SirBillybob

The team Captain & Shanilya.

Thanks for clarifying the bridging steps between PSA screening and intervention decisions which I expect were challenging but worked out given the findings. Had your brother with relapse had prostatectomy yet eventual metastasis? I think yes, since you indicated surgery. Has your brother opting for surveillance had to endure the invasiveness of multiple biopsies over time for progressive decision-making? Any of you had MRI steps for detection alone or for imagery-guided biopsy?

As the article underscores, some things evolve and call for adaptation.

Got that right. Too busy and distracted, like paying municipal, provincial, federal, and sales taxes.

It would have to be much more blunt, hence veering towards impolite, but you appear to have that style down. I think enough readers got it to my satisfaction.

This idea, TasP, is underscored repeatedly on this chat board. I think that U=U had its rightful place in the lexicon but it’s a challenge to replace it with something as pithy but more clinically accurate. “Undetectable” is progressively more and more a misnomer because the guidance is shifting towards thresholds of viral load, higher viral burden by volume denominators, that would never have been categorized as below previously defined limits of viral quantification. Paradoxically, this type of advance may create more anxiety because it’s natural to mentally couple degree of risk with how many viral particles are bombarding one’s mucosal tissue. But I think the psychological burden regarding risk attenuation measures appropriately rests more on the seronegative. I would be inclined to label myself as annoyingly needy and entitled if I required a guarantee that my uptake of contextually driven PrEP plus condoms could be relaxed. One associated upshot of my playbook is that I only have to be intimate with men that accept the value of multiple prophylaxis measures that benefit both. This position could be considered as virtue-signalling but for the fact that prophylaxis makes sex hotter for me. That’s more luck than anything. Otherwise I might end up resenting men that enhance the chain of STI transmission by putting at risk sexual partners we may happen to have in common. My only resentment is by proxy with respect to the vulnerable, as it’s not rocket science to maintain sexual health.

What could be more valuable than early detection of anything serious if early intervention has an impact? What I read from the OP’s account was a leap from an elevated PSA to surgical prostatectomy. If anybody thinks that such a clinical approach taken today, opined with certitude by one’s physician without other factors considered, is living under a rock, not through their own fault mind you, with said incompetent completely not up to date practitioner. I don’t know if that was the actual trajectory and an elaboration may yet occur. PSA alone is not diagnostic wrt cancer. The point about thorough individualized consultative screening is of course golden. My thousands of dollars spent out of pocket on surveillance isn’t regrettable to me due to my socioeconomic status. I’m able to ease the burden on public surveillance resources. However, intervention wait times, owing to resource access difficulty, also play a key role in cancer stage progression. I would be screwed there. It’s a shame that invasive surgery in some cases supplants effective more ideal measures categorically known as needed and applied in a timely fashion. The current need, boomer factors included, already translates to a leadened systemic burden. Earlier detection won’t solve who gets what when. I feel for anybody whose test results propel them into the caprice of the treatment realm.

In other breaking news related to hockey it looks like there may be some legit concern that the arena under prep in Milan won’t be satisfactorily ready for the Olympics. Do we want Reid backed into a corner writing steamy construction site scenes over the previous trend of relatively upscale locker room trysts?

At least in those cases, not rare for me, I don’t have to pursue either BFE or GFE. I would do poorly on my side of either of those dynamics. Arousal, orgasm, peace out it is.

The best way for me to accommodate admin input here is to express value for the topic theme while generously according to you some benefit of doubt. By that I also mean your word is final, for sake of peace.

If it’s already framed as human nature, normative, for the idea of various levels of others’ attachments to influence our subjective sense of relative worth or personal mojo, or alternatively have no bearing on the dynamics of transactional intimacy, what’s the point of a type of survey about it? Day to day pedestrian interactional affect and a categorizing of some relatability to jealousy versus none at all is the most likely thread yield. The topic is interesting to the degree that somebody chimes in with a description of being monstrously jealous, of being delusional about expectations to feel uniquely special. Anyone … ? No judgement on this board.

I, too, read both of Kelly Grant’s related prostate screening articles this year, as well as Dr Wilkinson's editorial and valiantly plowed through the extremely detailed epidemiology Wilkinson’s team published in oncology. It’s exhausting because it’s decades of data stratified by multiple age groups, cancer stages, survival, and mortality along with temporal sequences of cancer intervention stages. By the way, all the data are confounded by about 50% of men above age 50 with “opportunistic” uptake of PSA screening in spite of no recommendation for it. A lot of cancer is detected through routine PSA screening that transcends recommendations against such screening. Therefore, pro-con screening guideline alterations over decades' span are not a great independent variable for predicting clinical outcomes when half of men are behaviourally contrarian along with physicians erring on caution's side against a simple reductionist argument that too few deaths are prevented by too vast a number needed to screen per averted mortality. The actual testing data are not integrated into cancer surveillance registries and the dissonance between formal testing guidelines and testing reality at various points in time is unknown. The ratio of stage 4 cancer diagnosed due to non-screening that results in insidious under-radar progression and due to screening that colours outside the guidelines is unclear. An abrupt shift in the sands regarding guidelines was never going to eliminate pro-screening trends that existed previously. Like most journalists, Grant aims to get views from those with clinical expertise that often contradict, or present both sides of a topic. While there seems to be merit in reviewing and revising screening guidelines, one of the main areas of pushback against expanding PSA screening, following its systematic reduction within health protection recommendations some time ago, is cases wherein an elevated PSA is followed by radical intervention, leapfrogging over post-PSA intermediate steps. Naturally, removal of one’s prostate based on a PSA level alone will reduce or eliminate prostate cancer risk irrespective of whether cancer would have occurred. What is unclear about your prostate screening and intervention history is whether there were other diagnostic measures taken prior to prostatectomy. I am not referring to family history or the comparator of a male sibling. Those are not diagnostic but may reinforce a past surgical decision. Clinicians pushing back against certain revision recommendations are not attempting to undermine patient autonomy. Rather, a desire to circumvent unnecessary more extreme interventions that lead to poor outcomes outside of the binary of any grade of cancer or no cancer. If you had no diagnostic assessment between PSA and surgery yet you are fine with it, that acceptance does not alleviate the concerns posed about unnecessarily aggressive and invasive measures by clinician subsets wishing to constrain and temper screening revisions in spite of the morbidity and mortality tracking that currently steers recommendations for screening revision. Your personal anecdote is more meaningful and supportive of current screening revisions if your personal case details included inarguable evidence of true malignancy, not merely theoretically forecasted aggressive cancer. Anybody can put forward an anecdote. My elevated PSA levels commenced over a decade ago. I have, nevertheless, had no biopsy done. Biopsy can miss cancer so once you scale up diagnostic screening at that degree you risk repeated screening at invasive levels, potentially submitting to a regularity of biopsies that begins to mirror the frequency of PSA levels over time when younger. My prostate/ bladder MRI roughly bi-annually for 10 years, out of pocket cost, stable PI-RADS score of 2 on 1-5 scale. PSA screening did nothing for me but impel regular imaging that assuages concerns based on PSA interpretation. My cancer outcome is the same as preventive, but possibly premature, prostatectomy yet intact prostate and avoidance of pelvic nerve plexus trauma. I am happy to be alive with a non-cancerous prostate. There’s that. No point begrudging anyone a choice either way if the goal is no chance of site anatomically specific cancer that may or may not contribute to all-cause mortality for the individual. Postponing death that might have occurred and maintaining prostate gland function whose loss might have been averted are two values-specific factors hanging in the balance. My case supports revisions in PSA screening accompanied by far more expensive and difficult to access diagnostic procedures, short of tissue pathology, or inclusive of needle biopsy. It cannot easily fly within a public coffers funding model. My case also supports historically zero screening, for me, and for others never screened yet not having been affected by non-testing. The fly in the ointment is that in this clinical domain you can’t eliminate the risk of the associated medically iatrogenic by scaling up disease detection. Hence, tension between clinical opinion factions, attempting to reconcile the pros and cons of screening with morbidity and mortality data pit against do-no-harm concepts anchored in the true existence of needless invasive diagnostic and surgical harm. It’s difficult to portend the outcome of expanded PSA screening access on the future direction of morbidity and mortality because it would be egregious to withhold the costly components of a far more sophisticated diagnostic decision tree these days compared to a time when radical prostatectomy was more the default … getting that thing out instead of waiting for its eventual short- or long-term status.

Whatever makes you less bitter about disagreement related to the worth of something.

Ep3 script spoiler alert …

I don’t need or want to hire that way. Some things are simply anachronistic for a reason. I’ve had no brushes with trade passing through, though I understand the effort and occupational vicissitudes associated with this model. Guest strippers, though, a different matter.

You can meet the Nova Scotian author in Bangor Maine in May. There may, however, be less banging than on pages and screens.

A toast …

Ouch, $580. Now that’s attitude at altitude.

Without prejudice, careful what you ask for.

Interesting read on overlooked single senior male social isolation. I hope I circumvented the paywall for readers here; apparently I can share a few articles based on my subscription. https://www.theglobeandmail.com/gift/d24329df22effd948451188cd4a53720da09a01320d2d0c6ab7108defc139af0/7CQMOFQXKVHQ3H57LDSUOPHHF4

Whose success where $$ and pleasure intersect? The true definition of mutual success is hard enough to fuck all holes at earth-moving levels but not hard to unearth. Orientation to me is merely any colour’s angle of entry.

With Wagner Moura in title role. Sold out weeks ahead in my city’s annual Brazilian film fest in November so I missed it. But opens now in general release select theatres including my city to which I return imminently following international travel.

If Rentmen disappeared that would not have one iota of influence on the abundance of worthwhile transactional sexual intimacy with a range of candidates in which I regularly engage. Rentmen to me is a perfect example of context in which what can actually be satisfactorily obtained in other ways contrasts with the importuning of hordes of ad platform labourers seeking payment for time. The modest costs of subscriptions simply yield reinforcement of such a longstanding impression as well as the benefits of being steered towards utilizing one’s time to plan accordingly for alternative hire sources. YMMV and I’m glad it serves a purpose for some. BTW, if anybody these days finds himself in need of invoking the law regarding some kind of clinical disease transmission statute he simply had not gone about the transactional sexual hire, it’s screening and in-person behavioural components, correctly.

As I’ve indicated, my hires consistently present condoms by default in the absence of awareness of my asks. They do so because they have the apparent audacity to think they are the most clinically informed and wise among us. I am unaware of their degree of flexibility on the matter because it would be bad form as a transactional employer, usually a guest in a different world region, to imply some degree of intellectual inferiority on their part in relation to best practices, to undermine systematized programs geared to recommended disease prevention methods, or to merge higher levels of calculated occupational disease risks with the imperative of their well deserved fruits of honestly waged labour. What an ordeal, though, to suffer through love-gloved anal reception of gorgeous studs while crying for my mommy, or through the deprivation of protected anal insertion while enthusiastically thanking mommy for my existence as well as those of the hunks bent over in front of me for theirs.

An observation or a requirement?