An interesting fact learned today...Thoughts?

John,

Thank you for the clarification. I see you continue to discuss treatment, which I feel we agree on. My statement dealt with detection not treatment. "For the PSA tests there are no appreciable risks."

I again post the question of how a guy can chose to do AS if you do not do some form of detection first? Don't you have to do some form of detection before you do AS?

As a working Internist , I would have to say that paying attention to PSA test is what has allowed me to arrest my PCa at stage 3 instead of progressing to Stage 4 . I had no palpable evidence of disease on exam . Not all MD's ignore their health. I am thankful that the PSA test was discovered . James

PeterDisAbelard. said...


In a way, an oncologist with a family history who doesn't worry about his PSA or about early diagnosis is showing confidence in his own medical specialty. He is, in effect, saying that with current and emerging treatments he feels that advanced prostate cancer can usually be managed and he'd just as soon take those risks rather than putting up with the risks involved in early detection and (often futile) attempts at a cure.

That's pretty much how we viewed his statement.:)

F8 said...
ignorance is bliss. with that attitude I wouldn't want him treating me.

ed

Ed, I respect your opinion. But, he is actually quite brilliant overall. We left a center closer to home to follow him. We wouldn't follow that blindly.

I'd be curious to know how many of you guys (not just you) actually know if your male doctor has PSA tests? It took us three years to discover this.

my doctor referred me to the same urologist that treated him when his PSA was elevated. knowing what I know now about the PSA testing "controversy" I would absolutely not let that doctor treat me.

ed

F8, I respect that.

Meanwhile, we aren't arguing with the success thus far, however, we know that can turn on a dime at any time.

F8, understand that this is a medical oncologist who does not screen. He gets them after they have been diagnosed and he generally only takes the high risk cases. Actually, since he moved, he only sees about 15 patients, so he can focus more on his research center and a cure.

Of course, I believe men should be screened early. That has been pretty well known. There's no question about it.

HIS reasons for HIM make sense to me, as he explained it. If they were for my husband, not so much.

Post Edited (MsWorryWart) : 9/12/2014 12:09:18 PM (GMT-6)

In another thread, LupronJim posted a link with photos from the recent PCRI conference presentations (last weekend).  One of the slides had two simple sentences which may relate closely to the discussion here so far.  The simplicity of the statements undoubtedly provoked thoughtful ponderances amongst the laypersons, and was likely presented with a detailed descript ion which scanned the contemporary "PC landscape."  Interesting discussion, I'm sure.  The slide simply said: Market forces can overwhelm a weak evidence base. Patterns of "care" become disconnected from evidence. MsWW, do you feel that either of these statements related to your experience?

JohnT,

John the three options you listed should be expanded to (at least) include the one option that has worked. The "More" testing option (versus the "Less" testing option you listed) has worked. It is my understanding that we have seen a significant decrease in PCa deaths since PSA testing began.

You make the statement that guys with low risk DX choose to be treated when they do not need treatment, I agree with this. But how in the heck to you know if they are low, high, or some other kind of risk if you do not do some sort of testing. Are you really advocating that the minority of high risk patients miss early detection because the majority of low risk patients are making bad treatment decisions?

Jerry L. said...
I didn't get my psa checked from age 41-44...I kick myself every day for not doing that...but, the mixed messages from the media and the PC experts told me not to worry about it. That's why it's frustrating for me hearing stories like this.

But, I know I am a rare exception and for the majority of guys out there...they, indeed, will never get aggressive prostate cancer.

Jerry, that is pretty much my story and I kick myself also, I just see things differently now because of my personal results I suppose. But I can hear myself right now with all the arguments/reasons I gave my wife for why I was not getting my PSA checked again. Mine went from 1.6 to 2.5 over 5 or 6 years and then to 4 in another maybe 3 years? Well I had every reason in the world to have elevated PSA. I had a 35+ year history of prostatitis, for gosh sakes, and obviously I had BPH(turned out to be 107 gms!), so of course my PSA was higher than normal! Now if I get another PSA and it is up a bit more, then what was I going to do? The only next step was a Bx, which may or may not show PC even if it is there, and I kept hearing claims that Bxs spread PC from the prostate to to outside the prostate, taking it from maybe harmless to systemic.

So I just kept putting it off. I'm sure I never would have got it done except I wanted T therapy. So I discussed the PSA controversy with the PCP I went to seeking T and a checkup. He said he was well aware of the controversy, and he could see both sides, but since his father in law died from PC he was sort of biased in favor of PSA testing. So I had it done. Boy was I shocked when it came back at 9.1 and then 10+ a few weeks later.

So the entire time that I was a good spokesperson for the "no routine PSA" camp, my little G9 was growing, and managing to get into the SV and with 1 Foci out in the margin. There is no doubt in my mind that I wish I had done things differently. That doesn't mean that doing it differently would be the 100% correct way to go for any large group of men. But if I could have seen the future, I would have had a lot more PSA tests, and had them earlier.

Still, I simply don't know what the answer is for the average man. It just gets beyond my reasoning abilities. Because even though doing it differently would have been much better for ME, there are men who will almost be forced(by themselves and their worries or ignorance) by a slightly rising/high PSA to have a Bx and be hurt by that Bx. Then those Bxs will lead to possibly needless treatment and some of those men will be hurt by that treatment. And every man who, like my age 46(?) at Dx friend who had the surgery and had the penile implant and then dies at 51 from stroke, every man like that is hurt by treatment. And wouldn't that be an even sadder thing if it turns out he was just a G6? His last 5 years before his sudden demise were not near as pleasant as they could have been. Every man who dies 10 or 15 years before his PC would have been a bad problem was hurt by treatment for that PC. Maybe quite significantly hurt!

But, no way in the world to know which category you are in, and finding out once you go past the PSA results is not risk free. Another thing: if the PSA is high or rising, and you do not seek further Dx and treatment, then why even have the PSA? A lot of men will worry themselves sick if they don't proceed down the medical/surgical path once they know they have a bad PSA. Again, even Bx's are not exactly benign.

So I don't know the answer for the masses of mankind. But for me, I wish I had PSA's earlier and more often, and paid attention to them. Just a personal thing.

Peter,

I agree ... especially on the part dealing with BMI.