Prostate Cancer Taskforce Finding

[bentley]

Quote:

Originally Posted by bbbamI Without the regular prostate screening, (PSA) my DH would probably be close to death by now. Even though he's been treated for PCa, he could still die from it. But it gives him a fighting chance to live longer.

More than most posters here, I appreciate your comments. I was 57 at first diagnosis of PCa. My psa was less than 3, however it had risen to 2.93, from 2.26 a year earlier, both tests from routine annual physical. Family doc did a DRE and felt nothing. Said that we would watch it next year. This continued to bug me for the next few days, so after doing a little research, I called family doc, and asked for a "free psa" test. Doc agreed...and free psa test indicated all was not well.....this all prompted a visit to my urologist. He reviewed data, and said....we'll check it in 4 months, but first, I want to do a DRE. I told him that had just been done a week earlier, but he insisted. Guess what?....he felt a nodule on right side pf prostate.

Went for biopsy, which proved that prostate was 60% cancerous. But that wasn't the worst news. It was a Gleason 4+5=9 Major issue.

Uro recommended a prostatectomy. I asked him how this would evolve were I to do nothing. His profound statement was that within a year, I would have metastatic PCa, and within 3, I would be dead.

Obviously, these predictions were only his opinion, but he wouldn't have missed it much if at all.

Psa is painless and cheap, yet is just one indicator. There are others.
Prostatectomy surgery is not fun, but is manageable. I have no problems at all with urine control.

However I lost both nerves in the surgery. And there are a number of methods of dealing with that as well.

I would encourage every man to get his psa tested a couple of times during his 40's, and annually from 50 on.

[bbbamI]

Bless your heart bentley...a Gleason 9. ...sigh....

I think the misconception of PCa is it's always slow growing...as you and I know, that is not the case.

Yes...here's to regular PSA tests and to you and DH living many more years.

[bbbamI]

Quote:

Originally Posted by donheff I am sorry to hear about this bbbamI. I know a couple of people in a similar situation who feel the same and I am glad for them and for your husband that they caught it. But for the rest of us the question still remains should we risk biposies and treatment for cancers that would almost undoubtedly not cause us grief (with attendant risks and side effects) to avoid the small chance that we would die? If we lose that bet we will regret it but it may still be the preferable bet for many of us.

Ahhhh...don...I can't tell a man what he should do.

I suppose since I've been thru hell and back, I'm rather fixated on my experience.

When push comes to shove, the decision has to be yours. I wish you all good health and a long happy life.

[Zero]

My feeling is I want the PSA testing and DRE done yearly, when given the information I will ask questions, collect information and try to become Vulcan-like. But at least I have the info. Now, when I get about 70, I may stop all testing, period.

On that note, I have plenty of older friends who rarely, if ever, even get a physical and they seem to be doing just fine. I also had several relatives in rural places who had almost never seen doctors and all lived pretty long lives.

EDIT: Thought I would add this Prostate Cancer Forum, very informative and they are also having a few words about this latest PSA recommendation.

[Zero]

Heck, I'm curious, have any major cancer hospitals like Sloan-Kettering, Johns Hopkins, Mayo Clinic or MD Anderson in Houston, come out to support NOT testing for PSA.

One certain way to cut healthcare costs is not to do healthcare. Cutting our mammograms, PSA, PAP smears, Diabetes testing, blood pressure testing and colonoscopies would certainly reduce testing costs. Now the next logical step would be to reduce healthcare costs is to let everything just progress naturally, not treating either.

The message is essentially: "the number of lives lost by not PSA testing is not worth the cost of the testing.".

[tjscott0]

Quote:

One thing about screenings that I always wonder about is that all the recommendations come from a group comprised entirely of those that benefit economically from the tests: product manufacturers and specialized doctors. Do nothing or do simpler tests would be a severe blow their core business.

I recommend you read any of Dr /Nortin Hadler's books.

He talks about the medicalization of the aging process. That to be "well" is not to be without symptoms of morbidity. It is abnormal escape heartburn, heartache, headache, or backache. That to be well is being able to cope with morbidity.

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Medicalization is the process by which the morbidity is framed by the personas a medical iliness for which medical treatment could or should be sought. Medicaliztion superimposes a scientific idiom of distress on the common sense. Common sense is n ot common.....it is a sense that is highly susceptible presuppositions, magical thinking, and market pressure. to

He introduced me to the concept of Type II Medical Malpractice.

Quote:

Type II meical malpractice is doing something to patients very well that is not needed in the first place.

I would also recommend reading "Overtreated" by Shannon Brownlee.

She tells the story of how the federal gov't attempted to drive down doctor fee costs in the medicare program. The federal & state gov't ramped up medical education spending. By 1973 they had double the number of medical school graduates being produced annually. Doctors, being very smart, 1) started becoming specialists in higher numbers as the fees were greater or 2)provide more health care to their patients generating more income. Remember medicare isn't market based. It pays however much treatment is provided. And as a third party is paying; the patient could care less what the ost is.

[lightspeed]

There is no doubt there are men who are diagnosed with prostate who are treated that never needed it. The problem is identifying who needs treatment and who doesn't. Doctors have to make a best guess based on the aggressiveness of the prostate cancer, how fast the psa is rising, the man's overall health and life expectancy. No doctor in the US wants to tell a man he does not need treatment than have it show up metastatic in the bones 10 years later.

Prostate cancer deaths, or lack of impact on prostate cancer deaths, is the wrong endpoint. How many patients who do not get screened develop a significant prostate cancer and subsequently go on androgen deprivation therapy (chemical castration) would be a better measure. These men that are missed having early prostate cancer and present with more advance stages still may die of something else but have poor quality of life.

There was a time when we did not have the PSA for screening. Men would be diagnosed with prostate cancer after it grew so bulky in the prostate it was incurable, or invaded the bladder and rectum, or spread to the bones and lymph nodes. Maybe to reduce healthcare spending, we should go back to those days and when patients show up like that, castrate them (much cheaper than chemical castration with drugs).

[tjscott0]

Quote:

There is no doubt there are men who are diagnosed with prostate who are treated that never needed it. The problem is identifying who needs treatment and who doesn't. Doctors have to make a best guess based on the aggressiveness of the prostate cancer, how fast the psa is rising, the man's overall health and life expectancy.

Due to malpractice attorneys; I think doctor will err on the side of aggressive treatment.

Low-risk prostate cancer treated aggressively | Reuters

Quote:

Many men with low-risk prostate cancer get aggressive treatment, increasing the risk of serious side effects, U.S. researchers said on Monday. They said more than 40 percent of men who fell below the current standard for getting a biopsy had their prostates removed surgically, and a third had radiation therapy. They argue that current efforts to lower the threshold of what is considered an abnormal prostate cancer screening test would add significantly to the number of men who are overtreated for cancers that might never harm them.

[TromboneAl]

To anyone who feels that the PSA saved his life (or the life of a friend or spouse), it probably did, and you should be grateful.

But here's the part that most people cannot seem to understand: A test which involved a flip of a coin could also save your life. If by random selection, you were chosen to get a biopsy, and cancer were detected, your life could be saved. But the problem is that the PSA isn't much better than a flip of the coin, so it results in unnecessary risk to those who do not have cancer (or have the slow-growing type).

Quote:

The message is essentially: "the number of lives lost by not PSA testing is not worth the cost of the testing.".

You meant "The number of lives saved by PSA testing is not worth the cost of the testing."

But that is clearly not the message, unless by "cost" you mean the cost in lives and life-changing injuries.

Lives saved < Lives lost + Injuries sustained

Another way:

For 3,000 men tested:

3 will have their lives extended
1 will die
129 will have a permanent life-changing injury.

[lightspeed]

Quote:

Originally Posted by tjscott0 For 3,000 men tested: 3 will have their lives extended 1 will die 129 will have a permanent life-changing injury.

True, but the more important question is what happens to the men who are not screened and diagnosed with early prostate cancer. Not the number of prostate cancer deaths, which is the only endpoint evaluated in these studies, but...
--how many unscreened men show up with advanced, incurable prostate cancer and go on androgen deprivation?
--what is the quality of life in patients presenting with advanced prostate cancer living the rest of his life on androgen deprivation?

[lightspeed]

Quote:

Originally Posted by tjscott0 Due to malpractice attorneys; I think doctor will err on the side of aggressive treatment.

Totally agree. Watchful waiting is much better accepted in some of the European nations, by patients and doctors. Doctors in ALL European countries rarely get sued. The average medical student graduating in the US today will get sued 3 times in his or her career. And those law suits, even if the doc is not successfully sued, last years and are very demoralizing, maybe practice ending. The malpractice cost for a doctor in France, Germany for an entire year is what the malpractice cost for a doc in the U.S. of the same specialty for a week. But this is thread drift....

[grasshopper]

I have blood drawn for my annual physical every year, why not include a PSA.

[TromboneAl]

Quote:

Originally Posted by grasshopper I have blood drawn for my annual physical every year, why not include a PSA?

A. Because chances are it will do you more harm than good.
Q. How can getting more information do me harm?
A. Because the information is unreliable.
Q. Well I'd rather know than not know.
A. You will not "know" based on the PSA score, you will only "maybe know."
Q. Well that's better than not knowing, isn't it?
A. No, because it may lead you down a dangerous road.
Q. Well, I'll decide that after I get the PSA result, isn't that best?
A. No, because at that point you will not be able to make a rational decision.
Q. What's the worse that could happen just by my getting my PSA?
A. You could spend your life impotent and wearing a diaper even though you never had a type of cancer that would have ever done you any harm.
Q. How's that thing of not posting on controversial health topics going for you, Al?
A. Not well.

[JOHNNIE36]

Really some interesting reading and thought provoking questions, which I will leave for my doctor. At present, I have never had an elevated psa blood test. My doctor insists on a digital exam also, saying the psa test is not conclusive on it own. At age 76, my doctor says we will continue the annual psa test along with the other normal blood checks and the digital exam. If something turns up, we wll address it at that time. At my age he would be leaning toward doing nothing and so would I.

My brother just underwent robotic surgery for removal of the prostate. At this time it's not been determined if additional treatment is necessary.

[BigNick]

Quote:

Originally Posted by tjscott0 Due to malpractice attorneys; I think doctor will err on the side of aggressive treatment.

That; plus the economic interests of all the billable treatments; plus the fact that patients don't want to get cancer, because the guys with cancer are visible, unlike the 40,000-100,000 (take your pick) Americans who die in hospital each year from something that they didn't go in with.

Oh, and plus the fact that the majority of medical professionals don't understand (or, in some cases, have never heard of) Bayes' Theorem.

[Mulligan]

Quote:

Originally Posted by JOHNNIE36 Really some interesting reading and thought provoking questions, which I will leave for my doctor. At present, I have never had an elevated psa blood test. My doctor insists on a digital exam also, saying the psa test is not conclusive on it own. At age 76, my doctor says we will continue the annual psa test along with the other normal blood checks and the digital exam. If something turns up, we wll address it at that time. At my age he would be leaning toward doing nothing and so would I. My brother just underwent robotic surgery for removal of the prostate. At this time it's not been determined if additional treatment is necessary.

As I mentioned in a previous post, I am in the camp of not wanting to get tested. Right or wrong I am worried about a wrong decision than finding out. I have read that something near 70-80% of men over 80 had prostate cancer at death, but did not die from it. I wonder if my current age is clouding my perception. At 47 now, I would be thrilled to know I had the opportunity to live to be 76. But once Im in my 70s Im sure I would want to live into my 80s. I wonder if I suffer from some leftover teenage invincibility ideas in my head that this will not happen to me. I know I don't want to even do the test, but I also fall into Al's line of thinking that I will make poor decisions with the information and would have been better off to not know at all.

[Zero]

Rereading that article, I really wish Rich-In-Tampa would address this assertion.

"The problem is that even with staging and grading of tissue samples, there is no way to know for sure which cancers detected through screening are likely to kill a man and which could be left untreated and unnoticed for decades."

I cannot believe that is true.

[donheff]

I suspect that many of us who are inclined to forgo the tests at this point are also in the camp that would carefully evaluate the likelihood of significantly extending quality life years before agreeing to aggressive treatment of illnesses like lung cancer. For some of us, nothing seems worse than death, for others extending a miserable life (or needlessly imposing misery) weighs heavier on our minds. Neither side is right or wrong.

[tjscott0]

Quote:

I wonder if I suffer from some leftover teenage invincibility ideas in my head that this will not happen to me.

Yeah I don't feel much different than when I was 18. But it always startles me went I see that 61 yr old fart staring back at me in the bathroom mirror.<LOL>

More & more as time passes; I catch myself saying to myself "I used to be able to do do that."<G>

[Zero]

Quote:

Originally Posted by donheff I suspect that many of us who are inclined to forgo the tests at this point are also in the camp that would carefully evaluate the likelihood of significantly extending quality life years before agreeing to aggressive treatment of illnesses like lung cancer. For some of us, nothing seems worse than death, for others extending a miserable life (or needlessly imposing misery) weighs heavier on our minds. Neither side is right or wrong.

Hey, you must be talking to my best friend, he asked me the same question yesterday. His question was; "5 years of blissfully unaware life doing what you like, versus 15 years of knowledge of health issues and fighting to stay alive one more year."