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Old 05-23-2012, 09:52 AM   #61
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Those stats certainly don't tell us that forgoing PSA tests is a tradeoff between ignorant bliss and long lived knowledge. As to the question that since we have been relying on these tests for years why change our practices based on a few studies, I would ask why not take advantage of better medical evidence?
What would you do if Dr did a digital exam and said your prostate feels a bit large, do you want a PSA test?
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Old 05-23-2012, 09:54 AM   #62
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I woulld like to hear from Rich also. Haven't seen (heard) from him in a while. It always seems like he can put an understanding to the situation. I just like way he always answered the posts.
More Prostate Info

More Prostate Info
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Old 05-23-2012, 10:04 AM   #63
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What would you do if Dr did a digital exam and said your prostate feels a bit large, do you want a PSA test?
Very good question and one I wondered about as well. I actually don't know how I would or should react. The article I referenced talked about DRE as still being a useful tool but it didn't address why and how to rationally use the information. For example, it mentioned DRE finding "bumps" but does that mean bumps are a more significant indicator than a simple enlarged prostate that most men develop? I don't know and will rely on my doctor's advice unless and until I think something else counsels ignoring that advice (e.g. as this recommendation does with respect to PSA screening).
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Old 05-23-2012, 10:14 AM   #64
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Very good question and one I wondered about as well. I actually don't know how I would or should react. The article I referenced talked about DRE as still being a useful tool but it didn't address why and how to rationally use the information. For example, it mentioned DRE finding "bumps" but does that mean bumps are a more significant indicator than a simple enlarged prostate that most men develop? I don't know and will rely on my doctor's advice unless and until I think something else counsels ignoring that advice (e.g. as this recommendation does with respect to PSA screening).
Don, no question its not a cut and dryed decision.

On a lighter side, I recall the individul that had a DRE from the Dr and was told your prostate is enlarged. He says to the Dr, I want a second opinion, so the Dr says bend over and I'll insert 2 fingers.
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Old 05-23-2012, 10:26 AM   #65
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There are more definative tests, like the Free PSA test which compares the ratio of free to total PSA, hopefully avoiding the dreaded prostate biopsy.

I got that t-shirt. Not really painful but oh the indignity!
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Old 05-23-2012, 02:17 PM   #66
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I should start off this post by promoting cheerful good news: studies have shown one of the best ways to avoid prostate cancer appears to be frequent sexual intercourse.
prostate health and ejaculation
Per the quote & link above, I think we are hiding the real jewel in this thread.

(I kid, I kid.....I know this is a serious topic and thread.... )

Also, DW reminds me that if the washing machine is broken, I can still wash a load or two by hand....
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Old 05-23-2012, 02:46 PM   #67
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Also, DW reminds me that if the washing machine is broken, I can still wash a load or two by hand....
How does that punch line go? Something like, "it was a small load so I did it by hand?"
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Old 05-23-2012, 03:00 PM   #68
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As I was having my breakfast this morning, which consists of prescription medication and orange juice, I happened upon the newspaper which contained an article of interest on the editorial page. Titled "Current prostate cancer protocol isn't the answer", it is by Dr. Virginia A. Moyer, head of the U.S. Preventive Services Task Force. It's pretty interesting reading and is where a lot of the remarks in the various posts came from. I think it is a must read for anybody that posted on this thread. It's right from the horses mouth. Try the US Preventive Services Task Force.psa
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Old 05-23-2012, 04:49 PM   #69
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Before this thread began, I used to get PSA anxiety just every 6 months.
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Old 05-24-2012, 08:35 AM   #70
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Very interesting discussion and great posts! Pc seems to be so prevelant lately, many friends have had it and I see many side effects of surgery. One friend had the seeds and now his PSA is 1200.

I have had roller coaster psa tests and dre's for years. I've had two biopsys and the first one was not very pleasant. My question to urelogist (I got two opinions) so if my psa goes up, how many times are you going to biopsy me, every year?

I do think eveyone has to make up there own mind on what is right for them. But I do believe that some doctors are over testing way to much. It is just hard to decide whats best for me, when you read the tests may not be accurate.

I have had way to many tests this year and everyone turned out to be negative. Many of these tests are dangerous and could have side effects and are costly.

One urologist did a dre and had very short fingers, I personally thought he should be a cardiologist. After that experience I found a new dr.
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Old 05-24-2012, 02:28 PM   #71
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Like Nords - I come from a family that lost the genetic dice roll when it comes to cancer. So that factors my opinion on this.

I do think family history should play a part. I'm female so I have ZERO risk of PC. But my cousin beat the odds by being fairly young (was 43 or so) when he had an elevated PSA, and it turned out to be cancer. He's fine after treatment. (And happily married for whatever that works... so it looks like no longterm issues from treatment.)

My dad had PC as his first cancer. Radiation treatment cured him. He was cancer free for another decade, remarried after my mom died, and I know more than a child should know that it did not effect his sex life. (He was so happy when he met my step mom.)

Unfortunately, he got a completely unrelated cancer, Multiple Myeloma.

My brother had melanoma stage 2 when he was in college, after skin grafts and a lymph node removal he was fine. He died at age 48 of an unrelated, very obscure, VERY aggressive Neuorendocrine Carcinoma.

My mother had normal CA125 levels and had raging ovarian cancer. She died age 67.

I flunked a blood occult test at age 41. Sigmoidascope turned up 7 pre-cancerous polyps - 2 were too big to get with the sigmoidascope so I got to go back for a colonoscopy. I'm now on the 5 year plan of colonoscopies. If I'd not had the blood occult test, they might not have found the polyps... I was a decade younger than the normal first colonoscopy.

3 of my 4 grandparents died of cancer. 2 were in their early 60's.

Because of all this I paid, out of my own pocket, for a BRCAA test. Negative thank goodness. Money well spent for peace of mind.

My HMO has guidelines that suggest mammogram every 5 years and pap every 5. But for me- they have me come in every year. My doctor was smart enough to recognize a family pattern.

One of my big reasons for wanting to retire early is because of my mom's age at death, as well as my paternal grandmother (breast cancer, age 63), paternal grandfather (age 72 lung cancer) , and maternal grandfather (age 71 leukemia). I budget for age 100, but realistically know I'll be lucky to make 80.

Statistics are great in general... but specific family history to should be considered as well.
I'll keep getting my mamogram, pap, and colonoscopies. I'd rather catch it early than late.
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Old 05-24-2012, 08:25 PM   #72
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Q. How's that thing of not posting on controversial health topics going for you, Al?
A. Not well.
Well diagnosed, Al.

Ha
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Old 05-24-2012, 09:26 PM   #73
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My question to urelogist (I got two opinions) so if my psa goes up, how many times are you going to biopsy me, every year?
That's the thing. DH started getting somewhat high PSAs in his mid 50s. He followed up on on it with the urologist every time. Several times it seemed to be prostatitis and antibiotics helped. A couple of times he did the biopsy and it was negative. He's 64 now and at his last physical once again had a higher than normal PSA so, once again, they told him to see the urologist. That was several months ago and he hasn't gone as from his experience he always has a high PSA and it is never anything. That said -- I do realize that this time it really could be something. He says he will go to the urologist but just hasn't been in a hurry to do it.
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Old 05-24-2012, 11:31 PM   #74
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PSA = Patient Specific Anxiety
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Old 05-25-2012, 01:07 AM   #75
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If you truly understand what a Gleason score means, your opinion on this topic will be forever changed.

Does anyone understand that a Gleason 4+3=7 is 3x more aggressive than a 3+4=7 ?

Once you have personal experience with what a Gleason 9 means to your future, your thoughts on screening will adjust.

B
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Old 05-25-2012, 11:41 AM   #76
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If you truly understand what a Gleason score means, your opinion on this topic will be forever changed.

Does anyone understand that a Gleason 4+3=7 is 3x more aggressive than a 3+4=7 ?

Once you have personal experience with what a Gleason 9 means to your future, your thoughts on screening will adjust.

B
I agree, your comments on Gleason represent having real personal knowledge versus some Yahoo sponsored news article hype and can really affect the quality of the person's decisions making.

But this thread seems more about, "I'd rather not know, versus I want to know.".
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Old 05-25-2012, 12:26 PM   #77
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But this thread seems more about, "I'd rather not know, versus I want to know.".
I'd rather not know when the economy is crashing either, but I should know it.

Anyone who has a Gleason 4+3 or higher should know, because those are the kind that will advance and kill you if untreated.
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Old 05-27-2012, 05:46 PM   #78
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Is this recommendation an example of "evidence-based medicine?" We're not used to that! Isn't evidence-based medicine Rich's specialty/passion?
Hi, all. Just for the record, I agree with the task force findings and recommendations. And I have had the same opinion for decades given the iffy quality of prior studies.

When the number and percentile of false positive results is large, the diagnostic tests potentially dangerous (e.g. prostate biopsy), and the presence of other serious diseases high (as it is in older men), recommendations to screen readily had best be given with great discretion.

It's all about Bayes Theorem, but that's another thread.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Old 05-27-2012, 07:17 PM   #79
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Rich, thanks for that update.
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Old 05-27-2012, 08:04 PM   #80
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Hey Rich, glad to hear from you and thanks for the post on this subject. I am really following my brothers case and wonder about the future for him. I guess it was about six weeks ago he had his prostate removed using the DaVinci robotic surgery. He went home the next day. As far as he knows there is no further treatment planned. Your post kind of settles it for me. Case closed.
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