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Is everyone really different?

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Posted 4/29/2010 4:52 PM (GMT 0)
I have been reading for weeks. I keep seeing the same thing repeated, "everyone's different." Just the idea grates with me. To me saying everyones experience with cancer is different, is the same as saying, "we just don't know how to determine why some are effected differently than others."

I'm an electronics engineer and I guess I'm just spoiled in knowing the simple rule set associated with this trade. Lots of equipment from lots of places makes troubleshooting difficult due to documentation. But the rules are simple and there are few exceptions. The old engineering joke goes, I should have become a doctor. Only two models of equipment to learn. :P

I can certainly contemplate the overwhelming amount of statistical data that would be required in order to learn what effects some people and not other people, and why. DNA must play a part in this as well.

So now I read the following from this story. I want my prostate back... http://www.msnbc.msn.com/id/35874966/ns/health-mens_health//

As it turns out, prostate cancer is "heterogeneous," as the panel's report puts it. That is, one man's prostate cancer differs from another's. Some prostate cancer is aggressive, spreads rapidly, and will kill you. But screening tends to pick up the more slow-growing cancers. They can stop growing. You can live with them for years, symptom-free. Some may even regress on their own, says one theory.

Ok great, now we have a name to associate with our ignorance. It's "heterogeneous"...

Take care, Jim

 

Posted 4/29/2010 5:18 PM (GMT 0)
The fact that prostate cancer is a heterogeneous disease is well established.

Not only is one man's cancer different from another, it also differs within the individual man himself.

That's why Gleason is not a simple number, but a combination of the two most common types seen:

"The predominant pattern and the second most common pattern are given grades from 1-5. The sum of these 2 grades is referred to as the Gleason score. Scoring based on the 2 most common patterns is an attempt to factor in the considerable heterogeneity within cases of prostate cancer."
Prostate Cancer - Biology, Diagnosis, Pathology, Staging, and Natural History
http://emedicine.medscape.com/article/458011-overview

"The success of Gleason grading system is due to the following reasons:
* It takes into account tumor heterogeneity by identifying primary and secondary patterns..."
Bostwick Labs, https://www.bostwicklaboratories.com/global/physicians/medical-library/articles/gleason-grading.aspx
Posted 4/29/2010 5:41 PM (GMT 0)

Jim - maybe this will help-> Take the blueprints from the last 10 story building you worked on and use it to build five 2 story buildings. Let us know if you run into anything different idea

Well, that might not have been a very good example for an electronics engineer, but I bet you get the picture.

Posted 4/29/2010 6:34 PM (GMT 0)
I can give you an example within cousins. My cousin (on my mother's side) had the davinci surgery six months before I did. Mine was more agressive than his, so I had the open surgery. I was leaking for very few weeks after the catheter was removed. He had leaking issues for 18 months.

Same thing with the ED, I healed faster than he did. But he is five years younger than I am, almost same weight, height, body frame, etc. We both grew up on farms and work in Information Technology. I don't think there is anything common about Prostate Cancer between men or the healing process.
Posted 4/29/2010 6:45 PM (GMT 0)
And it is difficult to see shades of grey when you are so use to looking for only black and white.

Michael

Posted 4/29/2010 7:00 PM (GMT 0)
In addition to differences in the cancer itself, it seems to me there are profound differences in how people deal with pain, anxiety, uncertainty, side effects, etc. Many docs are better at dealing with "scientific" differences (different psa, different Gleason score, etc.) than wtih the "human" differences.
Posted 4/29/2010 7:06 PM (GMT 0)
Sorry Steve, but it doesn't help. My point is I believe there are enough resources to figure this out. (what do you have and how will it effect you) But the complexity prevents it from getting done. Plus there is no financial motivation for understanding, just treating. So who's going do it? Not me. It takes me 45 minutes to read a three page paper because every 4th word requires a google search for the definition to even follow along. Just call me anserine...
Posted 4/29/2010 9:29 PM (GMT 0)
Jim,

Everyone is different is of course a gross simplification of a complex answer.

Probably 70-80 % of men respond favorably to their treatment of choice and never look back. While they may be different, their results are very undifferent.

For those who choose surgery, 50 to 60 % are continent, and an similar number regain sexual function. Those 50 to 60 % are similar in many ways.

The other Tx's have realtively high success rates. Even tho each man is different in terms of PSA, biopsy results, and Gleason scores, etc, the protocol for each TX is pretty much the same.

So my take is, we really aren't all that different for the most part.

Now take many of the guys on this forum, and and you may find some big differences. Many are on here because they have problems with their TX side effects, their cancer staging, failed TX, etc. It is important to remember for me that many are in a minority from the run of the mill prosate cases that were diagnosed, treated, and now live a fairly normal life.

Good luck Jim. Once the shock effect wears off, you may see that we relly aren't all that different. Just one model to deal with, but a few million revisions.
Posted 4/29/2010 11:33 PM (GMT 0)

Jim is sick said...
Sorry Steve, but it doesn't help. My point is I believe there are enough resources to figure this out. (what do you have and how will it effect you) But the complexity prevents it from getting done. Plus there is no financial motivation for understanding, just treating. So who's going do it? Not me. It takes me 45 minutes to read a three page paper because every 4th word requires a google search for the definition to even follow along. Just call me anserine...

Jim, did you read the book yet?

Posted 4/30/2010 12:14 AM (GMT 0)
A diseases and ailments and cancers are different. Each person's medical history is different. You can go as far as DNA and other genetic difference, family history, etc. I don't see that as a negative thing. Now when you factor in that PCa is a fickled and ornery cancer to start with, unlike some cancers which are more predictable to treatment and outcomes.

Your frustration is well understood and I definitely empathize with you. But you are not going to ever come to terms with your cancer and situation using logic and the building blocks you know as an engineer, no more than I can apply business logic and accounting fundementals in my trade to reconcile my dealings with my cancer.

Denial is bad. Acceptence at face value is best, and adapt to the exact situation that you face personally. I would have never dreamed at the time of my PC dx, that almost 18 months after surgery, I would be on my 16th catheter, dealing with a never ending stricture problem complicated by salvage radiation that I never believed I would need, and definitely would have told you back then that I would never consent to radiation again. But reality is reality, and I adapated.

My radiation oncologist (a woman) told me how men fight mentally having cancer much worse than women as a general rule, because men want to be in control, and men want to put everything to the test of logic. That's why some guys get obsessed with life changes, strategies, diets, supplements, anything - to have some kind of control over their situation.

David in SC
Posted 4/30/2010 10:59 PM (GMT 0)
32 cores....bet ya had to pack a lunch!
Started my PSA / BHP journey and biopsy's with a urologist who" didn't do" the Novocain or numbing agent.....Once I hit PSA 4.0 he wanted me do do a biopsy every six months.

74 years old / PSA 6.7 Gleason 3+4=7 / 2 of 12 cores at 30% and 70%. DiVinci at Henry Ford 2/10/2010. Margins, lymph nodes clear along with various other components. Nerves spared and gave up on the pads last week with an occasional sneeze drip (man those male pads feel like pillows). Doing 25 MG / viagra / nightly and things are looking up. Five week PSA was undetectable.
Posted 5/1/2010 12:45 AM (GMT 0)
I think we are in the "every snowflake is unique" discussion. Each is made of water by a freezing process. So why are they not identical?

I am also an engineer by training, but to apply logic to PCa in general will only drive you to insanity. We certainly apply logic to developing cures, but to the disease?

Post Edited (142) : 5/1/2010 7:41:19 AM (GMT-6)

Posted 5/1/2010 1:24 PM (GMT 0)
Just remember- each of us are special and unique, just like everyone else... smilewinkgrin
Posted 5/1/2010 3:18 PM (GMT 0)
yes we are all different: age, medical history, general health, genes, lifestyles, height, weight, fitness, attitude etc and we're like that before we get diagnosed with cancer, so it's no wonder that the cancer and what happens to it and with it will be different too, but sometimes the differences will be small and sometimes large.
Alf
Posted 5/1/2010 5:59 PM (GMT 0)
Jim,
I'm with you. I figure everything out based upon measurable data. I expected with all the data collected from all the patients in the world, there should be a best approach and an equation I can use to determine the highest probablilty of success.
But to quote my wife: "Physiology isn't Physics."
Darn it.
Jeff
Posted 5/2/2010 12:01 PM (GMT 0)
Differences:
Lets not forget the providers as these days DiVinci nerve sparing robotic prostatectomies are available in just about every major metropolitan area. Then one has to consider the qualifications of the surgeons and how many procedures they have performed. Same would apply to radiologists... How experienced are they and what is their performance record? How many botched procedures have they performed. I feel for those guys who have gone through one of the procedures only to have the big C return.

74 years old - DiVinci 2/10/10 - No pads now. So far life after is good.
Posted 5/3/2010 8:24 PM (GMT 0)
Perg... Dude you are an amazing man. I could never handle what you are going through. I look up to you in that regard. I probably am still in denial... As far as handling this... I think I am probably the worst person here. I here you on the control thing, but in life I'm not a control freak. I'm actually a pretty laid back guy.

Heavy... I have not read the book yet. I haven't even cracked it. I read very slowly and I have been putting it off.

Good Life... "Just one model to deal with, but a few million revisions." lol good one! :)
Posted 5/3/2010 11:08 PM (GMT 0)

Jim is sick said...
Perg... Dude you are an amazing man. I could never handle what you are going through. I look up to you in that regard. I probably am still in denial... As far as handling this... I think I am probably the worst person here. I here you on the control thing, but in life I'm not a control freak. I'm actually a pretty laid back guy.

Heavy... I have not read the book yet. I haven't even cracked it. I read very slowly and I have been putting it off.

Good Life... "Just one model to deal with, but a few million revisions." lol good one! :)

Jim,

 

I asked you if you have read the book because I think that reading this book & Dr. Walsh's can help you to be more comfortable with your situation.  I believe you said that you are an engineer.  As a professional, you should be able to appreciate the knowledge  some of the statistics in the book can give you.  I think you are concentrating on all of the inconsistencies in the disease rather than absorborbing the info & coming up with a plan of action that can give you some control over your treatment.  None of us have had it easy in fighting this disease.  I went through 4 years of tests before my cancer was diagnosed even though my PSA kept rising, eventually reaching 18.  I still have some pretty serious incontinence problems but I am very lucky compared to some of the guys here.  In addition, this disease has been a wakeup call as far as my general health goes.  I've lost 35 lbs & am exercising regularly.  After being sick I decided that I want to be healthy & I am going to do everything I can to be healthy.  It's pretty likely that you will be lucky also.  Try to get control of your emotions & let that scientific mind of yours lead you in your battle.

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