Prostate Cancer Taskforce Finding

[Zero]

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.".

 

[lightspeed]

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.

 

[Rich_by_the_Bay]

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.

 

[MichaelB]

Rich, thanks for that update.

 

[JOHNNIE36]

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.

 

[Mulligan]

I read an article yesterday that was interesting as I never knew the historical genesis of the test. One of the pioneers who helped develop the test said it originally was developed to help monitor patients who already had been diagnosed with PC. It was then turned into using as a screening device without any actual studies to prove its merit in that area. Needless to say he also was in support of the committees recommendation, too.

 

[Born2glf]

I had PSA test starting at age 45 was always good till I turned 51 ended up with cancer and removed the prostate. Test came back 50% of the prostate had cancer in it. So I personally think the PSA saved my life.

 

[lightspeed]

I had PSA test starting at age 45 was always good till I turned 51 ended up with cancer and removed the prostate. Test came back 50% of the prostate had cancer in it. So I personally think the PSA saved my life.

The benefit of prostate cancer treatment seems to be more apparent in men with higher risk (and higher volume) disease who have a life expectancy of at least 10-12 years, so you made a good decision.

 

[Rich_by_the_Bay]

I had PSA test starting at age 45 was always good till I turned 51 ended up with cancer and removed the prostate. Test came back 50% of the prostate had cancer in it. So I personally think the PSA saved my life.

Glad it worked out well for you.

In others the biopsy may have been negative for cancer, a false positive. Or the disease would have remained dormant til a ripe old age without treatment. Or the biopsy itself may have caused sepsis or other serious side-effects. Or the biopsy may have been negative yet the patient gets diagnosed with advanced prostate cancer a year later.

We need a more accurate test than PSA. It is probably harming more low risk patients than it is helping.

 

[Disappointed]

Glad it worked out well for you.

In others the biopsy may have been negative for cancer, a false positive. Or the disease would have remained dormant til a ripe old age without treatment. Or the biopsy itself may have caused sepsis or other serious side-effects. Or the biopsy may have been negative yet the patient gets diagnosed with advanced prostate cancer a year later.

We need a more accurate test than PSA. It is probably harming more low risk patients than it is helping.

How about the PCA3plus and the new test from City of Hope?

http://www.nccn.com/type-of-cancer/prostate-cancer/264.html

https://www.bostwicklaboratories.co...ory-services/urologic-pathology/pca3plus.aspx

 

[lightspeed]

It would be nice if any test that replaced PSA predicted Gleason Sum, because you can't really decide if watchful waiting is an option without it, so it still might lead to unnecessary biopsies. The other peice of information missing without a physical biopsy is the number of cores/% of tissue involved with cancer. Someone with 12/12 cores of Gleason 6 is probably not a watchful waiting candidate, whereas someone with 1/12 cores probably is. Someday imaging may give us a reliable idea of how much cancer is in the gland and predict gleason sum but we are not there yet.

BTW part of the problem contributing to more biopsies and many negative biopsies being done, is that there has been a proliferation of urology owned pathology labs. History has shown over and over that if a doctor owns equipment, s/he uses it more because of the financial incentive. One of the dark dirty secrets of American healthcare.

 

[Disappointed]

Lightspeed, this is also interesting, I am going to give them a call today.

Molecular machine may yield advances that lead to better diagnosis for prostate cancer

 

[lightspeed]

Lightspeed, this is also interesting, I am going to give them a call today.

Molecular machine may yield advances that lead to better diagnosis for prostate cancer

Fascinating stuff.

 

[landover]

On a broader perspective, annual exams are also many-way pointless and dangerous. Here is the link-from-NYTimes.

 

[lightspeed]

On a broader perspective, annual exams are also many-way pointless and dangerous. Here is the link-from-NYTimes.

Most routine general physical exams (not just a digital rectal exam) are a waste of time. The NHS (United Kingdom) figured this out long ago and do not schedule routine exams or blood work for a healthy person, regardless of age, unless there are symptoms a patient complains about.