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Now that I'm over 70, I won't be having prostate surgery. Or surgery for anything else that won't likely kill me within a few years. Edit: If you would, in my

Now that I'm over 70, I won't be having prostate surgery. Or surgery for anything else that won't likely kill me within a few years. Edit: If you would, in my circumstances, please share why.

melling 7y ago
Fortunately, people are working on less invasive solutions for prostate cancer: https://news.ycombinator.com/item?id=21762242 https://news.ycombinator.com/item?id=21762242
- mirimir 7y ago
  Good stuff there. Thanks. I do get ~annual PSA tests. And if I tested positive, I'd have a biopsy. And if it was low-grade, I'd just get tested more often. And then there's this study, which I have taken to heart: "Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up".[0] > Patient summary: We evaluated whether ejaculation frequency throughout adulthood is related to prostate cancer risk in a large US-based study. We found that men reporting higher compared to lower ejaculatory frequency in adulthood were less likely to be subsequently diagnosed with prostate cancer. 0) https://sci-hub.se/https://doi.org/10.1016/j.eururo.2016.03.027 https://sci-hub.se/https://doi.org/10.1016/j.eururo.2016.03....
  - tonyedgecombe 7y ago
    I seem to remember there is also a strong association between the more deadly forms of prostate cancer and STD's.
    - mirimir 7y ago
      Yes, trichomoniasis.[0] From Medscape:[1] > Trichomoniasis is one of the most common STIs in the United States, with a prevalence estimated at 8 million cases annually; however, exact numbers are difficult to obtain because the infection is not nationally reportable and many infections are asymptomatic. ... Prevalence is also thought to be underestimated owing to the low sensitivity of the commonly used wet mount technique. Yet another reason for safe sex. Or no sex, which is safer. 0) https://www.webmd.com/sexual-conditions/guide/trichomoniasis https://www.webmd.com/sexual-conditions/guide/trichomoniasis 1) https://emedicine.medscape.com/article/230617-overview https://emedicine.medscape.com/article/230617-overview
    - mirimir 7y ago
      PS - Ejaculation != sex. Just sayin'.
thaumasiotes 7y ago
Hm, I just looked into this after my friend's father-in-law was found to have advanced prostate cancer. It is, in general, very slow acting. Current standards for treatment are based on how advanced the cancer is and what the patient's life expectancy would be in the absence of cancer. For a small cancer, because of the slow pace of the cancer, it's common to do nothing ("watchful waiting") or take androgen suppressants. For a cancer large enough to be viewed as threatening in the more short-to-middle term, you'd usually go for radiation therapy if you expect the patient to die within 10 years, and surgery if you expect the patient to last longer than that. The reason for the radiation-surgery divide is that the very unpleasant side effects of the radiation generally show up about 10 years after treatment. (Whereas the side effects of surgery show up immediately and, hopefully, get better over time.) The father-in-law in question is in his late 60s, but would be expected to live into his 80s if he were otherwise healthy. His father reached the age of 95. So I can understand why everyone recommended surgery in his case. No real bottom line here, but I hope this was helpful to someone.
- mirimir 7y ago
  Thanks, that's pretty much my perspective. Although I'd likely opt out of androgen suppressants. In my experience, life without testosterone was unpleasant. My arthritis was worse, and I was prone to tendonitis. I lost muscle mass, and got fatter. I became borderline diabetic. My acne got much worse. And I lost all interest in sex. Testosterone supplementation reversed all of that.
  - thaumasiotes 7y ago
    Yes, I am uncomfortable with androgen suppressants for the same reasons -- they have quite far-reaching effects, including some dramatic personality effects. However, doctors tend to view them as minimally invasive (which I agree with) and harmless (which I don't).
omgwtfbyobbq 7y ago
Besides being over 70, what other circumstances discourage you from having surgery? My grandmother had two EGDs and hip surgery after 90 with no long term deficits from them that we can see. She was even classified as frail at the time, although in retrospect I'm pretty sure that was incorrect. From what I've read it's a good idea to stay away from GA, but there's a lot that can be done with mild sedation and a spine block.
- mirimir 7y ago
  I don't trust surgeons, generally. As Maslow said: "I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail." I've never had surgery. I opted out of gall bladder removal, and changed my diet instead. And I haven't had further problems. So sure, if I get multiple opinions that I need surgery for something that'll kill me in a few years, I'l likely agree. But if I'm otherwise not happy with my situation and health, I might opt out.
  - omgwtfbyobbq 7y ago
    Anything effective besides surgery is generally a better bet. Based on my limited experience with surgeons, they go out of their way to confirm there really is a problem and that you really want to go through with the surgery. If they don't do that I would be wary about taking their opinion at face value, and like you said it's always a good idea to get multiple opinions. To be fair, I think everyone should have the same critical approach to any treatment and/or diagnosis, but it's especially important with higher risk treatments like surgery.

Now that I'm over 70, I won't be having prostate surgery. Or surgery for anything else that won't likely kill me within a few years. Edit: If you would, in my circumstances, please share why.

melling 7y ago

Fortunately, people are working on less invasive solutions for prostate cancer: https://news.ycombinator.com/item?id=21762242 https://news.ycombinator.com/item?id=21762242

mirimir 7y ago
Good stuff there. Thanks. I do get ~annual PSA tests. And if I tested positive, I'd have a biopsy. And if it was low-grade, I'd just get tested more often. And then there's this study, which I have taken to heart: "Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up".[0] > Patient summary: We evaluated whether ejaculation frequency throughout adulthood is related to prostate cancer risk in a large US-based study. We found that men reporting higher compared to lower ejaculatory frequency in adulthood were less likely to be subsequently diagnosed with prostate cancer. 0) https://sci-hub.se/https://doi.org/10.1016/j.eururo.2016.03.027 https://sci-hub.se/https://doi.org/10.1016/j.eururo.2016.03....
- tonyedgecombe 7y ago
  I seem to remember there is also a strong association between the more deadly forms of prostate cancer and STD's.
  - mirimir 7y ago
    Yes, trichomoniasis.[0] From Medscape:[1] > Trichomoniasis is one of the most common STIs in the United States, with a prevalence estimated at 8 million cases annually; however, exact numbers are difficult to obtain because the infection is not nationally reportable and many infections are asymptomatic. ... Prevalence is also thought to be underestimated owing to the low sensitivity of the commonly used wet mount technique. Yet another reason for safe sex. Or no sex, which is safer. 0) https://www.webmd.com/sexual-conditions/guide/trichomoniasis https://www.webmd.com/sexual-conditions/guide/trichomoniasis 1) https://emedicine.medscape.com/article/230617-overview https://emedicine.medscape.com/article/230617-overview
  - mirimir 7y ago
    PS - Ejaculation != sex. Just sayin'.

thaumasiotes 7y ago

Hm, I just looked into this after my friend's father-in-law was found to have advanced prostate cancer. It is, in general, very slow acting. Current standards for treatment are based on how advanced the cancer is and what the patient's life expectancy would be in the absence of cancer. For a small cancer, because of the slow pace of the cancer, it's common to do nothing ("watchful waiting") or take androgen suppressants. For a cancer large enough to be viewed as threatening in the more short-to-middle term, you'd usually go for radiation therapy if you expect the patient to die within 10 years, and surgery if you expect the patient to last longer than that. The reason for the radiation-surgery divide is that the very unpleasant side effects of the radiation generally show up about 10 years after treatment. (Whereas the side effects of surgery show up immediately and, hopefully, get better over time.) The father-in-law in question is in his late 60s, but would be expected to live into his 80s if he were otherwise healthy. His father reached the age of 95. So I can understand why everyone recommended surgery in his case. No real bottom line here, but I hope this was helpful to someone.

mirimir 7y ago
Thanks, that's pretty much my perspective. Although I'd likely opt out of androgen suppressants. In my experience, life without testosterone was unpleasant. My arthritis was worse, and I was prone to tendonitis. I lost muscle mass, and got fatter. I became borderline diabetic. My acne got much worse. And I lost all interest in sex. Testosterone supplementation reversed all of that.
- thaumasiotes 7y ago
  Yes, I am uncomfortable with androgen suppressants for the same reasons -- they have quite far-reaching effects, including some dramatic personality effects. However, doctors tend to view them as minimally invasive (which I agree with) and harmless (which I don't).

omgwtfbyobbq 7y ago

Besides being over 70, what other circumstances discourage you from having surgery? My grandmother had two EGDs and hip surgery after 90 with no long term deficits from them that we can see. She was even classified as frail at the time, although in retrospect I'm pretty sure that was incorrect. From what I've read it's a good idea to stay away from GA, but there's a lot that can be done with mild sedation and a spine block.

mirimir 7y ago
I don't trust surgeons, generally. As Maslow said: "I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail." I've never had surgery. I opted out of gall bladder removal, and changed my diet instead. And I haven't had further problems. So sure, if I get multiple opinions that I need surgery for something that'll kill me in a few years, I'l likely agree. But if I'm otherwise not happy with my situation and health, I might opt out.
- omgwtfbyobbq 7y ago
  Anything effective besides surgery is generally a better bet. Based on my limited experience with surgeons, they go out of their way to confirm there really is a problem and that you really want to go through with the surgery. If they don't do that I would be wary about taking their opinion at face value, and like you said it's always a good idea to get multiple opinions. To be fair, I think everyone should have the same critical approach to any treatment and/or diagnosis, but it's especially important with higher risk treatments like surgery.