Wednesday, February 13, 2013

Latest Salvage Radiation News

A small, in-house study from the Graduate School of Medicine in Kyoto, Japan found multiple, independent risk factors for recurrence after salvage radiation (SRT). These were:

  • Gleason at or above 8
  • PSA nadir (low point) after SRT at or above 0.04 ng/ml
  • Negative surgical margins
They found that 77.8% of patients in their study with zero risk factors were free of PSA progression five years later.  50% of patients with one risk factor were progression-free, and only 6.7% of patients with two or three risk factors were progression-free at the 5 year mark. 

In my own case, I was okay on the Gleason and surgical margins, but I don't know my PSA nadir to that level of specificity. 

This was an interesting little study, but I trust Andrew Stephenson's much larger one a lot more.

Kyoto blossoms. Photo: jmurawski  Creative Commons license.

Friday, February 8, 2013

Attention must be paid

In my office I have a few pet trilobites, in the same way people used to keep pet rocks.
Trilobites were highly successful, as species go, and their timeline will dwarf that of our own in the geologic record. They scuttled about the ocean floors for over 270 million years.  Imagine the alien paleontologist of the future: "Humans--flashy but self-destructive. But these trilobites--wow!"
250 million years after the trilobites died out, I  was promoted into my current position. Before that, the incumbent was here for over a decade. In a few years, that manager will largely be forgotten, aside from an occasional visitor to the company's archive. Almost no one remembers the two (or was it three?) people who came before her. "Look upon my works, ye mighty, and despair!", the forgotten Ozymandias admonishes across the sands of time. What my predecessor thought of as their potential legacy--a training program--was eliminated in a brief email discussion that probably took all of two minutes' thought. Not even a pen stroke, just a tap of the Enter button.  "Look upon my--oops, okay, I'll just put my stuff in a box and go."
Last week, a friend of my father's, not even 70, dropped dead in a parking lot as she went to pick up her grandchild. Here one second, gone the next. As a genealogist, I know that the majority of people do not know the last names of their great-grandparents. Three generations, and poof!
Time, even on  the scale of one minor planet in the Milky Way, is vast, and our lives are short. Ars longa, vita brevis. Art is long, life is short, Hippocrates tells us. But even art is short, and quickly forgotten, compared to geological time. That's what my frozen little friends on the shelf remind me. "Look upon our works, ye mighty," trilobites proclaim, "and despair."
I may be a poor player strutting and fretting my hour on the stage, but the hour is mine before I am heard no more. Cancer refocuses priorities for a lot of patients. I feel that refocusing.
As Geddy Lee put it, we must get on with "the real relation, the underlying theme."

Friday, February 1, 2013

I'll have whatever he's having..