'Penile Rehabilitation' After Cryo Surgery - Not Like After Radiation

In a blog post five years ago I cited the work of cancer specialist Dr. John P. Mulhall, and the need for "penile rehabilitation" in prostate cancer patients who've undergone surgery or radiation, e.g.

http://brane-space.blogspot.com/2012/10/penile-rehabilitiation-what-most-docs.html

Mulhall is the author of an academic monograph entitled: "Sexual Function in the Prostate Cancer Patient,"  and also wrote a less technical book for actual prostate cancer patients and their significant others, entitled: "Saving Your Sex Life: A Guide for Men with Prostate Cancer".  In this book, Dr. Mulhall takes the 'bull by the horns' and shows that men who've had prostate cancer treatments - whether radical prostatectomy, radiation or hormone therapy, actually face immense work to overcome the attendant sexual problems.

The incipient damage is called "atrophy" which increases in probability the longer a patient goes without erection,  post-surgery. (p. 98) Atrophy is, in fact (op. cit..):

"a scarring of the erectile tissue, and if the erectile tissue scars, the patient will never get his own erection back and will always struggle with medication".

Dr. Mulhall goes on to note (ibid.) that "the incidence of erectile tissue damage, as measured by the presence of venous leak is very uncommon before the fourth month after surgery. However, at eight months after surgery it "occurs in about 30% of men and at one year 50% of men".  This also occurs or can occur after high dose radiation which I had in September, 2012.

Radiation attacks the DNA in cells. It causes breakages in the DNA, and when this occurs, the cells commit suicide, a process known as apoptosis. Normal cells have better repair machinery to fix some radiation damage while cancer cells do not.  As well as killing off the actual prostate cancer cells, radiation causes injury "to the blood vessels that supply the cancer."

As Mulhall notes later, these blood vessels- many of them - also supply blood to the erectile tissues. Most shocking to me was to read that erectile success rates are the same for surgery and radiation after 24 months, and while radiation oncologists tend to look at sexual function after 12 months or so, Mulhall indicates it needs to be 3-5 YEARS after (p. 83) . He refers to this as a "glaring deficiency" (ibid.) and adds:

"Any study looking at erectile function outcomes should really assess these outcomes at no sooner than 24 months, if not 36 months, after the completion of radiation."

So, bottom line, I knew going into focal cryosurgery salvage treatment (treatment after initial radiation) the chances were not good to recoup erectile success. What I wasn't prepared for after the cryo is that this would plummet even more than after the high dose radiation (5 year mark). Of course, you are informed that though the targeted cryo can eliminate the localized tumor there is no assurance that adjacent nerve networks can't be damaged. This is because, unlike the tumor, these nerves branch out and aren't so localized.  The risk is also much greater for older patients, i.e. over 65 (I am 71).

On Monday I returned to UC Health in Aurora for the follow up appointment (after the procedure done on June 20th). This was with Dr. Crawford's professional assistant, Kristen -  a 26- year old woman and Columbia University grad. She had me fill out a "sexual and urinary function" form and then went over it with me afterward. The form covered about 15 aspects, i.e. urinary frequency, urgency, erectile quality, maintenance etc. - each on a 0 to 5 scale.  

I also, since I reported urinary frequency beyond the norm, had to submit to a bladder ultra sound in the office, performed by a medical assistant. Kristen noted that if the urinary retention was too high in the bladder (over 100 ml, after urinating) I might have to have a bladder dilation performed. Naturally then, I was relieved the retention volume was barely 30 ml.

In terms of the sexual -erectile aspect, and interestingly connected to the urinary issues as well, Kristen pointed out that both could be improved by taking 5 mg of Viagra or Cialis each day. As also noted by an American Cancer Society website., this is not enough to produce erections but it is sufficient to keep some blood flow going to those tissues which otherwise would receive little or no oxygen.  Thus, she sent in a prescription for our pharmacy.

The ACS site in relating similar information, points out that - typically - erectile quality, if it is to return at all, usually happens after two years. It takes the nerves roughly that long to heal, so we see that cryosurgery, like radical prostatectomy - is not exactly without its issues (including some incontinence).  In the meantime, it is important to be doing the low dose PDE inhibitor .  Recall the chemical pathways here: the cavernous nerves close to the prostate gland secrete nitric oxide which stimulates release of an enzyme (cyclic GMP) inside the smooth muscle cells, which promotes relaxation of smooth muscles and erection. An enzyme known as PDE5 prevents this, since else there may be a prolonged erection. Hence, a PDE5 inhibitor works to suppress secretion the PDE5 enzyme.

In terms of orgasms, Kristen pointed out that these were still possible even without erections.  As noted on a UCLA website:

"An erection is not necessary for orgasm or ejaculation. Even if a man cannot have an erection or can only get or keep a partial erection, with the right sexual stimulation you can experience an orgasm. Your orgasm has little to do with your prostate gland. As long as you have normal skin sensation, you can have an orgasm."

As far as "supplementary aids", Kristen did mention possibly using special vibrators which "we could discuss at a later date", which was fine with me.

The session lasted about an hour, including the ultrasound, and the takeaway I came away with was that I was certain most men didn't have clue one what they were sacrificing when they opted to have prostate cancer treatments of any kind.  It also helped me understand the many thousands of men who refused to have any treatments, opting to do "watchful waiting" instead. (Alas, as Dr. Crawford had told me in our November meeting, that wasn't an option for me given the Prolaris score)

The tragedy is that this cancer can wreak so much havoc especially on younger males, some in their early 40s, who've reported serious marital problems, e.g. on the 'Team Inspire' group.   Once you're in your 70s this isn't so much of an issue, but still you don't want to see certain organs just waste away....so you kind of do whatever the dr. (or his P.A.) suggests.

My primary hope is that the physical (also mental - see my post on memory loss) sacrifices are worth it and this is the final end of this damned cancer. Kristen said I need to get a first PSA test done early next week and then another in three months. I hope that all future PSA test results are as close to 0.0 as possible!

When I jokingly told Kristen: "No more biopsies!"  She laughed and said "We'll see."

So I have "Aggressive Prostate Cancer" -- What Exactly Does That Mean?

Sample report for the Prolaris genetic test .

First, let's clear the air.

Why do I blog about my prostate  cancer and the assorted tests,  treatments? Well, let's start with the fact this is the second leading cancer killer of men, up to 30,000 a year. But that often takes no account at all of the hell many men endure in terms of the tests (like biopsies) as well as treatments - often described as more savage than the disease.  One can scan and google but unless one is actually a member of a prostate cancer survivor group (as I am) he or she will have scant idea of the pain and suffering aroused by this disease, including in spouses.

Thus, the point here is not anything to do with some narcissistic disease obsession but rather getting information out about how one might very well have to deal with this cancer - especially after recurrence. (More men than you think, in fact, kill themselves after undergoing treatment then having the cancer recur - on being plunged into deep depression).

The other aspect is to show not all cancer narratives are of the saccharine form, e.g.:  'I beat the cancer and it never came back! NO, that's a tall tale, one often peddled by a sappy PR-based media and lackeys that don't know any better, or have an agenda to avoid any negativity. But, they avoid mentioning that in nearly 1 of 3 instances prostate cancer returns, even for those who have radical prostatectomy.

Six days ago, the local urologist's office  phoned to tell me the result of the Prolaris genetic test (of tissue extracted at my MRI fusion biopsy) was that the prostate adenocarcinoma was aggressive. To fix ideas, the sample shown on the image above yields a score of 3.0 and is in the "less aggressive" region.  This in concert with other  clinical-pathologic values enabled an estimate for a 10-year prostate cancer-specific mortality risk. This patient then has a 10-year prostate cancer specific mortality risk of 2%..

My score by comparison was 6.6, corresponding with a 12.5 % specific risk of mortality at ten years. That translates to a 1 in 8  probability of croaking from it if I decided to do nothing. While this sounds like a fair risk to take for many, it would be roughly analogous to walking through a South Side Chicago neighborhood at 3 a.m. and expecting to get back home in one piece. In other words, a no go. In addition, it leaves out all the nasty side effects you'd have to deal with if the cancer breaks out of the capsule (metastasis)  which it is now on the verge of doing given the "perineural invasion" cited in my recent post on the MRI fusion biopsy result, e.g.

http://brane-space.blogspot.com/2016/09/biopsy-result-shows-writing-on-wall.html

It is via the nerve pathways by which the cancer escapes, gets into the bones (bone mets) as well as lungs, etc. The PET scan image below shows bone mets even in the spine. Each met is in reality a locus of prostate cancer.



The question for the medical assistant who phoned was: What is the risk of metastasis?  She gave me the five year risk of metastasis as 39.5% or nearly 2 in 5.  Again, if I chose to do nothing.

Since then, with further research, including gleaning insights from a prostate cancer survivors' group called Team Inspire, I have opted to do a salvage treatment known as focal cryotherapy. This will entail a 150 point 3D staged biopsy. Then that will be used as a guide to freeze the specific tumor regions in the gland. It is described as an "outpatient treatment" but done under general anesthesia, see e.g.

https://www.youtube.com/watch?v=-OnqA-mJDWg

The plan is to have it done at the University of Colorado Anschutz Center, with focal cryotherapy  specialist Dr. E. David Crawford, e.g.

http://www.edavidcrawford.com/targeted-prostate-cancer-treatment

A phone consult with Dr. Crawford's medical assistant, after seeing the MRI fusion biopsy and Prolaris reports, indicated I had the leeway to wait into until the new year to get it done.  This meant not having to contend with any side effects, etc. during the holidays. In addition, Janice six days ago experienced a mini-stroke (TIA or transient ischemic attack) so that means she must also get much better before we can move forward . I suspect all the tension with Trump and this election played no small role in her attack.

Anyway, I will need to have a preliminary meeting with Dr. Crawford in November, at the Aurora UC center, then we will discuss when to have the biopsy and  the treatment.  The latter, I am informed, is usually done at least two months later to allow enough healing time after 150 sticks through the perineum.

By now most everyone has also seen or read of actor Ben Stiller's bout with prostate cancer, e.g.

http://www.cnn.com/2016/10/04/health/ben-stiller-prostate-cancer/


But what they may have ignored is how the treatments and testing can often be worse than anything else - especially if one has a slow growing cancer. The risks of further tests, treatments include sexual impotence and incontinence  The latter means wearing diapers - as in Depends - permanently. This is also why Otis Brawley of the American Cancer Society, has warned that most men need to be very careful before stepping through that testing and treatment door.  Nine times out of ten the cancer will be so slowly growing that you can do 'watchful waiting' - especially for Gleason scores of 6 or less.

Once you go further - based on the PSA test-  be prepared for the biopsy which doesn't always treat a lot of men very well, not only the pain but possible sepsis, or other complications (e.g. incontinence). And if you decide to act on the biopsy results, be prepared for having to decide which treatment is best for you, realizing whichever you choose is a crap shot. As one member of Team Inspire put it (perhaps a tad hyberbolically):: "If there's even one cancer cell left it can grow back."

Well, if there is tissue left at the margins after a surgery, it certainly can!

See also:

https://www.youtube.com/watch?v=HDGAQdHid1c


And:

http://brane-space.blogspot.com/2012/09/thge-longest-dayand-then-some.html

And:

http://brane-space.blogspot.com/2012/10/is-there-sex-after-prostate-cancer.html

And:

http://brane-space.blogspot.com/2012/10/penile-rehabilitiation-what-most-docs.html

What I Got Wrong About My MRI Fusion Biopsy

MRI scan (not mine) with possible hot spots, lesions as it would be used in an MRI fusion biopsy.

As I wrote in my post from July 1, after noting the basis for an MRI fusion guided biopsy, e.g.

https://health.clevelandclinic.org/2014/09/fusion-guided-biopsy-a-smarter-way-to-look-for-prostate-cancer/

"This will then limit the needle insertion (and extraction of tissue) to the four suspicious areas noted in the MRI as opposed to "shooting in the dark" with 12 random stabs in the standard needle biopsy. Fortunately, a phone call to the local Urological Associates has determined that they can do it."

Well, I got one part of that right, the other wrong. The part I got wrong was assuming that the needle insertions would be "limited". They were not. In the MRI fusion guided biopsy I had yesterday afternoon no fewer than 19 sticks with the needle were delivered one after the other.

When I was first notified of this after I entered the biopsy room I couldn't believe it. I sputtered: "But I thought because there were only four suspicious areas* the extractions would be limited to four maybe one or two more."  "No" was the answer, "the four suspicious regions only means we now know where to concentrate our focus so can really go in there and take up to 24 samples!"

Fortunately, it ended up being only 19 thanks to several "calcified" areas - most likely from the previous radiation (HDR)  treatment-  that they didn't want to disturb. But still, to prepare for the onslaught, I not only had to take the prescribed 750 mg  Levofloxacin antibiotic tablet but also two stabs of gentamycin in each buttock 20 minutes before the biopsy commenced (this in addition to the lidocaine needle to numb the gland, and hopefully not pass out from the pain.)

I ought to have figured something wouldn't be as I expected when we had to wait over an hour for what was supposed to be a 1:45 p.m. appointment. Then, only after entering the biopsy room did we find out the guy in before me had passed out on the table. They, of course, had to allow sufficient time for him to recover- so then all the appointments that followed were backed up.

As the needle sticks were ongoing, lasting maybe 30 minutes because each tissue extracted from the prostate had to be sample-tubed and labeled, I talked with the doctor performing the sticks about treatment alternatives. He seemed to believe the "ice ball" or cryotherapy was the best for salvage, e.g. the general procedure outlined here:

https://www.youtube.com/watch?v=-OnqA-mJDWg

And more detailed here:

 https://www.youtube.com/watch?v=Hoi0872F3Cg

I told him I was thinking instead of HIFU (high intensity focused ultrasound) which many prostate cancer survivors on various forums said worked for them. (Though they had to obtain the treatment in Mexico or Canada since at the time the FDA hadn't yet approved it here  -only some clinical trials. I have since found out that HIFU-  'Ablatherm'-  received approval since October last year but is still awaiting CPT code assignment. Until then no Medicare payments for any HIFU!)  ). His snarky reply was "I wouldn't do that to my dog".  But remember, this guy is a urologist and in their 1-dimensional universe surgery (radical prostatectomy) is the one and only solution. Never mind in 25 percent of cases cancer is left in the margins and there is biochemical recurrence. Nearly the same percentage have to get salvage therapy, though to be sure making a choice after surgery is easier than after radiation, given the damage to tissues already inflicted by the latter.

I also mentioned not doing anything, and he agreed that could be a valid option, or non-option, especially if it is found the Gleason scores are high (8, 9). Then I just accept 4 to 7 more years of life and go with it, ditching the many side effects of hormone treatment like cardiovascular issues, metabolic syndrome and cognitive decline. As I told him "we all gotta go some time".

Now, I play the waiting game and in the next week or so should receive the results of the histology-pathology analysis of the slides.

I am hoping for the best.


---------------------------------------------------------
* Details

Adopting the PI-RADs MRI imaging scale my original MRI report noted 4 lesions ranging in size from 7 mm to 12 mm (almost a half inch across) with a PI-RADS score of category 4.

According to the Radiopaedia site:

"PI-RADS (Prostate Imaging Reporting and Data System) refers to a structured reporting scheme for evaluating the prostate for prostate cancer. It is designed to be used in a pre-therapy patient.The original PI-RADS score was annotated, revised and published as the second version, PI-RADSv2  by a steering committee with the joint efforts of ACR, ESUR, and AdMeTech Foundation.

The score is assessed on prostate MRI. Images are obtained using a multi-parametric technique including T2 weighted images, a dynamic contrast study (DCE) and DWI. If DCE or DWI are insufficient for interpretation the newest guidelines recommend omitting them in the scoring. (DCE = dynamic contrast enhanced imaging, and DWI = diffusion weighted imaging.)
.
A score is given according to each variable. The scale is based on a score from 1 to 5 (which is given for each lesion), with 1 being most probably benign and 5 being highly suspicious of malignancy:

• PI-RADS 1: very low (clinically significant cancer is highly unlikely to be present)
• PI-RADS 2: low (clinically significant cancer is unlikely to be present)
• PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal)
• PI-RADS 4: high (clinically significant cancer is likely to be present)
• PI-RADS 5: very high (clinically significant cancer is highly likely to be present)" 

'The Great Prostate Hoax' - A Must Read Book For Every American Male

When the doctor who discovered PSA writes a book about how the PSA test is basically a sham, and a device used to amass tens of billions of bucks for the urology sector of the medical industrial complex, you have to pay attention. Dr. Richard J. Ablin, author of 'The Great Prostate Hoax' described his discovery of the prostate specific antigen in 1970 as comparable to "the thrill of looking through a microscope and peering into the unknown reaches of space".

That thrill soon tempered by the misuse of a test (PSA) never designed to be cancer detection specific and hence "opening the floodgates for a tsunami of routine nationwide testing" (p. 7).  Dr. Ablin is adamant that the FDA made a "fateful error" to approve the PSA test as a means to detect prostate cancer. But as Ablin notes, PSA is even in healthy tissue and it can spike from all manner of external stimuli including: riding a bicycle, riding a horse, or after a rectal exam or colonoscopy. So what the hell use is it? Virtually none, as Dr. Ablin makes clear.

All it does, according to Ablin, is result in nearly a million risky biopsies a year - to the tune of billions of bucks for urologists- as well as tens thousands of unnecessary radical prostatectomies leaving most of those men mere shadows of their former selves. Often incontinent as well as impotent - even using Viagra every day and getting costly penile implants.

Ablin cites Dr. Alan Shapiro (p. 192) - once a promoter of the PSA- whose wake up call on the unnecessary harms caused by PSA testing arrived "when a 50 year old man came to his urology practice wearing a condom catheter - a flexible, condom -like sheath that fits over the penis and is attached to a tube that drains the urine into a storage bag."

As Dr. Shapiro put it (ibid.):

"This relatively young guy had a radical prostatectomy and now he couldn't get an erection or control his urine. He was crippled. "

This was five years before Ablin and Shapiro decided to make their documentary, 'Second Opinion', showing men who'd undergone the procedure recounting their experiences and later suffering. All the men lament the predictable trajectory that imprinted and ultimately altered the quality of their lives: the initial PSA test or tests, the advice to then get a biopsy because of a "spike" and finally the urging of the urologists to get treatment- usually radical prostatectomy because each one of those puts the biggest bucks into their pockets.

Hence, urology has become - thanks to PSA testing - one of the most lucrative branches of the medical industrial complex.

Ablin notes men are often pushed "to have it out" and so the initial reaction to a PSA spike or high level is an emotional response, often from their wives asking - "Can you really live with that cancer inside you?" Failing to realize that after their hubby follows her imperative he will no longer be able to have any kind of sex with her. Thus we behold the power of naked emotion to sway sound scientific judgment. Of course, there are exceptions - but these are not the "rule" - something its eager advocates forget or neglect.

Ablin essentially insists a man ceases to be a man in many vital respects, after this surgery. He writes for example (p. 36):

"A man can live without his prostate but once it is removed he suffers varying degrees of physical and psychological changes."

He goes on to quote one patient who actually wrote a book, 'I Want My Prostate Back':

"He wasn't the same man after the robotic surgery and pulled no punches talking about it. In an article in Men's Health, he wrote: 'Without any ejaculate I felt like a broken toy, like a water pistol that squirts jelly. Or nothing"

Harsh words but he cuts through the BS surrounding the test, just as Dr. Ablin does in his book, including all the flack he's taken from the nabobs who are trying to protect their profitable lives.

Perhaps the best chapter is Six: Unintended Consequences, wherein we learn of the battle between the American Urology Association (AUA) and the U.S. Preventive Services Task Force, which had noted as early as 1993:

"The Task Force has determined that PSA screening fails to meet the criteria for effective screening. The test lacks accuracy in detecting early stage disease. There is little evidence that early detection of prostate cancer improves patient outcomes and there is mounting evidence of the adverse effects of testing and treatment."

It took nearly 20 years of ongoing PR battles with the urologists - remember they pocket a pretty penny from biopsies as well as surgeries - before the Task Force recommendations became generally accepted and have now  - in the past year- yielded for the first time fewer biopsies as well as cancers detected. While a segment of the pro-PSA bunch is still left to hair on fire screeching, blasting that "all those men not getting screened are playing with their lives" the evidence simply isn't there.

As Ablin notes,  prostate cancer is an inevitable disease of aging. By age 65 nearly half of all man have some manner of "neoplasm" in their prostates. By age 85 it is nearly 95%. What? We're going to cut out all those cancers despite the fact they're all likely to die of anything but prostate cancer?

Let's also bear in mind that Richard Ablin's take on the PSA test is not new. Years before we beheld medical author Shannon Brownlee's take, in her book 'Untreated: Why Too Much Medicine is Making Us Sicker and Poorer' (2007, p. 202):

"The evidence suggests that PSA testing is not saving any lives, and even it is the large numbers of men who are treated unnecessarily are paying a terrible price. They're the equivalent of civilian casualties in our war on cancer.".

That take very nearly resembles Ablin's of havoc wrought across the years by this screening test which actually isn't cancer specific.

Yes, in the interest of full disclosure,  I did have radiation therapy treatment myself - under pressure from my wife, my urologist, my primary doc and others. BUT......as a fellow Intertel member emailed me (soon after I wrote about the experience in the Intertel Regional Newsletter 'Port of Call') I might also have lived with only minor problems (the cancer stage was T1c) and croaked eventually  of something else. This is because 97% of prostate cancers are slow growing. (Incredibly, 99% of males autopsied who are 80 years or older  are found to have prostate cancer .....and most never knew about it!)

Even if you're an avowed and dedicated believer in PSA screening, you should try to get this book and at least see another point of view. Those who are in the age range for such tests, or have medical providers who recommend getting it, absolutely should read this book first.

See also:
https://www.inspire.com/groups/us-too-prostate-cancer/discussion/psa-test-is-misused-unreliable-says-the-antigens-discoverer/?page=4

Testosterone-Blocking Cancer Drugs Linked To Much Greater Alzheimer's Risk

While we're on the topic of prescription drugs and costs, we can also consider the set referred to as "anti-Androgen" or "testosterone-blocking". These are usually prescribed by oncologists after a treatment "failure" -  defined in the case of radiotherapy as three successive PSA increases after the defined PSA nadir (or lowest reading). Since treatment such as radiation often leaves tissues a "mess" it isn't generally a good idea to barge in with a radical prostatectomy - so anti-Androgens are prescribed to cut off the testosterone feeding the tumor.

As Dr. Mark Scholz observes in 'Invasion of the  Prostate Snatchers', p. 42:

"testosterone fuels prostate cancer growth  and prostate cancer is the only type of cancer susceptible to testosterone inactivating pharmaceuticals"

It is also true that anti-Androgens can be prescribed for men who've been biopsied and found to have localized prostate cancer but opt not to go for the extreme treatments like surgery or high dose brachytherapy - such as I had in 2012. It is now estimated that a half million American males are on these drugs for one or the other reason.

The Androgen deprivation therapy - also known as chemical castration - lowers levels of testosterone and other male hormones that can fuel the disease but can also wreak havoc including: a higher risk of cardiovascular disease, diabetes, high cholesterol, loss of muscle mass and impotence.

Now we learn males on this therapy probably need to also do more watchful waiting for Alzheimer's disease.

According to a WSJ article ('Alzheimer's Danger Seen in Prostate Drugs', p. A3, Dec. 10), a new study published in the Journal of Clinical Oncology found that men taking testosterone-blocking drugs had an 88 percent increased risk of  developing Alzheimer's disease compared to those not taking such drugs.

The researchers from Stanford and the University of Pennsylvania searched electronic medical records from Stanford Health Care in Palo Alto, CA and Mt. Sinai Hospital in New York City. They identified 16, 888 patients with "non-metastatic prostate cancer" between 1994 and 2013. Of those:

"Nearly 2,400 were treated with anti-Androgen therapy and they had an 88 percent increased change of being diagnosed with Alzheimer's disease in the next three years than those who weren't"

According to one urologist from Brigham and Women's Hospital in Boston, while this therapy "can extend survival when used with radiation in some cases", he also warned:

"But we should never use androgen deprivation therapy alone for localized prostate cancer".

My view is perhaps it shouldn't be used at all, especially after reading and reviewing How We Survived Prostate Cancer: What We Did and What We Should Have Done ...by Victoria Hallerman. Hallerman writes of her husband who had brachytherapy and also the anti-Androgen treatment. She notes that basically, he was reduced to weeping at the slightest provocation and also losing the ability to think clearly. To me it showed the wisdom of me not adding this to my own high dose brachy treatment.

One is led to ask: 'What is the quality of life if it means getting Alzheimer's?' You are better off croaking earlier from the cancer than be converted to a living vegetable.

Low T Therapy For Bigger Muscles? Blame This "Remedy" For Medical Interventions You Don't Want!

Kristen was still distraught after losing her hubby Rob, a year earlier. What had been planned as a trip for two to Barbados this year ended up a trip for one. The saga isn't new and will likely unfold in many more households as low T mania continues unabated. How bad is it? According to the article, 'Low T: Real Problem or Ad-driven Fad?' in the AARP Bulletin (July-August, p. 18):

"A 2013 study in JAMA Internal Medicine found testosterone prescriptions grew more than threefold between 2001 and 2011. Data from IMS Health shows T sales rose from $324 million in 2002 to nearly $2.3 billion in 2012. Sales could hit $5 billion by 2018."


As the article also notes, most of this increase isn't based on any genuine medical issue. It is based on ads shamelessly playing to male insecurities. The loss of muscle mass , sex drive or energy -  once described as "getting older" -  suddenly was transmogrified into a condition dubbed "low T" by the Madison  Avenue Ad makers. Thus were unleashed a torrent of print and TV ads from the makers of testosterone replacement meds and gels. One ad actually advised: "Millions of men 45 or older may have low T so talk to your doctor!"

Really? Gimme a break!

In Kristen's husband's case, Rob (then 47) felt he needed an edge at work so began the low T prescription solution. He did feel his energy rebound, his muscle mass increased and his renewed sex drive pleased Kirsten. Only she worried about taking increased testosterone which as a medical person (urology RN) she already knew provided a fuel for prostate cancer.

According to Dr. Mark Scholz, in 'Invasion of the  Prostate Snatchers', p. 42:

"testosterone fuels prostate cancer growth  and prostate cancer is the only type of cancer susceptible to testosterone inactivating pharmaceuticals"

Alas, Rob dismissed all such concerns, according to Kristen, and even increased his testosterone use. If some is terrific, more got to be better, right? Not quite. Within a year Rob's PSA had doubled, and six months later tripled. Finally, under pressure from his wife he reluctantly submitted to a prostate biopsy and prostate cancer was found in five cores with Gleason scores 4 + 5, and two with 5 + 5. The urologist pronounced "advanced prostate cancer" and recommended radical prostatectomy in combination with female hormone treatments.

The next year or so was 'hell' as he descended into depression following the surgery which left him incontinent, his penis shrunken, zero sex drive and with large breasts - arising from the hormone treatments.  Kristen confided that at least he hadn't ended up like another T-using patient who - after his operation around the same time - experienced a vesicularectal fistula-   farting through his penis and saddled with other complications before having to get a colostomy.

Despite all the horrific side effects Rob had to endure, the prostate cancer spewed secondaries into bones and lungs - and he died 6 months ago.  Kristen said if she had one wish it would be to "get men to back off from this silly, idiotic non-solution".

She may well have a point. Even if by some miracle prostate cancer isn't spawned, other negative medical impacts abound. According to Dr. John La Puma, quoted in the AARP article,

"When you take testosterone your body shuts down production. As a result the testicles shrink and you could be using supplementation indefinitely."

He noted this circumstance meant "expense, inconvenience and  worst of all, possible catastrophic health consequences."

Think aggressive prostate cancer. But as the AARP article also pointed out:

"A study published last year in the Journal of the American Medical Association reported a 30 percent jump in the risk of stroke, heart attack and death among men undergoing testosterone therapy."

It would seem that any guy seriously thinking of aspiring to be muscle-bound  and energetic using T, would be advised to watch the video below first and pay close attention! Note the particulars of treating low testosterone, including the fact: a) testosterone can vary during the day so the time you get the blood test is critical, and b) the low testosterone can be due to multiple other causes than natural, including stress, fatigue, diabetes or other hormonal imbalances.


http://www.webmd.com/prostate-cancer/video/testosterone-replacement-prostate-cancer

The AARP article also adds (ibid.):

"But what is a healthy T level for an older man? Doctors can't agree. Many laboratories use wildly varying reference numbers based on the average testosterone levels of young men, anywhere from 300 to 900 nanograms per deciliter."

The Bulletin adds that,  incredibly, just about any purported "symptoms list" will ensure a low -T diagnosis.

The fact is, as Dr. La Puma observes,  most men (maybe 80%) don't need this "therapy" at all, period.  As he puts it:

"All men need to do is eat a healthier diet and be more active."

To reinforce that, "it's found that when obese men shed an average of 17 pounds,  testosterone levels climb 15 percent."

This in addition to quality sleep and regular exercise can help any guy improve his energy and muscle mass as well as sex drive.

Trouble is, too many guys want the "quick fix".  For those who want the T-quick fix to “muscle up” to look better or get more energy, I'd say just be prepared for what’s coming later. It might also help to imagine yourself long past the cancer treatment stage when your dick is U-shaped, your breasts are bigger than Mariah Carey’s (so much you want to hide from your wife) and you have to wear giant diapers just to go to the corner 7-11.

Mail Brane: Readers Seeking Answers to Questions

Q. I hope you can help! My husband, age 38, had  been diagnosed 2 years ago with aggressive prostate cancer (classified adenocarcinoma with stage T2(c) in biopsy) and had to have the radical prostatectomy or so he was told. The urologist told him he would need to begin penile rehabilitation as soon as the Foley catheter was removed but he refused. He said the pain was still too unbearable after the surgery and couldn't bear any erections from Viagra or whatever. To make a long story short his initial resistance to penile rehab - such as you described in your October 14 blog last year- became hardened. Gradually, he became incapable of getting any erections and his penis deformed. Much like you described. What can be done? Anything? - Barbara B., Orlando FL

A. At this stage it's doubtful since if the therapy isn't done soon after surgery and erections are allowed to lapse as you described, the tissue damage - due to lack of consistent blood flow - becomes permanent. There may be some surgery that can correct the deformation (I presume you mean the U-shape that Dr. John Mulhall describes in his book that I referenced in that Oct. blog) but the urologist would have to weigh in on that. This, of course, is a cautionary tale that those who have radical prostate surgery need to follow this  with penile rehab as soon as possible, though yes, there may be some residual pain. Your question also seems to imply that a radiation therapy treatment might have been better, but generally at the stage you described (T2c) it isn't an option.  Also, remember the effects of radiation increase over time, as tissues become hardened by the delayed radiation impact. This is also why it's essential to remain sexually active, whatever mechanism is employed.

Q. I was disheartened to read in your July 24 post that Colorado Springs had opted out of the marijuana retail business! Don't they know how much money they are losing? Are there any counties in the state that plan to implement the retail businesses? How many have opted out so far? - Clint, Pompano Beach FL

A. At last count some 57 communities in the state had opted out, but 21 remain in play -seeking rational ways to implement legal guidelines for MJ retail stores. Among those latter are Denver, and Aurora, CO. Almost to a tee, the opt- outs are in conservative counties, though they seem to forget they are flouting the voters' will by their opt out (and in many of those counties, Amendment 64 passed!)  I believe they might well pay at the polls next time any of the respective city council members come up for re-election. It never pays to piss off the voters! The mistake was probably making any "opt out" part of Amendment 64 in the first place. It gave too facile a way to deal with the nettlesome problem of how to regulate, where the controls would be and the level of taxation. It was a cheap way out, a cop out. So, I guess cities like Colorado Springs will have to keep on getting revenue from other sources, say like becoming or staying top national speed traps.

Q. Thanks for your post on being child free! (Aug. 18th). My husband and I were delighted to read and now feel much better about our childless choice. But how do you deal with nosey people that persistently inquire why we're childless? It really bugs me! - Delores, Sioux City, IA

A. Tell them: "Mind your own business, please!  Haven't you enough to do with your own time as opposed to meddling in others' lives".

Q. I've been wanting to join Mensa for a long time, but none of my past standardized tests (SAT in 1995, GRE in 2002) have been found acceptable. I dread taking the actual Mensa test because I hear it's a lot harder. Is this true? What can I expect? - Ricardo, Mt. Shasta, CA

A. It's not that big a deal. Below is an image from the U.S. Mensa site showing some of those taking a recent test.

The Mensa Admission Test takes two hours to complete and includes two tests featuring questions involving logic and deductive reasoning. If you score at or above the 98th percentile on either of the two tests, you'll qualify and be invited to join Mensa. Score below....well I understand there is a 5% society (The International High IQ Society) that accepts entrants at the 95th percentile level.

If you'd like a practice test (always a good idea) you can also get an idea if you're Mensa level by taking the home test, e.g. https://www.us.mensa.org/join/mht/

A more dated (1989) example which doesn't cost anything to see or assess can be found at this link:
http://articles.chicagotribune.com/1989-01-04/entertainment/8902220824_1_typists-chickens-eggs

Another shorter version with "Mensa-style" questions and answers:
http://www.agincourtpractice.co.uk/resources/mensa.htm

Q. I get a real kick out of your loopy brother (Mike) who thinks he's a Confederate raider or something. On clicking at the entry link to his blog on your August 8 post I see he always tries to appear this homespun dude with this "My friends" stuff. Who's he trying to fool? He's not friends with anyone! You just have to read his crappy blogs to see how disturbed he is. Any take on if and when he might change his blog again to be more tolerant? Also, what is this guy's damage? Was he dropped on his head as a kid?, Murray T., Norman, Oklahoma

A. I do agree that his 'my friends' intros are a bit over played. He likes to portray himself as this down home, relaxed type of southern dude but his own words and hateful content betray him. He's a raging maniac underneath the soft soap veneer, calling people "apes" (mainly blacks), "libtards", "c*nts" or worse.  As for being dropped on his head, no. But maybe in one too many fights where he took as many blows to the head as he delivered. We know, from looking at the NFL football head injuries that have come to the fore (e.g. Junior Seau), that repeated blows can have deleterious effects on the brain. This can lead to erratic behavior.  As for changing again, I could care less if he does or doesn't. It's his choice to make, and he has to deal with who and what he is. As an aside, it's really goofy and misplaced how he often makes lame invocations of our dad, when dad detested everything about Mike's hateful blog when he was alive.

Q. You mentioned doing a blog post soon on JFK and how he challenged the national security state. When can we expect it? Desmond, Portland, OR

A. That post is still in the process of preparation, as I'm juggling that with completing a book, that's due to launch in about 4 weeks, maybe sooner. The title is 'Beyond Atheism, Beyond God'  (to be published by iUniverse) and will be my final entry in my atheist series, showing how a rational atheism can lead to a Materialist conception of Being. Meanwhile, I am also trying to re-organize a science fiction novel on the Kennedy assassination, entitled, The Lancer Expedition. If all goes well it should be out by Nov. 1st, but hopefully sooner!

Q. When can we expect more interviews with your delightful sister-in-law Krimhilde? (Aug. 12 post) She has me considering joining Eckankar. - Molly D., London, UK

A. The next interview will probably be when I see Krimhilde again, perhaps next Spring. Will keep readers posted!

Men Using T for a Cosmetic ‘Fix’ – Playing Roulette with Prostate Cancer

The news that five million American males are now brandishing their tubes of ‘Androgel’ and other testosterone-delivering gels, etc. is not surprising. The post-45 lot seem to believe they’ve found a new lease on life where biceps pump up, and flabby abdominals turn into hardened six-packs. Their brains work better, or so they claim, so what can go wrong?


Well, how about aggressive prostate cancer – then having to get a surgery or radiation treatment that leaves you with having to use penile implants, endless Viagra and penile injections?


It is amazing how many sites one finds on doing a Google search that pooh-pooh any evidentiary connection between testosterone increases and prostate cancer. One site I located actually referred to any such connection as a “myth”. I have news for them: they are living in a fool’s paradise and furthermore are encouraging male readers over 45 into taking immense risks that they’d be better off avoiding.  The truth is that "testosterone fuels prostate cancer growth" and prostate cancer is "the only type of cancer susceptible to testosterone inactivating pharmaceuticals" (According to Dr. Mark Scholz, in 'Invasion of the  Prostate Snatchers', p. 42).


Two nights ago on an ABC News segment on testosterone fixes, a muscle-bound 60+ year old was shown flexing his biceps and bragging about all his energy ….and so on. Hey, great! But I just hope you’re ready when you have to be treated for prostate cancer – whether radiation therapy or a radical prostatectomy leaving you dependent on penile shots, implants or PDE5 inhibitors, or worse, never being able to get it up again because the cancer is so aggressive that you’re put on female hormones. (With large breasts you will want to hide, to boot).


Dr. John P. Mulhall, author of an academic monograph entitled: "Sexual Function in the Prostate Cancer Patient," also wrote a less technical book for actual prostate cancer patients and their significant others, entitled: "Saving Your Sex Life: A Guide for Men with Prostate Cancer". He makes clear the extent men will have to go to in a process of “penile rehabilitation” to regain sex lives after prostate cancer. In this case, sex lives that can be hampered not only by erectile dysfunction, but painful orgasms and dry ejaculations – even if they do take enough Viagra or penile shots to get the machinery working.

As if that isn’t enough to terrify any macho fool idiot into halting an enhanced T -regimen unless absolutely necessary, there is the prospect of surgical error leading to infection (c. diff.)  and vesicularectal fistula such as reported  by Dr. George Rinaldi on p. 20 of 'Invasion of the Prostate Snatchers'. Rinaldi was not one of the lucky 50% who emerge from radical prostatectomy relatively unscathed. He ended up farting through his penis and saddled with other complications before having to get a colostomy!

Apart from such extreme consequences, something like 50% end up wearing diapers for the rest of their days. This is possible because in the course of the prostatectomy (the most frequently chosen treatment) the urethra has to be sliced in two different places (since it passes through the prostate) then the base of the bladder has to be resected to the remaining part of the urethra excised from the prostate base.


One problem with the above is the response that “it won’t happen to me” – resorting to the exceptionalist meme. But I have news for these guys – it can happen to you unless you’re lucky enough to get the skilled hands of a surgeon that can minimize the collateral damage. Oh, and if you’re thinking about using that fancy dancy da Vinci surgical robot to do it, think again. Accumulating evidence discloses this thing will actually produce worse results unless – I repeat – unless, the prospective surgeon using it has at least 600 such operations under his belt. You really want to take a chance with some clown who's only done 12 or even only 100? Good luck on that!


Radiation treatments, which many opt for instead of surgery, are also dependent on the soundness of the center's treatment planning system and the skill, experience of the radiation oncologists delivering the doses. One thing you don’t want is an excessive dose of radiation which occurs in what’s called an “administration error” which can leave your bowels suppurating and your bladder in a mess, or ulcerating. Oh, and if you’re game for that new method using a giant linear proton machine, just be sure the oncologists administering the treatments don’t have a “geographical miss” – where the proton beam misses the cancer site totally and uh, goes through your bowel or bladder instead! As for a geographical miss hitting your penis instead, well we won’t go there, but it could make a clever horror flick!


Apart from incontinence, the greatest risk that surgical patients face post-op is loss of erectile ability. .The incipient damage is called "atrophy" which increases in probability the longer a patient goes without erection post-surgery. (Mulhall, p. 98) Atrophy is, in fact (ibid.):

"a scarring of the erectile tissue, and if the erectile tissue scars, the patient will never get his own erection back and will always struggle with medication".

Dr. Mulhall goes on to note (ibid.) that "the incidence of erectile tissue damage, as measured by the presence of venous leak is very uncommon before the fourth month after surgery. However, at eight months after surgery it "occurs in about 30% of men and at one year 50% of men".


If any former Mr. T-using Muscleman has these effects post -surgery, and is also unable to sustain enough blood flow he has another little complication to look forward to: a misshapen penis! Mulhall invokes the "use it lose it" saying here. In some cases, indeed, prolonged disuse engenders organs which are badly misshapen (bent as in a U-shape) and essentially unusable because of unequal scarring in different tissues.


Any guy seriously thinking of aping the muscle-bound CEO spotlighted on ABC News (in his T-regimen) would be advised to watch the video below first and pay close attention! Note the particulars of treating low testosterone, including the fact: a) testosterone can vary during the day so the time you get the blood test is critical, and b) the low testosterone can be due to multiple other causes than natural, including stress, fatigue, diabetes or other hormonal imbalances.


http://www.webmd.com/prostate-cancer/video/testosterone-replacement-prostate-cancer


If a guy has no T-problems and just wants to “muscle up” to look better, I say just be prepared for what’s coming later. It might also help to imagine yourself long past the cancer treatment stage when your dick is U-shaped, your breasts are bigger than Mariah Carey’s (so much you want to hide from your wife) and you have to wear giant diapers just to go to the corner 7-11.

Mail Call Brane(Pt. II)

Continuation of questions from Brane Space readers:

Q. I am a young, married woman of 28, whose husband of 34 recently had treatment for aggressive prostate cancer. This included a radical prostatectomy followed by hormone therapy using a combination of luteinizing-hormone releasing hormone LHRH or  Leuprolide (marketed as Lupron) and a non-steroidal anti-androgen (Bicalutamide). The problem is that though this treatment ended six months ago (the doctors took him off the hormones since) he has no interest in sex at all! Worse, he’s still bothered by the way the hormones caused his breasts to enlarge so is very body conscious. We have tried everything including massage therapy and even trying to use mutual masturbation, but nothing works! Even watching porn videos doesn’t have any effect! Do you have any suggestions, as I noticed you wrote a number of blogs on your own treatment as well as ‘penile rehabilitation’. – Alissa J., Roanoke, VA

 

A. One of the awful aspects brought out in your question is the way prostate cancer is striking at younger and younger males. To this day, the base causes are still being explored, but my theory is that at least half the new and more aggressive cases can be traced to carcinogenic chemicals, toxins in the environment.

Anyway, as I noted in the blog you referenced (Oct. 14, last year) the real need for the penile rehab is on account of  post-op scarring of the erectile tissue, which - if it progresses too far- will prevent the patient from ever getting his own erections back and lead to an endless struggle with medication. This was according to Dr. John P. Mulhall ('Saving Your Sex Life: A Guide for Men with Prostate Cancer') Dr. Mulhall is the Director of the Sexual & Reproductive Medicine Urology Service based at the Memorial Sloan- Kettering Cancer Center.

He notes that "the incidence of erectile tissue damage, as measured by the presence of venous leak is very uncommon before the fourth month after surgery". However, at eight months after surgery it  "occurs in about 30% of men and at one year 50% of men". This is why it's essential, if men care at all about their future sex lives, they do everything possible to ensure erections of some mode (they are graded on a scale of 1-10 for hardness) occur before the 4th month after radical surgery. Why do erections need to occur? Because the absence of blood, and hence oxygen getting into the penis, leads to ongoing and progressive atrophy and tissue scarring. Mulhall invokes the "use it lose it" saying here. In some cases, indeed, prolonged disuse engenders organs which are badly misshapen (bent as in a U-shape) and essentially unusable because of unequal scarring in different tissues.

His aim in penile rehabilitation is for the patient to chemically-manually induce at least 2-3 erections per week as soon as possible after the surgery (this would be especially needed if HT was to be started after recovery).  In Mulhall's penile rehab program, the pre-op use of PDE5 inhibitors (such as Viagra)  is implemented up to two weeks before surgery. Recall the chemical pathways here: the cavernous nerves close to the prostate gland secrete nitric oxide which stimulates release of an enzyme (cyclic GMP) inside the smooth muscle cells, which promotes relaxation of smooth muscles and erection. (PDE5 blocks release of cyclic GMP, so PDE 5 inhibitors block the action of the cyclic GMP- blocking PDE5's.)

Now, the question is whether your husband was put on such a pre-op therapy. If not, as Mulhall points out, then it would be much more difficult to get success later. Post-surgery, the patient gets a prescription for a PDE5 inhibitor the day the Foley catheter is removed. He is then told to take a full dose of Viagra (100 mg) or Levitra (20 mg) once per week with adequate accompanying stimulation to attain at least a 6 scale out of 10 erection. On the other 6 nights he's told to take a low dose pill (50 mg Viagra or 10 mg Levitra) before going to bed.  Again, if none of this was done, the difficulties would be much much greater in gaining any success. The problems would be magnified if hormone therapy was delivered soon after.

There are, of course, other alternatives as I noted in the blog, including using vacuum pumps as well as the drugs Bimix or Trimix with a 29-gauge needle 1/2" in length for penile injection (as recommended by Dr. Mulhall). There is also the option of having a penile implant, but this also requires surgery.

In any case, the best option is discuss these with a urologist and see what strategy might work at this phase. By all means, explore every possibility since losing one's sex life so early cannot be any fun!

Q. if the Shroud of Turin is separately re-tested and found to be genuine, and more evidence also comes forth to show it really was Jesus, would that make you give up atheism? – Brenda K., Scarsborough, NY

A. Not at all. Merely because the Shroud is proven to be historically accurate, doesn’t prove the additional hypothesis that Yeshua was a God-man. As I noted in my blog on the Mithra-Mithras God-man mythology:
http://brane-space.blogspot.com/2012/12/more-on-mithraic-god-man-mythooogy.html


Mithraism provides the template from which Christianity adopted all its savior myths, including being born of a virgin, rising from the dead, etc. Heck, the Christians even copied Mithras' birth date on Dec. 25th.

J.M. Robertson, author of Pagan Christs, observes (op. cit.)


The celebration of the Mithraic mysteries, of the burial and resurrection of the Lord, the Mediator and Savior, the sacrament of bread and water...all these were in practice long before the first Christian Gospel of a Lord who was buried in a rock tomb


Robertson (op. cit., p. 121) also cites other common symbols that the Christians appropriated from Mithraic traditions, including the Agnus Dei, or "Lamb of God". As he notes:


"The Christian assimilation of Mithraism is still more clearly seen in the familiar Christian symbol in which Christ is represented as a lamb, carrying by one forefoot a cross."

What about the way in which Christians have consistently copied images of Mithras and used them for Jesus? Robertson again (op. cit.) supplies an answer (p. 124):


"The Christian imitation, took place, be it observed, because the features imitated were found by experience to be religiously attractive."

It’s clear from this that the Mithras mythology sticks in the craw of many biblical literalists and even orthodox Christian non-literalists, since their dependency on the notion of one unique "Savior" exposes their egocentric certainty they alone possess the truth. But they are deluded. They merely possess an ancient God-man myth stolen from earlier sources.

More to the point, Oxford Scholar Geza Vermes in The Authentic Gospel of Jesus, dismisses the notion that Christ himself believed himself to be special or a God. Vermes points out any such belief on Christ's part would have been interpreted as self-idolatry. He never ever referred to himself as "Son of God" only as "Son of Man", nor did he dictate any belief be accorded him. All such references were fraudulent later additions.
Given all of this, if the Shroud is proven to be historically valid, all I’d be prepared to admit is that a man actually lived at the time indicated and this may well have been Yeshua.

But he wasn’t a special divine creation!

Q. Your blog on the next stock market crash (March 19) really has me worried with my 401k and all. From my reading, it seems like almost a 63% chance we will have a major correction and maybe as much as 90%. Couple of questions: 1) How long would it take to make up losses if there was a big crash or correction? And 2) What other places can a person put his money to get anything?- Regis M., Seattle, WA

A. The math for recouping major losses after stock market corrections is pretty straightforward. For example, a stock – or mutual fund- that drops in share price from, say $20 to $10 has suffered a 50% loss. But for that $10 stock or fund share price to return to $20 it must gain 100%, or double. This may take not just two or three years, but more than TWENTY! In some cases it may NEVER return!


Many cheerleaders, as well as innocent lay folk, do not know that if a share of anything goes down by 20%, it requires an advance of 25% to get back just to the breakeven point. If the value of a share drops 40 percent (as has occurred with some recent mutual fund hits since 1999), you need a 66.7 % advance to break even. If the share drops 50% - as already noted- a 100% gain must be registered to return to ‘break-even’ (i.e. you’re not losing more than what you already paid).

Let’s assume then that this current bubble bursts in October, and there are 50% losses across the board, ‘blood in the streets’ as it were. Let’s say in the wake, with the arrival of austerity budgets and consumer retrenchment, the new increases are more on the order of 1%- 1.5% a year. (More realistic returns as predicted for example, by William Wolman and Anne Colamosca in their book The Great 401k Hoax, 2002)

Then you could be looking at about a thirty year time horizon to just get to the break event point. But in that thirty years inflation will likely have risen at least 2% per year, so in many ways you are in even worse shape and more so- because you’re likely at an older age when employers cease being interested.

The best advice one can give, then, is simply not to chase yield. If you are looking for a safe investment, always be wary of anything promising more than 4-5% in our current Fed cheap money environment.

My personal wake up call appeared in The Wall Street Journal, from Nov. 27, 2003, page D1,

'A Harsh Truth: Most of Your Investments Won't Make Money- Even in the Long Term'.

 
The piece showed that when stock or mutual fund investors actually include fees, commissions, taxes, expenses etc. they essentially don’t “make” any money at all. They’d be better off just staying with totally safe investments. The piece showed that when stock or mutual fund investors actually include fees, commissions, taxes, expenses etc. they essentially don’t “make” any money at all. They’d be better off just staying with totally safe investments.


People need to know the basic Wall Street pyramid game has never changed in over 70 years and is elementary to grasp. Pundits, wags and paid whores hype the various stocks, funds or instigate a "buzz" about them - to get suckers to buy in.

The increasing buy in inflates the price-to -earnings ratio (P-E ratio) and produces a bubble of high profits. The "Big boys" (large, institutional investors) get tipped 1-2 days in advance and cash out, leaving the little guys to sink. If they're lucky they may earn a few bucks. Not much.

The thievery works eventually because most manjacks are conditioned to "buy and hold" rather than fold when the share price dives below a certain threshold. (Which ought to be the tip off). Thus, there are always ample marks left at the end game to be properly fleeced. Amazingly, they're always ready to play the game again, and pile their newly saved up money in.


Q. I found your blogs on exegesis and the Shroud so powerful and convincing that they have me thinking of becoming an atheist or at least agnostic. Meanwhile, out of curiosity, I checked your fundie brother’s blog (through the portal you gave in the Amazing Race blog) and see he’s bitching about ‘NBs’ having the chronology of the resurrection events all wrong. Is there any more you can add to what you already showed to bolsters arguments for the Fundies getting it wrong?- Carol, Los Angeles, CA

 

1. There is a lot more that can be added, but we can always be sure of one thing: People (fundies) like my bro will always worm their way out and find more rationalizations, excuses and nonsense. For example, any proper Materialist or physicalist could ask why reports of supernatural beings vanishing, talking and materializing out of thin air, along with long-dead corpses coming back to life, and people levitating should be given serious consideration at all. At face value, this is the stuff of psychosis and in any other setting the propounders would be locked up and the key thrown away!

In this light it’s really funny that traditionalist Christians (including Protestants and Catholics) seem to have no trouble applying healthy skepticism to the miracles of Islam, or to the claims of Eckists, like my sister-in –law. But if they do that they have an obligation to scrutinize their own supernatural stories.. Why should Christians treat their own outrageous claims any differently? This is one of the things I detest almost as much as nationalism, the religious exceptionalism!

But again, we go back to the numerous contradictions in quadriform gospel accounts which the rational person is obligated to see as the first indicator that they don’t add up. Let’s list some:

Who was at the tomb when the women arrived?

• Matthew: One angel (28:2-7)

• Mark: One young man (16:5)

• Luke: Two men (24:4)


Where were the "messengers" situated?


• Matthew: Angel sitting on the stone (28:2)

• Mark: Young man sitting inside, on the right (16:5)

• Luke: Two men standing inside (24:4)

• John: Two angels sitting on each end of the bed (20:12)


• John: Two angels (20:12)

When Mary returned from the tomb, did she know Jesus had been resurrected?

• Matthew: Yes (28:7-8)
• Mark: Yes (16:10,11)

• Luke: Yes (24:6-9,23)

• John: No (20:2)

 

When did Mary first see Jesus?

    • Matthew: Before she returned to the disciples (28:9)

• Mark: Before she returned to the disciples (16:9,10)

• John: After she returned to the disciples (20:2,14)

 

Could Jesus be touched after the resurrection?

  • Matthew: Yes (28:9)

• John: No (20:17), Yes (20:27)

 

After the women, to whom did Jesus first appear?

    • Matthew: Eleven disciples (28:16)

• Mark: Two disciples in the country, later to eleven (16:12,14)

• Luke: Two disciples in Emmaus, later to eleven (24:13,36)

• John: Ten disciples (Judas and Thomas were absent) (20:19, 24)

• Paul: First to Cephas (Peter), then to the twelve. (Twelve? Judas was dead). (I Corinthians

 

Where did Jesus first appear to the disciples?

  • Matthew: On a mountain in Galilee (60-100 miles away) (28:16-17)

• Mark: To two in the country, to eleven "as they sat at meat" (16:12,14)

• Luke: In Emmaus (about seven miles away) at evening, to the rest in a room in Jerusalem later that night. (24:31, 36)

• John: In a room, at evening (20:19)

 

Did Jesus stay on earth for a while?

  • Mark: No (16:19) Compare 16:14 with John 20:19 to show that this was all done on Sunday

• Luke: No (24:50-52) It all happened on Sunday

• John: Yes, at least eight days (20:26, 21:1-22)

• Acts: Yes, at least forty days (1:3)

 

Where did the ascension take place?

  • Matthew: No ascension. Book ends on mountain in Galilee

• Mark: In or near Jerusalem, after supper (16:19)

• Luke: In Bethany, very close to Jerusalem, after supper (24:50-51)

• John: No ascension

• Paul: No ascension

• Acts: Ascended from Mount of Olives (1:9-12)

There are so many contradictions, that in the end NONE of the claims can be trusted. SO they amount to exactly what Rev. Thos. Bokenkotter has said they are: PR efforts to try to convert unbelievers.

Oh, the fundies will always try to rationalize a way out, but the problem is that this only works for irrational, ignorant or stupid people - who refuse to consult the sources themselves! Far from trying to "take anyone's faith away" we skeptics are trying to show that these ancient books written by semi-literate nomads, are the last place one ought to invest faith!

PSA Test Results Are Back: To Celebrate or Not?

Barely ten minutes ago a nurse phoned from my primary care doc and gave the results of the PSA test taken last Friday, and roughly 3 months after the conclusion of my prostate cancer radiation treatment. She reported the PSA as 2.0 - which is "within normal range". While wifey was ecstatic, and this was definitely a positive,  considering it had gone up to 6.1 in June (before the biopsy and radiation treatment in September, see e.g. http://brane-space.blogspot.com/2012/09/thge-longest-dayand-then-some.html) I noted we still had to wait to see what Dr. Hsu of UCSF made of it. Would he be satisfied with this first post-treatment result? We'd have to fax the lab report to him then see.

In the meantime, I am not hitting the panic button though I had hoped the PSA would have been closer to 1.5. But in a way it makes sense. As I noted before one can't compare a first PSA taken 3 mos. after radiotherapy (even high dose) with that taken after radical prostatectomy because in the latter case the whole gland is effectively removed, while in radiation it is left in. Thus, one still has production of prostate specific antigen by the remaining intact cells of the prostate, and one knows this is fueled by testosterone. (I haven't had a test for testosterone level, but if I had I am sure it would show close to normal levels.)

The other thing one must bear in mind is that the effects of radiation are progressive. Most statistics show that by five years after radiation high dose treatment the effects are almost identical to those after radical surgery. In other words, my time line will disclose increasing effects- many of them negative - such as damage to the erectile tissue, blood vessels etc. as the effect of the radiation dose continues on the cells. Over this increasing time line, one ought to see a decrease in PSA, though as I also noted before there may be aberrations which occur - temporary blips upward- and then declines. A "treatment failure" is only reported when there is no further decline. When I hit the lowest PSA over a timeline, say two years, that will be defined as the "PSA nadir". If it pops back up, we call it a "PSA bounce". Ideally we don't see too many bounces!

The "cure rates" reported in most studies tend to depend on two factors: 1) the quality of the treatment, and 2) the average risk type of the patient. Note most studies are "retrospective" or ex-post facto, only concluded after the fact. This is consonant with both the nature of the disease and also the treatment, especially radiation. The problem is that accuracy is limited by variations in "risk types" for different institutions. (Oncologists do their best to match risk types from institution to institution but for a number of reasons the matching process is less than perfect, introducing uncertainty.)

In one of the most notable studies, completed by Dr. Patrick Walsh (who invented the modern form of radical prostate surgery) at Johns Hopkins, the 15-year cure rates as reported in the journal 'Urology' in 2007, were 85%, 63% and 40%. These were for low-risk, intermediate risk and high risk disease, respectively. (Let's also bear in mind that even the best surgeons in one study group left cancer behind in 10% of cases - as determined by the "positive surgical margin rate". This is the frequency, usually given as a percentage, of leaving cancer cells behind over a number of 'n' surgeries performed.

Meanwhile, in the most prominent reported study for (low dose) seed implant brachytherapy, in the International Journal of Radiation Oncology (2007), the cure rates were 86%, 80% and 68% for low, intermediate and high risk cancer.  (By all considerations my high dose rate brachy results ought to compare even more favorably!) In other words, the two methods compare very well at least from these two studies. (A futher interesting point is that a Johns Hopkins study has shown that relapses after surgery occur on average five years earlier than seed implants.)

In the end, it's a waiting game. Over more time, perhaps at least two years, the chief oncologist will be able to definitely say that the battle has been "won" or perhaps only drawn, or lost. Right now I am just elated to have a much lower PSA than I had 6 months ago, and will take that as a 'W'.

When A Prostate Cancer Patient's Luck Runs Out: A Miracle Drug?

Shown above: a micrograph of prostate cancer cells obtained via needle biopsy.

You've had your prostate cancer treatment and it's decimated your body - sent you into a microcosm of pain and humiliation, however it was done. For the least lucky survivors (often of radical prostactecomies - which one urologist has estimated sees 40,000 of every 50,000 surgeries as unnecessary) there can be hideous complications, such as vesiculorectal fistulas - which are abnormal channels formed after surgery between rectum and bladder. When these fistulas cannot be surgically repaired, a colostomy bag is often the result. In other cases, infections set in(perhaps from improper drainage of fluids)  which are treated with antibiotics which precipitate c.diff. (which my own wife nearly died from after taking a prescription of amoxicillin in December, 2006, for a sinus infection.)

But after going through all manner of turmoil, pain and recovery what if the cancer returns? What then? Worse, what if it's more aggressive than ever and breaks through the 'capsule' and invades bone and vital organs? Consider these appalling facts:

- In about a third of prostate cancer patients, the disease recurs, becomes resistant to treatment, and spreads to other parts of the body.


--The five-year survival rate for men with cancer that has not spread outside the prostate or has just spread to nearby areas is almost 100 percent. But in patients whose cancer has spread to distant nodes or organs, the rate drops to 29 percent.

In the first stat, researchers have learned a certain breed of prostate cancer exists in which the cancer cells actually adapt to the treatment. For example, in the case of hormone treatments (HT) whereby female hormones are administered to suppress testosterone production ( testosterone being the 'fuel' that energizes prostate cancer cells) the cancer cells then begin making their own testosterone.

Even men who undergo the treatment believed to be the "gold standard" - radical protatectomy- aren't out of the 'woods' by any means. This surgery, now done to the tune of nearly 50,000 times a year (with lots of moola lining the pockets of the urologists who perform it) depends on a firm skill set and let's face it, innate talent, as measured by something called the "positive surgical margin".  This is the frequency, usually given as a percentage, of leaving cancer cells behind over a number of 'n' surgeries performed.

In 2004, Dr. Peter Scardino of Sloan Kettering Memorial published a study documenting the differences in success of radical prostatectomies base on the positive surgical margins for 26 urologists who performed the surgeries at Sloan Kettering and Baylor. His finding? The best surgeon in the group left cancer behind in 10% of cases. The positive margin rates of the other 25 surgeons ranged from 11% to 48%.  Meanwhile the much extolled da Vinci robotic surgery isn't any better with similar statistics and incontinence and impotence rates that equal or exceed those for non-robotic procedures.

Now, if the remnant cancer cells are there, were aggressive, and can metastasize, then what? In Barbados, we say the patient is in duck's guts. Now, in most cases the  cell pathology would have disclosed that a cancer is "high risk" and requires supplemental treatment. In this case, HT is given supplementally to radiation or surgery.  Because the cancer is fueled by the hormone testosterone, HT assumes the guise of treating the cancer with testosterone-blocking hormone therapies. But even so, the cancer cells can develop the ability to make their own hormone and learn to survive, giving the disease the ability to progress.

If it progresses, especially rapidly, the patient's time and hope will have run out. (Partial apologies to a certain brother "pastor" who has declared this cancer is the means "god" chose to rid the world of the "spiritually cancerous"  - he needs to take a good long look in the mirror!) Until relatively recently there was no further hope.

Then, in June of 2012, a funny thing happened - actually a serious event as reported in the June 2 San Francisco Chronicle online. Researchers at the University of California- San Francisco discontinued a clinical study they were conducting with a drug to treat advanced prostate cancer. They discontinued the trial because they discovered the drug (called Zytiga) showed such remarkably successful results that the researchers believed all the participants needed to benefit. So both the "control patients" (on a placebo) and non-controls used it.  Zytiga uses a mechanism that allows the drug to get inside the cancer cell and block it from making its own testosterone.

This is HUGE! It means that a means has been found to diminish the cancer cells' fuel supply and hence slow growth. The advanced cancer patients by dint of this drug therapy managed to get 5-6 more years of life. The downside?  Zytiga - and a 'sister drug' Xtandi-  still aren't effective for all patients.  According to Dr. Eric Small, deputy director of UCSF's Helen Diller Family Comprehensive Cancer Center and principal investigator of the project


"We're already seeing resistance to these agents. The outcomes are fairly predictable and bad. Our patients die."

Even those who do well will eventually develop resistance because the cancer cells adapt and learn how to survive on even a tiny bit of residual testosterone, Small said. Some patients simply don't respond at all. Either way, there's no way for doctors to know how a patient will respond until the resistance occurs.

"We don't know who these patients are or why or how to treat them," Small said.

According to the SF Chronicle piece:

"Small is the leader of the "dream team," which beat out 13 other competitors for the $10 million award. The team, selected by the nonprofit American Association for Cancer Research, involves more than 30 investigators at six West Coast institutions: UCSF, UCLA, UC Davis, UC Santa Cruz, the Oregon Health & Sciences University and the University of British Columbia.

The team will focus on identifying the pathways the cancer cells use to work around the current therapies and figure out ways to inhibit them using a combination of treatments to reach those escape routes in multiple ways. "

Since then some positive fruit has been borne as workers in the U.S. and the United Kingdom announced in two studies that they had identified separate "signatures" for prostate cancer that could better determine the aggressiveness of the disease and could be used to predict survival. The studies were published in the journal the Lancet Oncology . According to UCSF's Small:

"These signatures tell you you have high-risk cancer, but they don't tell you why and they don't tell you what to do with it. What we're going after is fundamentally different: try to understand the pathways that are involved in developing resistance and using co-targeting agents to treat it."

Congrats to Eric Small and his team for providing advanced prostate cancer patients with even a small ray of hope with the new drugs. But let's hope much more rapid strides are made and soon. Prostate cancer has nada to with any "spiritual cancer"  but with an actual, real biological-chemical pathway peculiar to the cancer cells. These cells aren't controlled by "demons" nor are the men in whose bodies they grow- whether believer or unbeliever- in any way responsible for them, nor did "god" design those cancer cells as a means to get unbelievers into a fictitious "hell" faster. Only screwballs that merit being tethered to an ECT machine for life would believe so.

Mail Call Brane - Readers Seeking Answers!

(Note all the following questions were received in 'comment' format but with the askee requesting no special comment space rather the question(s) collated into one blog ....this one!)

Q. President Obama in response to a question yesterday at his news conference stated that one can't be sure if superstorms such as Sandy are really caused by climate change. What is the take of the climate science community on this? - Roger B., Minneapolis, MN

A. This is a tricky question, and Obama can be forgiven for dodging it in a way at his press conference, because let's face it: most of the press corps possesses the attention span of gnats.

The truth is that one aspect of climate change does show a causal relation to the genesis of Superstorm Sandy. That is the phenomenon known as the North Atlantic Oscillation (NAO) and its geographical distribution at particular times of the year. The NAO embodies the atmospheric pressure over a particular region (in this case it was the U.S. northeast) and it can be either 'positive' or 'negative'. In the case of the latter, which was what we observed preparatory to Sandy's arrival, the jet stream displayed a pronounced southward dip. In a positive display the jet stream would have more straddled the higher latitudes (e.g. 45N) and not bent so far south.

Now, here's the kicker: research by Charles Greene at Cornell University and other climate scientists has shown that as more Arctic sea ice melts   e.g. in the summer because of global warming (as I noted before, see my blog of  Sept. 21) then the NAO is more likely to be negative, i.e. jet stream sloping way south. This condition then set the stage for a superstorm in two stages: 1) the warm Atlantic water off the eastern U.S. coast fed energy into the system, and 2) the encounter with the cold air ensconced in the southerly jet stream added the energy equivalent of 5 single megaton nuclear bombs to the system and dramatically expanded its reach - incepting the massive destruction we beheld.

We can predict then, that if northerly moving hurricanes become a more common feature, as does a continued negative NAO, then we will see more superstorms like Sandy. The east coast and its cities will then have to decide whether or not it will spend the money, as the UK has, to construct a massive system of dykes etc. to ward off the storm waters, waves. If not, we better have no more wars, because we're going to need all that money for constant rebuilding!

Q. Reading about your brother ('Fighting Cancer, Fighting Your Brother') I can't believe you had to put up with all his crap while you were recovering from prostate cancer! What gives with the dude? Is he 52 cards short of a full deck or just ornery or what? - Mitch C., Stanford, CA

A. Well, what would you think of a guy that once circulated an idea to put all atheists in the country on a "national registry" like sex offenders?  Granted, he had to be saved from himself (he received over 400 death threats via email from outraged atheists across the world) but all that meant is that he shut down the 'Pastor Mike' blog and started a new one ('Straight Talk with Mister Mike'). The bottom line is I don't know what his main problem is, but as I said in blogs from a few years ago, I suspect IF he has mental issues they arise from believing an insane fundamentalist brand of religion. His 'god' - if you can call it that, is totally batshit insane, since it has no problems allowing a son to be killed for mouthing off against parents - as per Deuteronomy 21;18-21, or adulterers (say like Petraeus and Broadwell) to be stoned to death by Deut. 22:22 or chldren to have wild bears set loose on them if they mock "prophets". (By 2 Kings 2: 23-24). Oh, his god also approves of genocide when it means "cleansing the earth" - as in Gen. with the slaughter of the Canaanites.

As I've said many times before, tell me the concept of god in which you believe, and thence the morality you uphold,  and I will forecast your odds of going nuts. Indeed, I can tell how much of a nut you already are. If you accept or believe in batshit crazy gods you will be a batshit crazy person, and likely end up in a straight jacket on thorazine, if not in some other horrendous end.

Q. I read your blogs on prostate cancer with great interest. My husband, age 43,  recently had a biopsy and it came back with four cores at Gleason 3+4. He's in a dilemma as to the treatment but as in your case, the urologist said watchful waiting wasn't an option. He dreads all the post-operative issues to do with surgery including difficulty with sexual relations, but isn't sure about radiation either, and doesn't want to face the prospect of having the cancer come back after having done the radiation. Any ideas, suggestions?  - Marilyn F., New Orleans, LA

A. In the end the choice of treatment is a highly personal one. Apart from the information already given in the blogs, I can only suggest he obtain the two books cited as well: 'The Invasion of the Prostate Snatchers' and John C. Mulhall's  'Saving Your Sex Life: A Guide for Men with Prostate Cancer". (Note: Dr. Mulhall is the Director of the Sexual & Reproductive Medicine Urology Service based at the Memorial Sloan- Kettering Cancer Center.) Mulhall's focus is also highly on the issue of "penile rehabilitation" : http://brane-space.blogspot.com/2012/10/penile-rehabilitiation-what-most-docs.html .

The aversion to post-op problems following surgery is understandable. Incontinence and erection problems are often mentioned (but the solutions to these were given in the blog link, based on Mulhall's book) but the acute or short term problems are also turn-offs for many men: including risk of infections, having a catheter inserted in the bladder for possibly as long as 3 weeks, coping with the pain, constipation arising from use of pain meds, and risk of rectal injury during bowel movements because the rectal wall becomes much thinner following surgery - after removal of the prostate which originally adjoined the rectum. All this is detailed in the UCSF Patient Guide for Radical Prostatectomy which also includes sections dealing with sexual recuperation, other treatments -meds for incontinence, etc.

I chose the high dose rate brachytherapy because: 1) I didn't wish to be laid up weeks with post-op difficulties or catheters, or bowel problems, 2) I didn't want to be possibly faced with months or years of incontinence limiting my travels, freedom, and 3) I didn't want to go to extraordinary lengths for "penile rehabilitation" including having to have an implant operation, or reduced to continually using Viagra, vacuum pumps or injections. But again, each man has to make his own choices!

Q. I found your blog on solar oblateness fascinating, and wondered if you would be so kind as to provide the oblateness formula for the planets from Earth outwards.to Neptune. Thanks! - Mick, Trenton, NJ

A. The oblateness formula depends on the planet's equatorial diameter, a and its polar diameter, b. Then:

f = (a - b)/ a

The values are as follows for Earth outwards to Neptune:

Earth: 1/ 298.257

Mars:  1/ 154.409

Jupiter: 0.06487

Saturn: 0.09796

Uranus:  0.02293

Neptune:  0.0171


Q. If your Aug. 22 blog on 'the biggest spy center on Earth' is to be believed, Gen. Petraeus had much to worry about churning out all those emails. Should he have known about this spook kingdom and how they can scoop up emails, tweets on a whim? Or was he just dumb? - Andy K.,  Tucson, AZ

A. I don't believe the general was 'dumb' but perhaps in the heat of his affair his brain cells didn't process that anything committed to cyberspace or that gets infused into the 'cloud' - is there for years for any spook to grab, save and see. In the blog you referenced, I specifically mentioned (from the cited WIRED piece, 'The Black Box'):

"The mammoth Bluffdale Center will have another important and far more secret role that until now has gone unrevealed. It is also critical for breaking codes. And code-breaking is crucial because of the data that the center will handle: financial information, stock transactions, business deals, foreign military and diplomatic secrets, confidential personal communications, legal documents and anything else initially heavily encrypted."

I also added:  "Everyone's a target, everybody with communications is a target."


So, it boggles the mind that Gen. Petraeus could have been that careless. Also, virtually anyone that spends any time on the net has to be aware that the FBI's "Carnivore" program - for ferreting out emails- is still in play. Also, the 4th amendment protections against extraordinary searches have essentially vanished since the critical provisions of the Patriot Act (mainly to do with wiretapping without the need for warrants) have been extended twice (by Democrats and Repubs - at least it's one thing they can agree on.)

My advice to anyone is that if you don't want the spooks to be amassing all your (saved) Facebook pages, blogs or tweets, then the best step is not to post them. If you don't care, it's no biggie. Btw, for those who want to learn more about the national security state we've erected (to keep us "safe") since 9/11 be sure to get hold of James Bamford's book: The Shadow Factory: The Ultra-Secret NSA from 9/11 to the Eavesdropping on America.