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Medical Forum / Diseases and Disorders / Prostate Cancer / January 2008Confused about PSA
I had a PSA done at the age of 50 and it was 0.2 but since then i have refrained from getting another due to all the controversy about whether it really saves lives. Some authorities claim it has not been shown to save lives and leads many down a path of treatment that is unneccesary. I am wondering if a DRE annually would be a better choice and to continue not getting a PSA. I am not high risk and have no family history of prostrate cancer. I am 54 years old. If PSA does not reduce ones chances of dying as a diagnostic tool in general, but increases the odds of false positives/negatives and that one will end up incontinent/impotent etc. what is the point of getting it. Until several trials now underway that are controlled studies have reached conclusions one way or the other does it not seem prudent to forgo PSA testing for asymptomatic men. Is there a consensus in this group on this? Comments appreciated. Mike C. > I had a PSA done at the age of 50 and it was 0.2 but since then i have > refrained from getting another due to all the controversy about [quoted text clipped - 13 lines] > > Mike C. Hi Mike...You raise some excellent points. You will find people on both sides of the "screening / no screening" debate, and both camps can make persuasive arguments. Here are a few points relative to the debate: 1) Since the introduction of widespread PSA testing in the US, prostate cancer (PCa) death rates have, for some reason, fallen dramatically (SEER database) 2) A number of population based studies have shown a decline in PCa mortality. For example, in the Tyrol study, PSA screening was practiced extensively in one Swiss canton, but not in a neighboring canton. After 10-15 years, PCa mortality had fallen significantly in the screened canton. However in these studies, flaws (compliance, analysis, etc.) have been pointed out calling the conclusions into question. 3) Smaller studies, such as the "Scandinavian" study, have shown that treatment does reduce PCa mortality 4) Treatment is associated with morbidity, but this is less so if you use an "artist" to treat the cancer. 5) Clearly there is overtreatment today. Numbers range all over, but probably something like 20-40% of men treated today, may not have needed treatment in their lifetime 6) Individual decisions about whether or not to test or treat may be made on a different basis than when the same question is asked at a acro level for a population What follows now is my opinion. I think screening does save lives and yes, there is overtreatment and morbidity. How you proceed depends upon how you view the attendant risks (unecessary treatment, morbidity) and the rewards (extended lifespan). Different people will fall at different points on such a spectrum and decide to procede differently. Personally, I'd rather have all the information (DRE, PSA, and then perhaps other tests if any of these came back suspicious) and then make an informed decision. If my PSA was rising a point a year, I'd probably behave differently then if it was rising by 0.1 point per year. Bottom line, your questions are fair, answers are few, opinions abound. Examine your personal situation, be cognizant of the risks and rewards and make a decision that is right for you...Best wishes and good health, ron Great Reply Ron, I think you covered all the bases and then some. Very articulate..........and non-biased..... jloomis On Dec 30, 9:32 am, mike <mcole8...@yahoo.com> wrote: > I had a PSA done at the age of 50 and it was 0.2 but since then i have > refrained from getting another due to all the controversy about [quoted text clipped - 13 lines] > > Mike C. Hi Mike...You raise some excellent points. You will find people on both sides of the "screening / no screening" debate, and both camps can make persuasive arguments. Here are a few points relative to the debate: 1) Since the introduction of widespread PSA testing in the US, prostate cancer (PCa) death rates have, for some reason, fallen dramatically (SEER database) 2) A number of population based studies have shown a decline in PCa mortality. For example, in the Tyrol study, PSA screening was practiced extensively in one Swiss canton, but not in a neighboring canton. After 10-15 years, PCa mortality had fallen significantly in the screened canton. However in these studies, flaws (compliance, analysis, etc.) have been pointed out calling the conclusions into question. 3) Smaller studies, such as the "Scandinavian" study, have shown that treatment does reduce PCa mortality 4) Treatment is associated with morbidity, but this is less so if you use an "artist" to treat the cancer. 5) Clearly there is overtreatment today. Numbers range all over, but probably something like 20-40% of men treated today, may not have needed treatment in their lifetime 6) Individual decisions about whether or not to test or treat may be made on a different basis than when the same question is asked at a acro level for a population What follows now is my opinion. I think screening does save lives and yes, there is overtreatment and morbidity. How you proceed depends upon how you view the attendant risks (unecessary treatment, morbidity) and the rewards (extended lifespan). Different people will fall at different points on such a spectrum and decide to procede differently. Personally, I'd rather have all the information (DRE, PSA, and then perhaps other tests if any of these came back suspicious) and then make an informed decision. If my PSA was rising a point a year, I'd probably behave differently then if it was rising by 0.1 point per year. Bottom line, your questions are fair, answers are few, opinions abound. Examine your personal situation, be cognizant of the risks and rewards and make a decision that is right for you...Best wishes and good health, ron I concur! Great job, Ron! Thanks and Happy New Year to all. Burney >Great Reply Ron, I think you covered all the bases and then some. >Very articulate..........and non-biased..... >jloomis >On Dec 30, 9:32 am, mike <mcole8...@yahoo.com> wrote: Bottom line, your questions are fair, answers >are few, opinions abound. Examine your personal situation, be >cognizant of the risks and rewards and make a decision that is right >for you...Best wishes and good health, ron RP in 1995 (age 52) RT in 2000 ADT (Casodex) 10/06 - 8/07 burney dot huff at mindspring dot com "ron" <oitbso@yahoo.com>wrote: > I had a PSA done at the age of 50 and it was 0.2 but since then i have > refrained from getting another due to all the controversy about [quoted text clipped - 13 lines] > > Mike C. Hi Mike...You raise some excellent points. You will find people on both sides of the "screening / no screening" debate, and both camps can make persuasive arguments. Here are a few points relative to the debate: 1) Since the introduction of widespread PSA testing in the US, prostate cancer (PCa) death rates have, for some reason, fallen dramatically (SEER database) 2) A number of population based studies have shown a decline in PCa mortality. For example, in the Tyrol study, PSA screening was practiced extensively in one Swiss canton, but not in a neighboring canton. After 10-15 years, PCa mortality had fallen significantly in the screened canton. However in these studies, flaws (compliance, analysis, etc.) have been pointed out calling the conclusions into question. 3) Smaller studies, such as the "Scandinavian" study, have shown that treatment does reduce PCa mortality 4) Treatment is associated with morbidity, but this is less so if you use an "artist" to treat the cancer. 5) Clearly there is overtreatment today. Numbers range all over, but probably something like 20-40% of men treated today, may not have needed treatment in their lifetime 6) Individual decisions about whether or not to test or treat may be made on a different basis than when the same question is asked at a acro level for a population What follows now is my opinion. I think screening does save lives and yes, there is overtreatment and morbidity. How you proceed depends upon how you view the attendant risks (unecessary treatment, morbidity) and the rewards (extended lifespan). Different people will fall at different points on such a spectrum and decide to procede differently. Personally, I'd rather have all the information (DRE, PSA, and then perhaps other tests if any of these came back suspicious) and then make an informed decision. If my PSA was rising a point a year, I'd probably behave differently then if it was rising by 0.1 point per year. Bottom line, your questions are fair, answers are few, opinions abound. Examine your personal situation, be cognizant of the risks and rewards and make a decision that is right for you...Best wishes and good health, ron Mike, Ron has certainly laid out the reasons to go ahead and get tested. I'd like to point out that there are really three steps to your decision-making: getting regular PSA tests, getting a biopsy if, at some point your PSA rises; and choosing a course of action if the biopsy results indicate the presence of prostate cancer. Getting regular PSA tests, of course, has no side effects and simply gives you a series of data points. If you get the tests annually and they remain low, you've simply "wasted" a few bucks and gained a little peace of mind. If the tests show a rising trend, then you need to decide if you want to take the next step, having your prostate biopsied. The biopsy is, for most men, relatively painless, although a few guys do better with a mild anaesthetic. If you do get a biopsy, you should have the results interpreted by a real expert, such as the group at Johns Hopkins. Your insurance carrier will in all likelihood cover the cost. Under no circumstances do you want to rely on a local lab alone. The biopsy results will be reported as a "Gleason score," named for the doctor who came up with it. Essentially it is an indication of how abnormal (and therefore cancer-like) the cells extracted during the biopsy are. A score of 5 or 6 suggests, in the view of most doctors, that your cancer is early and probably not very aggressive. A score of 8 or 9, on the other hand, means you've got a more worrisome situation. Based on your PSA and Gleason numbers, your age, health and a host of other factors, you then -- and only then -- have to decide how to proceed. You may opt for active treatment of the disease: surgery, radiation in any of several forms, and so on. But if you have a relatively low Gleason score and low PSA numbers you may, like me, decide to hold off on any treatment, and just monitor your cancer. That's called "watchful waiting" or "active surveillance." Any course of treatment has side effects -- incontinence and/or impotence for a certain percentage, and for some guys anxiety about recurrence even after active treatment. And for many men the idea of active surveillance is too anxiety-laden to be appropriate. They want the cancer out. For me, delaying any active treatment FOR NOW, and keeping a close eye on the cancer through quarterly PSA tests, semi-annual color doppler ultrasounds, etc., is acceptable. I am prepared to switch to active surveillance if and when the situation changes, but am comfortable simply remaining watchful for the time being. So there are good reasons for you to get tested, and a very good likelihood that (1) you will never develop prostate cancer, (2) develop an "indolent" or non-life-threatening form of prostate cancer in your 80s, when it really makes little difference, (3) develop an indolent form of the disease earlier, but decide that you are OK with active surveillance, or (4) decide you want to have the cancer removed and have a great outcome, as a large majority of men do. You are fortunate that we men have access to a cheap, easy test for an otherwise silent disease, and a whole range of treatment options available to you if, at some point in the future, you turn out to be the one out of six who are diagnosed with PCa. So why turn your back on those advantages simply because, as with all of medicine, there is some uncertainty involved? Good health, Alex > I had a PSA done at the age of 50 and it was 0.2 but since then i have > refrained from getting another due to all the controversy about [quoted text clipped - 11 lines] > > Is there a consensus in this group on this? Comments appreciated. That you invite our comments is a mere convenience; you're gonna get some anyway. ;-) 1. Name two medical/diet/health issues which are without controversy. 2. Elevated PSA alone only obligates one to additional test for infection, not "down a path to unneccessary cancer treatment". 3. Negative infection test leads only to DRE and biopsy, not to treatment. 4. The path reaches PC treatment only if further, more definitive tests verify prostate cancer AND several further criteria are met, including: a. Confirmed diagnosis of PC. b. Confirmed grade sufficiently high to warrant active treatment (vs WW). c. Young enough and healthy enough patient to warrant treatment risks. d. The informed patient's willingness. e. In my book, concurrence from all three PC oncologist specialties on both necessity and nature of treatment. Nobody messes with their risk of PC treatment SEs based on a PSA alone. 5. If they disagree, my research requirements increase tenfold. 6. Negative DRE means little compared to positive biopsy. Several oncologists poked my prostate, knowing I had a Gleason 8 PC; all but one pronounced it normal; the exception thought maybe she felt a slight abnormality. 7. Symptoms or a positive DRE are like the flashing lights on the police car; they simply say you're already highly likely screwed. You have many more options if you know the speed limit, choose a speed, watch for cops, and keep your radar detector turned on. 8. If tests show a confined Gleason 6 cancer and a smooth prostate, the next step is highly debatable and dependent on many factors. If tests show a Gleason 8 and/or a lumpy prostate, some next step is a no-brainer for a viable patient. 9. If you have or ever had a prostate, your risk of PC is inherently high by most cancer likelihood standards. 10. You probably have at least 30 good years left unless you have other risks. Are you willing to bet 20 of them on your family history? 11. Biopsies almost never produce false positives. Their errors are far more often in the other direction, i.e., too kind. 12. A symptomatic (of PC) man doesn't need a PSA test. He needs treatment, in the (highly diminished) chance it may save, or more likely merely prolong, his life. The only remaining question beyond "How's his heart?" is, "Which treatment?". The question I'd rather hear, far sooner and far more often is, "How's your PSA?" Similarly, I'd rather hear, "How's your fasting glucose level?" way before hearing, "You want that foot lopped off at mid-calf or at the knee?" A. Ignorance is dangerous. B. Knowledge is power. C. A PSA is our simplest and earliest step from A to B. I.P. . > Is there a consensus in this group on this? Comments appreciated. > > Mike C. I am 14 years post Radical Prostatectomy and doing great. My diagnosis came about with a PSA of only 2.8, but it had doubled from the previous year which caused concern on the part of a very able Internist who referred me to a Urologist. A biopsy indicated a highly aggressive. cancer with a Gleason score of 7, which at surgery was upgraded to 8. Apparently, the Velocity of Increase in PSA from one year to the next is significant and a low PSA is no indication that cancer is not present or aggressive. Am I a supporter of PSA testing? You betchor sweet a.s I am. As they say "The proof of the pudding is in the eating". > I had a PSA done at the age of 50 and it was 0.2 but since then i have > refrained from getting another due to all the controversy about [quoted text clipped - 11 lines] > > Is there a consensus in this group on this? Comments appreciated. That you invite our comments is a mere convenience; you're gonna get some anyway. ;-) Here's a baker's dozen of 'em. 1. Name two medical/diet/health issues which are without controversy. 2. Elevated PSA alone only obligates one to additional test for infection, not "down a path to unneccessary cancer treatment". 3. Negative infection test leads only to DRE and biopsy, not to treatment. 4. The path reaches PC treatment only if further, more definitive tests verify prostate cancer AND several further criteria are met, including: a. Confirmed diagnosis of PC. b. Confirmed grade sufficiently high to warrant active treatment (vs WW). c. Young enough and healthy enough patient to warrant treatment risks. d. The informed patient's willingness. e. In my book, concurrence from all three PC oncologist specialties on both necessity and nature of treatment. Nobody messes with their risk of PC treatment SEs based on a PSA alone. 5. If they disagree, my research requirements increase tenfold. 6. Negative DRE means little compared to positive biopsy. Several oncologists poked my prostate, knowing I had a Gleason 8 PC; all but one pronounced it normal; the exception thought maybe she felt a slight abnormality. 7. Symptoms or a positive DRE are like the flashing lights on the police car; they simply say you're already highly likely screwed. You have many more options if you know the speed limit, choose a speed, watch for cops, and keep your radar detector turned on. 8. If tests show a confined Gleason 6 cancer and a smooth prostate, the next step is highly debatable and dependent on many factors. If tests show a Gleason 8 and/or a lumpy prostate, some next step is a no-brainer for a viable patient. 9. If you have or ever had a prostate, your risk of PC is inherently high by most cancer likelihood standards. 10. You probably have at least 30 good years left unless you have other risks. Are you willing to bet 20 of them on your family history? 11. Biopsies almost never produce false positives. Their errors are far more often in the other direction, i.e., too kind. 12. A symptomatic (of PC) man doesn't need a PSA test. He needs treatment, in the (highly diminished) chance it may save, or more likely merely prolong, his life. The only remaining question beyond "How's his heart?" is, "Which treatment?". The question I'd rather hear, far sooner and far more often is, "How's your PSA?" Similarly, I'd rather hear, "How's your fasting glucose level?" way before hearing, "You want that foot lopped off at mid-calf or at the knee?" 13. A. Ignorance is dangerous. B. Knowledge is power. C. A PSA is our simplest and earliest step from A to B. I.P. I have to agree 100% with Lon. Hubby had been getting yearly PSA's for about 8 or 9 years when all of a sudden, it doubled in one year. The number was very low, but the fact that it doubled sent him to a urologist. A biopsy was done with many cores being positive. His Gleason was 7 before surgery. After surgery it was upgraded to an 8. Are we thankful for yearly PSA's? You bet!!! If he had not been getting them, he could possibly be dead or dying by now but he is doing absolutely great and his latest PSA was 0.002. And he never had any incontinence at all; not a drop. And because one nerve had to be removed he did have almost a year of ED, but that has gotten better and all is well!!! I guess I don't understand the 'not knowing' mentality. Wouldn't you rather know if something is going on so you can fix it, rather than wait until it's WAY too late to fix? Just my two cents. Jean >> I had a PSA done at the age of 50 and it was 0.2 but since then i have >> refrained from getting another due to all the controversy about [quoted text clipped - 74 lines] > > I.P. >I had a PSA done at the age of 50 and it was 0.2 but since then i have > refrained from getting another due to all the controversy about > whether it really saves lives. Some authorities claim it has not been > shown to save lives and leads many down a path of treatment that is > unneccesary. Name one. Not to be flip, Mike, but I was diagnosed with seven years ago with a 16 PSA. Since I first came to this newgroup, more than 800 men have reported their cancer here (including more than two dozen "Mikes"). Every one of them had a PSA test which led to further testing. In 2007, the absolute best way to catch prostate at its earliest is to get annual PSAs and see if a pattern begins. If it stay level, you almost certainly don't have cancer. If it suddenly rises, you almost certainly have a prostate problem. If it doubles in a discernable pattern, you probably have cancer. That COMBINED with annual DREs is what gets you a ticket to the biopsy. Don't listen to people telling you about supposed authorities. They may kill you.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04 10/11/07 Non Illegitimi Carborundum On December 30, Steve K advised yet another Mike: > Don't listen to people telling you about supposed authorities. They > may kill you. Bingo! And I understand that, to their shame, the American Cancer Society is one of them. Regards, Steve J > On December 30, Steve K advised yet another Mike: > [quoted text clipped - 5 lines] > And I understand that, to their shame, the American Cancer Society is > one of them. Is there a particular segment of their advice that is suspect, or is their credibility gap widespread? I.P. On December 30, Mike Freely wrote: Quoting me: >> And I understand that, to their shame, the American Cancer Society is >> one of them. He sorta replied > Is there a particular segment of their advice that is suspect, or is > their credibility gap widespread? I wonder whether Mike was serious or just trying to be amusing in some way. Rather than invite him and others to look it up themselves, as someone very near and dear to him habitually does, I'll refer to this: "No major scientific or medical groups (including the American Cancer Society) recommend routine testing for prostate cancer at this time." ---- from the ACS site. I rather doubt the statement's accuracy, as well as who or what ACS in its corporate wisdom considers to be "major scientific or medical groups." The *fact* is that, after widespread PSA testing began a few years ago, there has been a substantial decrease in PCa mortality. Make of that what you will. Regards, Steve J > On December 30, Mike Freely wrote: > [quoted text clipped - 12 lines] > Rather than invite him and others to look it up themselves, as someone > very near and dear to him habitually does ... Guess I should have known better; get a life, guy. Googling <"American Cancer Society" credibility> was of little help. The first critique popped up on page two, at http://www.newstarget.com/021896.html , which began with "The American Cancer Society, however, seems stuck in the nutritional dogma of the 1950's and continues to claim that only drugs, radiation and surgery can treat cancer, and that nutritional supplements have no role to play whatsoever in cancer prevention. This view is so out of date that it belongs in a museum of medicine, not on the agenda of an advanced nation. (Stating that vitamin D has no useful role in preventing cancer is as hopelessly outdated as claiming the Earth is flat.)" OK, sounds serious and conceivably credible, even though one can find serious and persuasive arguments on both sides of any issue, including cancer prevention and nutrition. But this site slides into the INcredible column when scrolling down leads to a protracted colon cleansing chemical sales pitch. (Tip: if your colon needs cleansing, go to the bathroom and sit down.) Anyone else have an answer to my question? Is the quotation above on the right track? I.P. Mike Freely wrote something: After a bit of judicious snippage that distorts what I wrote > Googling <"American Cancer Society" credibility> was of little help. The > first critique popped up on page two, at > http://www.newstarget.com/021896.html , which began with (snip) What Mike snipped was my reference to the ACS site and its comment on "routine testing for prostate cancer." I neither know nor care what his source was. The topic is *ACS's* position. What they say it is, not what someone else says it is. Got it? I guess Mike is just feeling combative this weekend. Lost his sense of humor, too. Regards, Steve J > "The American Cancer Society, however, seems stuck in the nutritional > dogma of the 1950's and continues to claim that only drugs, radiation and [quoted text clipped - 3 lines] > (Stating that vitamin D has no useful role in preventing cancer is as > hopelessly outdated as claiming the Earth is flat.)" > Anyone else have an answer to my question? Is the quotation above on the > right track? Ha! I think I just suffered a paradigm shift! My disgust for the ACS started many years ago when my father was suffering from prostate cancer. Many learned people had new and exciting research and ideas that indicated that PCa could be modified (not necessarily cured) with Vit. C and other things. Dirk Pearson wrote an entire book on it. The ACS denounced these theories and caused many not to try. When my dad died, I never thought about it again, but I disliked the ACS. Now that I am older and wiser (?), I realize the ACS, whether they were backward or conservative, was right. None of those ideas came to fruition. I hope they are not now correct about PSAs, Vit. D, etc. Looks to me like the ACS is trying to have it both ways... They believe the doctors should offer a PSA test and DRE, but then go on to say that they do not recommend routine testing for Prostate Cancer. "What the American Cancer Society Recommends The American Cancer Society believes that doctors should offer the PSA blood test and DRE (digital rectal exam) yearly, beginning at age 50 to men who do not have any major medical problems and can be expected to live at least 10 more years. Men at high risk should begin testing at age 45. Men at high risk include African American men and men who have a close relative (father, brother, or son) who had prostate cancer before age 65. Men at even higher risk (because they have several close relatives with prostate cancer at an early age) could begin testing at age 40. Depending on the results of the first tests, they might not need more testing until age 45. Doctors should talk to men about the benefits and risks of testing, and men should take an active part in the choice about whether or not to have tests. Men should also discuss the pros and cons of looking for and treating early prostate cancer before they have the tests. No major scientific or medical groups (including the American Cancer Society) recommend routine testing for prostate cancer at this time. Rather, they recommend that men talk to their doctors about the benefits, risks, side effects, and questions about early prostate cancer tests and treatment. Each man needs to have the best information to make the decision that is right for him." source: http://www.cancer.org/docroot/CRI/content/CRI_2_2_3X_How_is_prostate_cancer_foun d_36.asp?sitearea= >> On December 30, Steve K advised yet another Mike: >> [quoted text clipped - 10 lines] > > I.P. Thanks for the reply, Bert. It doesn't look controversial to me. On the contrary, it squares with most of what I've read and the way most big official organizations should operate: formally endorse procedures or medicines or supplements only when large, controlled, heavily reviewed studies prove their efficacy (does PSA testing meet that criterion?), but support informed choices if a less conclusive data trend supports it without strong controversy (I think it does meet that one). This minimizes knee-jerking but allows -- and even directs us towards -- informed individual choices. The VA operates similarly. Consider the turmoil if an agency that big swung with the changing medical tides we see at least monthly. The vitamin D hullabaloo I haven't followed in detail. I'm convinced and take it, but how "official" its acceptance is, I haven't studied. Look at how miserably many other "sure things" failed final muster once the research was done. I.P. > Looks to me like the ACS is trying to have it both ways... They believe > the doctors should offer a PSA test and DRE, but then go on to say that [quoted text clipped - 51 lines] >> >> I.P. > On December 30, Steve K advised yet another Mike: > [quoted text clipped - 5 lines] > And I understand that, to their shame, the American Cancer Society is > one of them. I haven't trusted the ACS since the bastard killed my dad. >>I had a PSA done at the age of 50 and it was 0.2 but since then i have >> refrained from getting another due to all the controversy about [quoted text clipped - 8 lines] >their cancer here (including more than two dozen "Mikes"). Every one of >them had a PSA test which led to further testing. Steve out of curiosity, what do you draw from all the numbers you've accumulated? >In 2007, the absolute best way to catch prostate at its earliest is to get >annual PSAs and see if a pattern begins. If it stay level, you almost >certainly don't have cancer. If it suddenly rises, you almost certainly >have a prostate problem. If it doubles in a discernable pattern, you >probably have cancer. That COMBINED with annual DREs is what gets you a >ticket to the biopsy. >Don't listen to people telling you about supposed authorities. They may >kill you. SignaturePSA @ 45 yrs. = 4.7 02/06/2007 Biopsy 03/16/2007 G7(3+4),T1c RLRP 06/12/2007 G7(3+4),T2cN0M0 Neg margins PSA 07/16/2007 = <0.1 PSA 09/12/2007 = <0.1 PSA 12/18/2007 = <0.1 > Steve out of curiosity, what do you draw from all the numbers you've > accumulated? If you mean the numbers that I've logged for several years, I guess the most salient point to be made is that I am a mere novice when it comes to medical education and expertise, but that I have a very high accuracy rate for predicting prostate cancer when newbies first come here with their PSAs. If I can do it from observing anecdotal cases, then I think one can call the PSA + DRE combo to be very good at predicting cancer. And, there is a lot of evidence to show that knowing sooner is better if you want to live longer and use your willy. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04 10/11/07 Non Illegitimi Carborundum >> Steve out of curiosity, what do you draw from all the numbers you've >> accumulated? [quoted text clipped - 7 lines] >of evidence to show that knowing sooner is better if you want to live longer >and use your willy. I'll attest to that :) SignaturePSA @ 45 yrs. = 4.7 02/06/2007 Biopsy 03/16/2007 G7(3+4),T1c RLRP 06/12/2007 G7(3+4),T2cN0M0 Neg margins PSA 07/16/2007 = <0.1 PSA 09/12/2007 = <0.1 PSA 12/18/2007 = <0.1 >I had a PSA done at the age of 50 and it was 0.2 but since then i have > refrained from getting another due to all the controversy about [quoted text clipped - 13 lines] > > Mike C. You make it sound like right after you get your reading, they're wheeling you down to surgery. Getting your PSA checked, or a DRE is not in anyway going to change whether or not you have prostate cancer. Why wouldn't you want to know is a puzzle to me? All it is, is a tool. No one gets treatment or surgery until it's confirmed with a biopsy anyway. SignatureJK Sinrod http://www.sinrodstudios.com http://myconeyislandmemories.com > I had a PSA done at the age of 50 and it was 0.2 but since then i have > refrained from getting another due to all the controversy about > whether it really saves lives. Some authorities claim it has not been > shown to save lives and leads many down a path of treatment that is > unneccesary. You have to understand just what that meaqns. It means that no prospective, randomized study shows that it reduces mortality compared to not doing testing. In such a study, men are rbndomly divided into two groups, making sure in the process that the men in the two groups are statistically the same in all apparently relevant ways. Then the men are followed for some number of years to see if one group shows less mortality than the other. It is difficult to do such a study for a disease such as prostate cancer because of its long time span. Usually the men are followed for some limited period of time, which may be too short to show an effect. There are in fact some such studies, include one in the US, in process now, but none has been completed. So it is just as accurate to say that it has not been shown that PSA testing does not save lives. But there is other evidence suggesting that PSA testing does benefit men. For example, in countries such as the US where PSA testing is relatively common, prostate cancer death rates have dropped compared to countries where testing is relatively rare. Also, in the US, doctors who treat prostate cancer find that it is diagnosed five or more years earlier and is at an earlier stage than was the case before PSA testing was introduced. The trouble with evidence of this kind is that there might be other factors, called confounders explaining the results. Randomized, prospective studies are considered the gold standard, but I think that rejecting all other lines of evidence is much too rigid a position. > I am wondering if a DRE annually would be a better choice > and to continue not getting a PSA. The same sort of argument about randomized prospective studies can be used to argue that DRE has not been shown, by that criterion, to extend life. > I am not high risk and have no > family history of prostrate cancer. I am 54 years old. If PSA does not > reduce ones chances of dying as a diagnostic tool in general, You don't know that. There is a difference between not knowing if something is true and knowing that it is not true. > but increases the odds of false positives/negatives and that one will end > up incontinent/impotent etc. what is the point of getting it. Keep in mind that no one has ever become incontinent or impotent from PSA testing or DRE. The argument is that it leads to treatment, which may not be necessary, and that treatment may lead to those side effects. But there is an alternative. You can have regular DREs and PSA testing, and then, if you are diagnosed with prostate cancer, you can decide what to do. Nothing will force you to have surgery or radiation. At that point you will have to decide if the treatment is likely to improve (a) your likelihood of living longer, (b) your likelihood of not developing metastatic cancer, and (c) your quality of life. By the way, it has been shown in a randomized prospective study in Sweden that radical prostatectomy improves men's prospects when compared with doing nothing until the cancer metastasizes, assuming it does. I am not sure this study is relevant for men in the US, for a variety of reasons, but it is in fact the kind of studies that the critics of PSA testing tout. The claim is that once a diagnosis is made, treatment is inevitable. But that is in fact not the case. For many men in the US, particularly older men, treatment is by no means automatic. Until > several trials now underway that are controlled studies have reached > conclusions one way or the other does it not seem prudent to forgo PSA > testing for asymptomatic men. No. Remember that prostate cancer is a very complex disease. A lot depends on specifics of each individual case. The analysis is very different for relatively young men than it is for older men. You are assuming that the results of such studies will show that the overall effect of PSA testing and subsequent treatment, for you personally, is negative. You have no basis for such a conclusion. > Is there a consensus in this group on this? Comments appreciated. I think you will find that we almost all disagree with your contention. But of course essentially all of us have been treated for prostate cancer, so perhaps we have a vested interest > Mike C. >> but increases the odds of false positives/negatives and that one will end >> up incontinent/impotent etc. what is the point of getting it. [quoted text clipped - 9 lines] > (a) your likelihood of living longer, (b) your likelihood of not > developing metastatic cancer, and (c) your quality of life. Exactly, or almost exactly, because the PCa diagnosis itself cannot be made unless there is also a positive biopsy, after a PSA test and DRE have indicated something may be wrong (and that does not necessarily have to be PCa; e.g. BPH or prostatis could also be culprits). When studies suggest there is overtreatment they have in mind the cancers with Gleason ratings of around 3+3. Consider the grumpy old men in this group and their groupies that declared that people opting not for treatment but for "watchful waiting" are irresponsible idiots waiting for "the beast inside" to break out. If you don't want to become a victim of overtreatment and avoidable side effects it is at the point in time Leonard refers to that you have to stay rational and remember that many more men die with PCa than of PCa. But at that point, obviously, you are better informed about your status than without any testing. I'm one of the grumpy old men in this group that that suggest that a number of the young whippersnappers here do newbies on this forum a disservice by suggesting watchful waiting or active surveillance for individuals that do not qualify for this cavalier approach. Two important things that some seem to miss or avoid when it comes to WW/AS. Number one is that the forum researchers never really read the articles in there entirety. If they did they would realize that contrary to the headlines referencing PSA, Stage and Gleason, there are other more important parameters to consider before one decides to follow this course; such as tumor volume and percentage of sample core not to mention ones overall health and life expectancy. For anyone to try and make a proper diagnosis of his own particular situation without the aid of a medical professional would be fool-hearty. Also to rely upon suggestions from this forum as an authority for making such a critical decision on your own is also not prudent. I've seen a number of times individuals mention the first three parameters as the numbers that count and then try an plug them into the Partin Tables and believe they are covered when every study states that the tumor is the primary determiner of whether someone could choose WW/AS. I suggest that the ones that are suggesting this course of action for anyone individual, make sure they know what they are talking about before doing so. Maybe some should stop trying to be medical professionals. Ron S. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html ronju99 wrote: (< card carrying member American Nazi Party; recognized pedophile; name caller; ad hominem artist) > I'm one of the grumpy old men in this group that that suggest that a number > of the young whippersnappers here do newbies on this forum a disservice by > suggesting watchful waiting or active surveillance for individuals that do > not qualify for this cavalier approach. No one is suggesting anything except you and your War of 1812 "kill the beast" friends. Two important things that some seem > to miss or avoid when it comes to WW/AS. Number one is that the forum > researchers never really read the articles in there entirety. What articles? Your party's articles? I confess. I don't care about them. If they did > they would realize that contrary to the headlines referencing PSA, Stage > and Gleason, there are other more important parameters to consider before > one decides to follow this course; such as tumor volume and percentage of > sample core not to mention ones overall health and life expectancy. For > anyone to try and make a proper diagnosis of his own particular situation > without the aid of a medical professional would be fool-hearty. Fool-hearty? What the hell does that mean? No one, really no one here suggested otherwise. But then again, Freely himself, the sole owner of this newsgroup, recently wrote that he ignored the express advice of no less than three learned practitioners. Also to > rely upon suggestions from this forum as an authority for making such a > critical decision on your own is also not prudent. Of course. Anyone that read your contributions would agree. > Maybe some should stop trying to be medical professionals. Have you found one now that does understand PSA numbers? > Ron S. > > -- > Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ > More information at http://www.talkaboutsupport.com/faq.html From the University of Texas M.D. Anderson Cancer Center...... "Watchful Waiting Because not all prostate cancers will progress to threaten patients$B!G(B lives, M. D. Anderson does consider watchful waiting as a treatment option for very carefully selected patients with low-grade prostate cancer. These patients fall into two general categories: Patients who believe the side effects of treatment (impotence, urinary incontinence) are excessive. Watchful waiting would be considered for these men if they: a.. Recognize there is no validated screening method for early detection of disease progression b.. Have a low Gleason score c.. Have low-volume disease d.. Have a PSA level within the normal range (or accounted for by an enlarged prostate) e.. Are willing to submit to follow-up with annual biopsies and quarterly PSA tests Patients in whom the risk for cancer is less than the risk from unrelated, co-existing health conditions. Watchful waiting would be considered acceptable if: a.. Patients have a less than 10-year expected survival b.. The Gleason score is low c.. Patients have low-volume disease d.. The PSA level is within the normal range e.. Patients have an estimated survival of less than 5 years and a cancer judged not to be at risk during that time f.. Patients are willing to submit to follow-up with quarterly PSA tests and annual biopsies The challenge of watchful waiting is that oncologists still cannot anticipate progression of the disease in a timely enough fashion to avoid risky treatment delays, and there are still no reliable methods to select patients in whom cancer is unlikely to spread. As the ability to predict prostate cancer progression improves, the risks of watchful waiting can be minimized." I believe that the first sentence of the last paragraph says it all. The real question therefore, is how much one is willing to gamble that the cancer will not spread before primary treatment is given. Roll the dice if you want, I don't care. It's your life, your decision. Happy New Year Gourd Dancer > I'm one of the grumpy old men in this group that that suggest that a > number [quoted text clipped - 26 lines] > http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ > More information at http://www.talkaboutsupport.com/faq.html > > I had a PSA done at the age of 50 and it was 0.2 but since then i have > > refrained from getting another due to all the controversy about [quoted text clipped - 91 lines] > > - Show quoted text - Hi all and thanks for the opinions. I had guessed that contrarian views would be rare if any from this group. That of course is very understandable as the above post made clear. My thinking about this was mostly shaped by this webpage: http://www.mayoclinic.com/health/prostate-cancer/HQ01273, The real possibility of enduring a lot of useless and potentially harmful treatment not to mention a lot of unnecessary mental anguish is well represented i think at this site. I will probably end up following this groups and my GP's rec's and go ahead with the testing. Again thanks to all of you for your very helpful support and insights. Mike > I had guessed that contrarian > views would be rare if any from this group. The world's leading experts disagree among themselves, studies contradict other studies almost every week, many physicians -- even urologists and oncologists -- are borderline idiots about PC, the same data means different things to different people, and patients and physicians alike have biases. Pick the top hundred PC issues and I'd bet you won't get full consensus among 20 informed people on more than five of them. Now ... about global warming ... JUST KIDDING! Don't even think about going there.. ;-) I.P. >I had a PSA done at the age of 50 and it was 0.2 but since then i have >refrained from getting another due to all the controversy about [quoted text clipped - 13 lines] > >Mike C. your PSA is what it is whether you get a test or not. If you don't get a test you just don't know what it is. If you do get a test then you do know what it is. Even if it comes back "high" no one can make you get any treatment. So it seems like a simple decision to me, you should get tested just so you KNOW. If you choose to not do anything, that's certainly your choice to make. I fail to see how not knowing benefits you in any way. On 30 Dec 2007, you wrote in alt.support.cancer.prostate: > I had a PSA done at the age of 50 and it was 0.2 but since then i have > refrained from getting another due to all the controversy about [quoted text clipped - 13 lines] > > Mike C. Before making some general comments on the issue raised I need to state up front that I am biased. I have PC, have had a prostatectomy (05)and 36 radiation treatments since (06). If it wasn't for the PSAV (prostate specific antigen velocity over time) and the TRUS Biopsy, I truly believe that I would be in a very sorry state today in terms of my prostate cancer. However, you raise some interesting questions in your opening statements. Many have already submitted excellent responses to the issue. Being a Canucker living in Ontario, I thought that I'd see what the Canadian Cancer Society's position is on screening. Overall I can say it is mixed, and states both positive and negatives about the PSA test. The info on testing can be found here: http://www.cancer.ca/ccs/internet/standard/0,3182,3172_13271_1858613010_lan gId-en,00.html . It does mention (strongly I think) that if you have any symptoms of the disease (or symptoms that might not, in the end, be PCa), then you, in consultation with your medical people, should seek further information through testing to confirm/deny the presence of the disease. IMO personal knowledge is power, and, since I have PCa, I want to know all I can about it before giving my input and consent as to any treatment strategy. In the end, doctors can advise, but you, as patient, must make the final choices. I recommend to my male friends that they start PSA testing at 40. If fine, again at 45 and again at 50, then yearly after 50. If there is a problem at 45, then pehaps, in consultation, yearly after that. However, I am a patient, not a doctor. Medical input on decisions, even testing pehaps, might be warranted. I just told my doctor that I wanted testing started at 50 when I had my annual physical and he agreed. Ontario males have to pay for the testing if <65 yrs old. It is very little cost in the whole scheme of things. Russ D I agree with Russ that many have already covered this issue well. I would like to say that most men even today probably haven't heard much about prostate cancer an how to tell if someone may have the disease. Everybody's situation is different and how it develops. For me if it wasn't for the American Cancer Society back in 1993 offering free PSA test I wouldn't have had one. I was healthy and not a candidate for cancer. HA.Ha. My psa was 1.9 and in three years went to about 2.3. In 2000, my GP, a Cardiologist, did a normal blood panel for my physical and is was 4.0. He said nothing about it. In December,2002 I went for another physical and it came back 6.9. He still said nothing. I was under the impression that if you had prostate cancer it was slow growing an the numbers didn't seem that bad. I hadn't done any research on the subject. Besides they were just numbers. Three months later, I went to a urologist for an unrelated issue and he did another PSA and DRE. Dre was negative but PSA was 6.7. He suggested a biopsy which came back (3+4)=7 and one core positive with 70% of specimen. I've often wondered what my Gleason might have been had I had a biopsy done in 2000 when PSA was 4.0. Even though the cancer appeared to be confined, my odds of recurrence is much higher now than if my Gleason had been lower. So at least in my case, the only marker that lead to the biopsy was PSA. So now that you have been informed, don't take the PSA lightly. You may regret if you wait too long for signs that you don't really want to see. It may well be too late then for a chance to have it removed with the prostate. RonS. -- Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ More information at http://www.talkaboutsupport.com/faq.html > I agree with Russ that many have already covered this issue well. I would > like to say that most men even today probably haven't heard much about [quoted text clipped - 6 lines] > 4.0. He said nothing about it. In December,2002 I went for another > physical and it came back 6.9. He still said nothing. Ron Judas is making a really convincing case here for regular PSA testing by someone having no idea what the numbers mean. "He said nothing." Did he do a DRE? Did he discuss it with you? No, "he said nothing". Are you trying to explain why malpractice insurance premiums for MDs are as high as they are? I was under the > impression that if you had prostate cancer it was slow growing an the > numbers didn't seem that bad. I hadn't done any research on the subject. [quoted text clipped - 8 lines] > > So at least in my case, the only marker that lead to the biopsy was PSA. Great example of anecdotal evidence. > So now that you have been informed, don't take the PSA lightly. You may > regret if you wait too long for signs that you don't really want to see. > It may well be too late then for a chance to have it removed with the And with all the false positives, the overtreatment and the side effects, it "may" also be too early. Don't let you scare into treatment by a disgruntled newsgroup poster. > prostate. > [quoted text clipped - 3 lines] > Message posted using http://www.talkaboutsupport.com/group/alt.support.cancer.prostate/ > More information at http://www.talkaboutsupport.com/faq.html >I had a PSA done at the age of 50 and it was 0.2 but since then i have >refrained from getting another due to all the controversy about [quoted text clipped - 13 lines] > >Mike C. Mike, You've already gotten a boatload of replies, but I'll add my opinion just to move with the mob so to speak. My PSA within five years went from 2.8 to 4.6, not good for a 46 year old of course. At no time did my DREs return anything suspicious. If I'm not mistaken, the whole prostate cannot be felt anyway which IMO immediately leaves the DRE on its own, as an incomplete benchmark. My PSA scores lead to drug treatments for potential infection which proved futile and ultimately a biopsy exposing my cancer. In my case, as is the case with many, a combination of the PSA and DRE exams were the best diagnostic tools available. Your concerns are valid, especially considering your lack of history. In retrospect, I had it easy, both my grandfathers died from PCa (p 79 & m 92), my dad (73) will more than likely pass this year from it and his brother (75) has it as well. For me screening and my catching it really was my destiny. What a bastardly insipid disease, this PCa. I read all the posts and stats here and the only thing that is certain to me is that no two cases are identical. It's behavior so chameleon like that I wonder if there'll ever be a bonafide screening test for it unless the DNA gods nail it and can accurately predict who has the genetic makeup and who doesn't. Maybe in the next generation's lifetime? Until then, we are like the proverbial swinging dicks in the wind.... SignaturePSA @ 45 yrs. = 4.7 02/06/2007 Biopsy 03/16/2007 G7(3+4),T1c RLRP 06/12/2007 G7(3+4),T2cN0M0 Neg margins PSA 07/16/2007 = <0.1 PSA 09/12/2007 = <0.1 PSA 12/18/2007 = <0.1 Ron wrote: > HI CalifChief, > You didn't mention your PSA and Gleason results. Just curious > and no I'm not about to make a recommendation. 2001 10.something (1st urologist) 2002 11.1 (2nd opinion, 2nd urologist) 2003 11.something 2003 10.something 2004 11.something 2004 10.something 2005 11.something 2005 11.something (2nd urologist retired) 2006 ditto (3rd urologist) 2006 ditto (oncologist) 2007 ditto (oncologist) 2007 ditto (oncologist) 2007 10.8 last week (4th urologist) The 2001-2005 medical records are lost. I have no idea what the gleason and other scores were. ___ Blue Wave/QWK v2.12 |
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