Survivor guilt (?)

Sorry for the mix-up. I know a little Russian, so I can puzzle out a few words in other Slavic languages as well (Czech, BCS, etc). I'd still love to see the original saying.

I know that in Russian, красный came to mean "red" as well as the original Slavic "beautiful", so the positive association sort-of tracks.

OK - here we go : "Žuti žutuju, a crveni putuju" lol

I haven’t experienced survivors guilt.

I was diagnosed with prostate cancer in 2012, was on active surveillance for 9 years, had proton radiation + ADT in 2021, and now just do periodic PSA tests.

I told my 3 brothers (2 older, 1 younger) about PSA testing when I was diagnosed 12 years ago. None of them took it very seriously.

Then, in August 2024 my older brother was diagnosed with pancreatic cancer. He died 2-1/2 months later.

My thinking is that people die for a variety of reasons. (“death and taxes.”). No reason to suffer from survivors guilt about that. The best you can do is to appreciate life and keep looking forward. Enjoy life!

(Something that I did look into during my brother’s final days, was the mortality rate of various cancers in men - once diagnosed, what % eventually die of that cancer? Using 2023 data, I created the attached spreadsheet.)

To say that it is “…just dumb luck” seems to bypass the possibility that life has its own agenda and it isn’t ours. Still, “luck” seems to acknowledge and name something we don’t fully understand. I hope you continue to have “dumb luck” as part of your journey…

Pretty cool, Brian…so what the hell are we all worried about??
I always say that I wouldn’t trade my ‘stuff’ for anyone else’s and your spreadsheet really illustrates this point perfectly! Thanks!

That's a great spreadsheet, but it combines all prostate cancer cases into a single bucket.

The challenge with PCa is that the vast majority of cases are slow moving (cancers can you die "with" instead of "of"). However, the aggressive minority can be *very* aggressive. If you already know you have the aggressive variety (e.g. it has metastasised or has a Gleason score of 8 or 9) then you're in a different cohort, and that 11.79% no longer applies to you.

The good news (yes, there is good news) is that that's not a death sentence either, like it often was a decade ago. With new treatments like the -lutamides, doublet/triplet therapy, etc., we may actually get the death rate from advanced cancer down to below 12% too in the near future as well. Fingers crossed.

True, although I would refuse to believe in a god who doles out special favours like surviving cancer only to those who beg and plead through prayer and denies those favours to others, or who has a cruel, complicated divine plan that involves killing millions of innocent people in wars, for example.

As pantheist, I prefer to believe in a caring deity who doesn't interfere in the physical world — it's up to humans to make the best of it or mess it up, as the case may be — but who is there to provide comfort and solace if we reach out and ask for it.

That, unfortunately, takes me back to "dumb luck" for my good response to cancer treatment so far. 🙂 YMMV

Yes - That’s the reason why early and annual PSA screening, and early detection is so important. I doubt if there are all that many aggressive, metastatic, Gleason score 8/9 prostate cancers at 45y/o.

No doubt there is “early” and “advanced” disease in most of those other cancer types as well. (My brother already had advanced pancreatic cancer when it was detected. They gave him up to a year to live; he didn’t last 3 months.)

While screening can sometimes catch the very aggressive kind in time, I've read that it can often develop and metastasise in the year between annual screenings. It's almost a different disease: my oncologist told me it represents about 1 in 20 prostate cancer cases, and most typically appears in people of African or Caribbean ancestry (which I'm not).

In my case, there was was nothing visible in my prostate. They were trying to figure out where the metastasis on my spine had come from, and CT and MRI showed a perfectly-normal prostate with no signs of tumours and normal volume. After the tumour biopsy showed prostatic origin, they gave me a DRE, and the urologist thought -- just, maybe, not sure -- he *might* have felt a tiny nodule, but he didn't sound too confident.

In my case, that sucker just escaped the prostate almost as soon as it was born and made a beeline for my spine. That's what I mean by two different diseases ­— with the really aggressive kind, you might not have the luxury of years, or even months, to catch it early. And just coincidentally, for a week I was sharing a hospital room with an army vet (also not of African or Caribbean ancestry) who'd had the same experience: he was getting annual PSA screenings, and his prostate cancer just appeared out of nowhere and almost instantly metastasised.

Fortunately, the cases where “… it can often develop and metastasize in the year between annual screenings…” are so rare that it wouldn’t even make the evening news.

That’s also the reason why when PSA is being tested, both the % Free PSA and the PSA Doubling Time should also be tracked. Those additional datapoints may give an indication that something more serious might be lurking unseen that the PSA test might be missing. Also, these days there’s a PSE test that can be used that is more sensitive than the standard PSA test.

As for the DRE, these days many centers are moving away from that. The data show that if an irregular prostate is felt, that 50% of the time it’s benign; and of the 50% that were cancerous, 95% of the time an MRI would’ve picked that up anyway. (So, the value of DREs is being questioned these days, especially since many men are skipping PSA tests just to avoid getting a DRE.) If an elevated PSA is found, and other possibilities are ruled out, then go straight to the mpMRI,

How old were you when you were initially diagnosed with prostate cancer?