the early 1920’s.”

You know Churchill was not a good-looking or fit man. But he was the right man with a bunch of experience at the right time in the history for England. When did it change that the leader of a country have to look good. Putin of Russia is always shown with his shirt off or doing something athletic. Is that a prerequisite?

Presidential elections always favor the incumbant.

So why is Gingrich still in it? Why did Hillary stay in it when she was doomed to fail?

Delegates in exchange for a high level Cabinet position anyone?

I probably bored you however the connection between LaGrange, Carrollton, and Orange Beach and a sprinkling of Gingrich was too much to pass up.

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two ways to handle when someone does you wrong...either forgive and move on (like nothing happened) or forgive and move on (leave)

The patients I see with prostate cancer and who are considering their options have done a whole bunch of research “before” they have seen me and then even more after they have been given the diagnosis. It is hard to imagine that after that research and particularly after speaking to other patients who have been through the process, that they would not know the risks and percentages of the various side effects. Could they be angry? Distrustful of surgeons as biased? I thought the urologist here made a pretty good point and that is that as more and more patients travel to have “the robot” the long-term relationship so valuable between the doctor and patient somewhat erodes and this might explain the “abandoned” remark.

I am sorry…but in the end it the patients job to do due diligence about his care…I don’t completely buy that in this day and time with the internet, availability of a second opinion and all the friends that have been treated for prostate cancer…that a patient goes into a procedure “hoodwinked” and aware of side effects.

Selective hearing, enamoured with the robot or protons, looking for a scapegoat? No I don’t buy it…but it does make for a pretty good NPR story…you kinda want to hear something bad about those money hungry surgeons from time to time.

Were you pushed into a particular treatment? Comment about it.

NPR discussion about the side effects of prostate cancer treatment.

CONAN: You wrote about one of them, Paul Nelson(ph) of New Canaan,
Connecticut. Tell us about him.

PARKER-POPE: You’ll have to remind me: Is he the wine – he’s, no, tell me
about Paul Nelson.

CONAN: He was – learned he had prostate cancer at the age of 46 and opted for
robotic prostotectomy – I don’t know if I’m pronouncing that correctly – with a
famous New York surgeon who played down the worries of erectile dysfunction.

PARKER-POPE: Yeah, I’m sorry. I’ve talked to so many men about this since the
story. I just – there’s so many that have stories to tell. And what’s
interesting about Paul Nelson is that he – you know, he sat down with a doctor,
a very respected surgeon, who gave him very promising statistics: 98 percent of
men do fine after surgery.

And he went in and had surgery, and he wasn’t fine. He had erectile function
problems after surgery, as the majority of men will have, and when he tried to
talk to his surgeon about it, you know, the response was: Well, you must just
have something. You know, it’s an anxiety issue. You’ve got your own set of
problems. And he was kind of abandoned by this surgeon.

He decided to start, you know, basically a support group for men to talk
about these issues because, as he discovered, that most men – there were more
men like him than those that the doctor was talking about, that 98 percent
success rate – which when you really get behind the numbers, what you learn is
that that’s a very specific, select group of patients under a very sort of
specific set of circumstances.

And while that is real – those are real data, those aren’t data that apply to
the average man who’s diagnosed with prostate cancer.

CONAN: Well, we want to hear from those of you who have undergone treatment
for prostate cancer, and talk about what your life has been afterwards. Give us
a call, 800-989-8255. Email us, talk@npr.org. But first, we’ll talk with Dr.
Jason Engel, director of urologic robotic surgery at George Washington
University Hospital here in Washington. And he joins us here in Studio 3A. Nice
to have you with us today.

Dr. JASON ENGEL: Nice to be here.

CONAN: And you’re a prostate cancer surgeon. What do you tell your patients?

ENGEL: I’m almost ashamed to say I’m a prostate cancer surgeon after that. It
sounds like I’m one of the bad guys. But I do agree with Tara in the sense that
those interactions with the surgeon and the patient, they’re very different –
it’s a different interaction based on each – different situation.

My approach, I think, has been different than probably many of the patients
that have called Tara and told them her story, in the sense that the recent
article in JAMA that came out, that outlined some of the outcomes and woke
people up as to the reality after prostate cancer treatments in general, are
things that I have been telling my patients for years, really.

CONAN: So this is not really news, what was in JAMA.

ENGEL: It’s not really news to the majority of urologists. And I would say
that we have to really differentiate between the urologist that takes the
approach of saying, I’m going to be the one following you later, I’m going to be
the one helping you later and looking you in the face later and helping you
through this time; from places, maybe larger centers, that have a different
model, where patients are going to travel to them, not necessarily see them
again. And the patient also is looking for a different thing from that surgeon.
They’re expecting better outcomes, in a large part.

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"Do not look where you fell, but where you slipped." - African Proverb

  • No symptoms…does it matter?
  • Low PSA…does it mean no cancer?
  • Big prostate…means cancer?
  • Small prostate means no cancer?
  • Surgery better than radiation?
  • Proton better than regular “ole” radiation?
  • Age over 75-is surgery best?
  • Do you have a higher incidence of impotence with cryosurgery?
  • Why do they only do Proton on the well-mod prostate cancer in terms of the “favorability” of prostate cancer?
  • High PSA means prostate cancer?
  • You have a biopsy of your prostate cancer because of a high PSA…and it is negative…was the biopsy unnecessary?
  • Can you die of prostate cancer?
  • Can you have it before the age of 50?
  • Are all urologists the same?
  • Are all surgeons the same?
  • Will surgeons only recommend surgery?
  • What is the Gleason’s score?
  • If the guy at your church had seeds for his cancer is that the best treatment for you?
  • Are all prostate biopsies that have cancer the same?
  • Are all prostate cancers the same?
  • Does everyone that has surgery become impotent?
  • Does everyone that has radiation preserve their potency?
  • What is HIFU?
  • What is NanoKnife?
  • If you have trouble voiding does that mean you have prostate cancer?
  • When do you think the male should begin having PSAs and rectal exams?
  • Is prostate cancer hereditary?
  • Do blacks have prostate cancer more or less often than others?\
  • Does Avodart cause cancer of the prostate?
  • Can a dog smell prostate cancer in a man’s urine?
  • What is a Free PSA? How can you use it in the treatment decision-making?
  • If your friend had a particular treatment and did well, if you have the same treatment by the same doctor does that mean you will do well?
  • Is it smart to have anything other than prostate removal for prostate cancer if you are 50 or so and in good health? Hint: Think years at risk.
  • Why is years at risk, your physiologic age important in your decision?
  • What is the Partin table?
  • If there is cancer in your lymph nodes can you be cured with radiation or surgery?
  • What is the Prostatic Acid Phosphatase and how can it help you and your doctor?
  • If your Free PSA is very high indicating that you have a low likelihood of prostate cancer..does that mean you won’t have prostate cancer on biopsy?
  • Why do men get infections after a prostate biopsy?
  • What is the difference in a “autopsy evaluation of the prostate” and “twelve cores taken at the time of a prostate biopsy?”

Do you have others? I am tired for now but have probably hundred others that I will add from time to time. Comment won’t you? Mr. Cass…I bet you have a few to add.

From my book, “What was thought to be a simple disease of old men becomes after diagnosis  a potentially lethal disease with a very difficult treatment decision scenario for the newly diagnosed prostate cancer patient to consider.”

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