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Medical Forum / Diseases and Disorders / Prostate Cancer / June 2004

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A Little More info on PSA Testing

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olfart - 08 Jun 2004 14:28 GMT
This article might be of interest
http://www.ajc.com/health/content/health/0604/08prostate.html

Age - 69
8/12/02 - PSA 3.7
10/13/03 - PSA 4.69
11/11/03 - PSA 4.8
11/18/03 - Biopsy - 10 cores
one core-25% of core-Gleason 4+4=8
all other cores benign tissue
12/10/03 - Consult - Oncologist
12/16/03 - Consult - Radiation Oncologist
Treatment Plan - Northeast Ga Cancer Center
HT - started 12/17/03 - Eulixen & Lupron (2nd 4 mo Lupron-4/26)
2/10/04 - Started - Flowmax and Megastrol
Radiation - IMRT to begin 3/30/04 - 42 treatments
Leonard Evens - 08 Jun 2004 15:13 GMT
> This article might be of interest
> http://www.ajc.com/health/content/health/0604/08prostate.html
[quoted text clipped - 12 lines]
> 2/10/04 - Started - Flowmax and Megastrol
> Radiation - IMRT to begin 3/30/04 - 42 treatments

The information in the article is generally accurate and well balanced.
 But I would question one point that was made, which can seriously
mislead men.

The statement that two thirds to three fourths of men who are diagnosed
with prostate cancer don't need treatment is questionable.  The article
refers to "studies", but I've done a literature search using
Medline/Pubmed, and I never found any articles which made such
estimates.  One study for example estimated that up to 15 percent of men
of European descent and 45 percent of men of African descent had cancers
which would never be a problem during the man's life.  That study was
based on Medicare data, and I wouldn't take the figures very seriously,
but I didn't see any other studies suggesting much higher figures.  Of
course, the vast majority of men who are diagnosed are older, and many
of those men will die of other causes before their cancers can affect
them significantly.  In fact, such men are not usually advised by their
physicians to undergo aggressive treatment.  The danger of statements of
this kind is that younger men may decide that the chances of their being
affected by prostate cancer are small.  All the evidence I've seen
suggests that men under 60, who may live 20 years or more, if diagnosed
with prostate cancer, will have their lives adversely affected by it if
left untreated.

A more general complaint is that the man being interviewed quotes all
sorts of statistics.  But these are at best guesses.  He makes the point
that there is much we don't know about prostate cancer.  Among the
things that are not known too well are just statistics of this kind.

The interviewee claims that only 10 to 20 percent of men with PSA over 4
have prostate cancer.   But I believe that figure is contradicted by the
article describing the study he supposedly took part in.   Even for the
men with PSA less than 4, I believe that about 25 percent with PSAs at
the higher end ended up having prostate cancer.  He should read the article.
Don Coon - 08 Jun 2004 16:50 GMT
> > This article might be of interest
> > http://www.ajc.com/health/content/health/0604/08prostate.html

<SNIP>

Leonard, I agree with most of what you wrote in your response. However,
being 62.4, I'm compelled to comment on your "under 60, who may live 20
years or more"  statement.  A 62 year young non-smoker has an average life
expectancy of 22.7 years.  Even at 65, a non-smoker can expect to live 20.2
years.  So let's raise the bar a little bit.  On the other hand for smokers,
the cutoff is 58  -- a life expectancy of 19.8 years on average --- a
sacrifice of 7 years!

Not a criticism; just my attempt to ensure that healthy guys my age get
proper treatment when/if big brother establishes new guidelines : )

Cheers,

Don

Age 62 (1/11/1942)
1/2002 PSA 3.5
1/2003 PSA 3.7
1/2004 PSA 5.94
2/2004 Biopsy Gleason 3+4 = 7, DRE normal, no tumors or enlargement
3/2004 RRP
Post-op:
 Gleason 4+3 = 7
 Margins negative, lymph negative, no invasion of seminal vesicles
 Nerves spared
5/2004 PSA 0.03
Still leaking but progress is noticeable.

> The information in the article is generally accurate and well balanced.
>   But I would question one point that was made, which can seriously
[quoted text clipped - 29 lines]
> men with PSA less than 4, I believe that about 25 percent with PSAs at
> the higher end ended up having prostate cancer.  He should read the article.
Leonard Evens - 08 Jun 2004 18:52 GMT
>>>This article might be of interest
>>>http://www.ajc.com/health/content/health/0604/08prostate.html
[quoted text clipped - 64 lines]
>
> article.

As you point out, the issue is life expectancy, not age.  Many men over
70, albeit not the majority, can expect to live more than 20 years.  So
age is really a proxy here for life expectancy.   In general, aggressive
treatment for early prostate cancer seems to me to be a slam dunk for
men under 60, usually a good idea for men 60-70, and less obvious for
men 70-80.  For men over 80, except in unuusal cases, WW and hormone
therapy if needed would be the obvious choice.

But each of us is different, and the choice has to be made with the help
one one's doctor, taking into account all the relevant factors.   I was
age 67 when I was diagnosed.   Despite some disk problems and GERD, I
was in excellent health for a man my age and a 20 year horizon was not
unreasonable.   My cancer was at the high end of the moderate range
(T1c, PSA 4.5, Gleason 7=3+4), so my urologist recommended either RP or
external radiation.   Considering the various odds, I chose RP.  Had I
been 5 years older I would have chosen external radiation.  Had I been
10 years older, I might have opted for watchful waiting, depending on
the state of my health at the time.  The results have been pretty good
so far with good quality of life, including sexual life.   Of course, it
is possible that the cancer will recur and I will die of it shortly
thereafter, so the treatment will have proved futile.  According to the
Sloan Kettering nomograms, that seems pretty unlikely.  On the other
hand, it is possible my cancer would have sat there in my prostate for
20 years without bothering me significantly, so the treatment was
superfluous.   In a certain number of cases like mine---no one knows how
many---that is the case.  But with a Gleason 7, studies of untreated
prostate cancer suggest the chances I would have had metastatic cancer
within 5-10 years were too high for me.  Even a chance as low as 15
percent of that would have been too much for me, and I doubt the chances
were that low.
 
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