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Medical Forum / Diseases and Disorders / Prostate Cancer / January 2005Question to the group.
What are the signs of prostate cancer? what are the simptoms? How do you knowwhen to be tested and who does the tests? Does your family phycisan give the test or does he refer you to a specialist to do it? sorry for so many questions > What are the signs of prostate cancer? what are the simptoms? How do you > knowwhen to be tested and who does the tests? Does your family phycisan > give the test or does he refer you to a specialist to do it? sorry for > so many questions There are no symptoms of early prostate cancer. Advanced prostate cancer has a variety of symptoms, but those symptoms also occur with many other conditions, which are much more likely. Such symptoms are difficulty urinating, and, if the cancer has spread to the bone, pain in the areas it has spread to, but, as I said, it is much more likely that someone having those symptoms is suffering common garden variety problems. If you have any symptoms which you think might be related to prostate cancer, you should see a doctor. It is unlikely that they are caused by porstate cancer, and whatever is causing the symptoms can probably be treated. Urologists recommend that all men past 50 have a simple blood test, called a PSA test. For men with a close male relative who has had prostate cancer, they recommend starting at age 40. A high PSA value or even a rapid rise in PSA can indicate early prostate cancer, but it can also indicate other less serious conditions. Your doctor will also feel your prostate (by putting a finger in your rectum) to see if he feels anything unusual. In either case, if there is something suspicious, you will be referred to a urologist who will probably perform a biospsy. This is a relatively safe procedure and not terribly painful if done properly. I should add that there are some doctors who don't believe that PSA tests are worth the trouble, but I don't want to get into that controversy here. EaZy GrOoViN, There are no symptoms of prostate cancer unless it's advanced. Your family physician or a urologist will probably give you a PSA test. However you better be aware that if the PSA is elevated the urologists will misuse these results as an excuse for invasive tests and other unnecessary procedures to increase their profits when they should be trying to lower it by simple non-invasive treatments first which they will never do. In other words if it is found your PSA is elevated you can expect yourself to part of the medical system for the rest of your life when there could possibly be simple treatments that can lower your PSA to zero yet the urologists will never tell you about them. I saved myself from being taken advantage of from the information in this excellent book "Surviving Prostate Cancer Without Surgery" by Dr. Brad Hennenfent. This book saved me from needless suffering and invasive tests. Regards, Everett > What are the signs of prostate cancer? what are the simptoms? How do you > knowwhen to be tested and who does the tests? Does your family phycisan > give the test or does he refer you to a specialist to do it? sorry for > so many questions Thank you, Leonard and Everett, for the helpful information that you both have given me and thank you both for taking the time to reply to my questions. I have also learned a bunch of info from http://www.oncologychannel.com/prostatecancer/index.shtml a web site that someone had posted in the alt.support.cancer.prostate newsgroup. Thanx again for your help everybody. Eazy. > Thank you, Leonard and Everett, for the helpful information that you > both have given me and thank you both for taking the time to reply to my > questions. I have also learned a bunch of info from > http://www.oncologychannel.com/prostatecancer/index.shtml I glanced through this site, and I didn't see anything specially wrong or misleading in what they say. But it does seem to be hawking some specific medications and procedures. That makes me a bit suspcicious. There are plenty of authoritative sites which will provide information about prostate diseases and prostate cancer in particular. One reliable one is the Mayo Clinic site at www.mayoclinic.com Another is the Sloan Kettering Cancer Center website www.mskcc.org/mskcc/html/403.cfm > a web site > that someone had posted in the alt.support.cancer.prostate newsgroup. > > Thanx again for your help everybody. > Eazy. > EaZy GrOoViN, > There are no symptoms of prostate cancer unless it's advanced. Your [quoted text clipped - 4 lines] > trying to lower it by simple non-invasive treatments first which they > will never do. This is a blatantly false statement since by the grammar it appears to apply to all urologists. Certainly there are urologists who will do just that, but the great majority of doctors, including urologists, don't operate that way. If you have doubts about your doctor's ethics, then find yourself another doctor. > In other words if it is found your PSA is elevated you > can expect yourself to part of the medical system for the rest of your > life when there could possibly be simple treatments that can lower your > PSA to zero yet the urologists will never tell you about them. PSA is produced by normal prostate tissue. The only way to reduce the PSA level to zero is to effectively destroy the prostate. Normal men without any disease will have easily measurable PSA levels, anywhere from 0.5 to 2.5 or even higher in older men. It would be crazy to apply any treatment which reduces the PSA to zero without knowing that the patient has prostate cancer, and no ethical doctor would do that. PSA can increase for a variety of reasons. One is prostate cancer, but it is not the only one, or even the most likely one. What a good doctor does is to try to diagnose the disease and to treat it if it causes problems. High PSA, by itself is not a problem if the underlying cause doesn't cause any problems. The most common cause of high PSA is benign prostatic hypertrophy, which happens in the majority of older men. The prostate grows and hence produces more PSA, but it doesn't need to be treated unless the prostate presses down on the urethra and makes urination difficult. It can be treated by drugs, or, if that doesn't work, by surgery. The second most common cause is prostatitis, which is an imflammation of the prostate, and usually needs to be treated. It can be acute, caused by a bacterial infection, in which case antibiotics can cure it. Often a uorlogist will prescribe a course of such drugs to see if it brings down the infection (and with it the PSA level). Unfortunately, often prostatitis is chronic and doesn't respond to antibiotics. In such cases, it can be difficult to treat. The remaining common case is prostate cancer. The only way to diagnose that definitively is by doing a biopsy. In cases where other explanations seem questionable, a urologist will do a biopsy. That is an invasive procedure, but it is relatively safe and not particularly painful for the vast majority of men. If you are more afraid of the biopsy than of prostate cancer, then by all means choose not to have one. > I saved > myself from being taken advantage of from the information in this > excellent book "Surviving Prostate Cancer Without Surgery" by Dr. Brad > Hennenfent. This book saved me from needless suffering and invasive > tests. He appears to be referring to biopsy. Do a google groups search in alt.support.cancer.prostate. You will find lots of testimony from men who have had biospies, and it will be clear that the above wording is a gross exaggeration of their experience. There, of course, is the possibility that a biopsy will show the existence of prostate cancer. Some doctors think that there is almost never any sense in trying to cure prostate cancer. They think either it is relatively benign and will never bother the patient or it is aggressive and will kill him whatever is done. They would advise not doing PSA tests at all and only doing a biopsy if there are explicit symptoms that suggest a progressive case of prostate cancer. In the great majority of such cases, it is fairly universally agreed that aggressive treatment like surgery or extensive radiation will not do much good except in a small minority of cases. The only effective treatment today is hormone therapy which will work for some period of time ranging from 1 to 10 years or more. I believe the median time in such cases is something like 3 years. But hormone therapy also has signifcant and unpleasant side effects. And it always fails, so the patient will die of prostate cancer if he doesn't die of something else first. The great overwhelming majority of urologists don't accept this dichotomy. They believe that many cases of early prostate cancer, which would advance if untreated, can be cured by early intervention such as surgery or radiation. However, whether a man should undergo such intervention is highly dependent on how long he can be expected to live. Since even when prostate cancer advances, it can take a while for it to be a problem. The recommended cut off point is ten years life expectancy, but each case has to be evaluated separately by a competent specialist. Factors which can affect the likelihood that the cancer will advance rapidly are the PSA level, its rate of increase, the extent of the tumor, and its Gleason grade. The latter two can only be dermined through biopsy. It seems crazy to me not to want to know if you have prostate cancer, if signs point that way. Even if you accept the idea that treatment is generally futile, there is no way to know whether in your particular case, special circumstances might make treatment a reasonable choice. For some men, it may be appropriate not to bother finding out because the likelihood of aggressive treatment being a good choice for them is small. That would include many older men or men in poor health. But for most men under 70, it makes sense to find out, or, so it seems to me. No one will take a gun to your head and insist you have surgery or radiation. Once you understand the odds one way or the other for your particular case, you can decide what to do. > Regards, > Everett [quoted text clipped - 12 lines] > >>so many questions > > EaZy GrOoViN, > > There are no symptoms of prostate cancer unless it's advanced. Your [quoted text clipped - 10 lines] > don't operate that way. If you have doubts about your doctor's ethics, > then find yourself another doctor. Name any urologist, when shown a PSA 4+, can risk a lawsuit by not insisting on biopsies and aggressive treatments? Since the PSA has never been shown to lengthen LIFE, it is a cultural issue (not medical) that treatments are pushed despite no supporting data, excecpt faith. > Name any urologist, when shown a PSA 4+, can risk a lawsuit by not > insisting on biopsies and aggressive treatments? > > Since the PSA has never been shown to lengthen LIFE, it is a cultural issue > (not medical) that treatments are pushed despite no supporting data, excecpt > faith. Why would I not want to know I have prostate cancer? Why, if I knew, would I not want to treat prostate cancer or any cancer for that matter. I don't think anyone has a crystal ball that can predict the future of A cancer if found to exist in your or my body. Seems like a no-brainer to me. Dale J.  SignatureEmail: dalej2@mac.com > > Name any urologist, when shown a PSA 4+, can risk a lawsuit by not > > insisting on biopsies and aggressive treatments? [quoted text clipped - 13 lines] > -- > Email: dalej2@mac.com You have given a perfect culturally-determined answer with no science mentioned at all. The issue is length of life. >>> Name any urologist, when shown a PSA 4+, can risk a lawsuit by not >>>insisting on biopsies and aggressive treatments? [quoted text clipped - 22 lines] > You have given a perfect culturally-determined answer with no science > mentioned at all. The issue is length of life. George, you keep invoking "science", but you've shown repeatedly that you have no interest in actually learning anything about the current scientific understanding of prostate cancer. You pick out a small number of specific isolated facts and harp on those. Aren't you at all curious about all the rest? > >>> Name any urologist, when shown a PSA 4+, can risk a lawsuit by not > >>>insisting on biopsies and aggressive treatments? [quoted text clipped - 28 lines] > number of specific isolated facts and harp on those. Aren't you at all > curious about all the rest? The issue is whether current treatments lenghen life, not how to deal with side effects of such treatments. The science has never been done because of the attitudes you keep falling back upon. As I said, women have been much less culture bound than men, and the science is 25 years more advanced for breast cancer than for prostate cancer. > > > Name any urologist, when shown a PSA 4+, can risk a lawsuit by not > > > insisting on biopsies and aggressive treatments? [quoted text clipped - 18 lines] > You have given a perfect culturally-determined answer with no science > mentioned at all. The issue is length of life. If there were a bullet heading in my general direction I would want to seek cover so as to lower my chances of being struck by it. Wouldent this be a prudent thing to do, or should I foolishly stand and take my chances? Seems to me this is more to do with a gamble than with culture. SignatureEmail: dalej2@mac.com > > > > Name any urologist, when shown a PSA 4+, can risk a lawsuit by not > > > > insisting on biopsies and aggressive treatments? [quoted text clipped - 21 lines] > If there were a bullet heading in my general direction I would want to > seek cover so as to lower my chances of being struck by it. A bullet is not something that 8% of men carry with them from age 30+. Nor is it something 100% of men will have by age 80. The issue is whether treatments as now known save lives. No one so far has shown that. If any effects exist, they are going to have to be small. >>>>> Name any urologist, when shown a PSA 4+, can risk a lawsuit by > [quoted text clipped - 42 lines] > A bullet is not something that 8% of men carry with them from age 30+. > Nor is it something 100% of men will have by age 80. You keep saying that. Please present some scientific evidence that it is true. References to several published papers would help. If you can't find such evidence, you should stop saying it. > The issue is whether > treatments as now known save lives. No one so far has shown that. If any > effects exist, they are going to have to be small. > A bullet is not something that 8% of men carry with them from age 30+. > Nor is it something 100% of men will have by age 80. The issue is whether > treatments as now known save lives. No one so far has shown that. If any > effects exist, they are going to have to be small. George, You are almost totally correct here. The only slight error you made is that it has been shown that the first prostate cancer cells develop during the 20's and 30's, not just in their 30's, (see Clinical Cancer Research, Vol 1, Issue 5 473-480). The reason for this seemingly slow growth rate is that apoptosis occurs almost as fast as prostate cancer grows in our youth. As we age and the amount of T drops and E increases, the rate of apoptosis slowly decreases while the rate of cancer growth remains the same, resulting in an apparent increase in overall growth rate. This is why,in my opinion, the correct way to approach prostate cancer is to view it as a systemic problem, where the solution is to change the rate of apoptosis to become greater than the rate of growth by manipulating hormonal balance. This requires a change in your mindset where you stop looking for a "cure" and settle for living a normal life with prostate cancer inside you, but without letting it kill you (which is what we have all been doing for decades without realizing it). This is why I beleive that Dr. Leibowitz and Dr. Tucker are on the right track in the way they treat prostate cancer at all stages. Ed Friedman >> A bullet is not something that 8% of men carry with them from age 30+. >> Nor is it something 100% of men will have by age 80. The issue is [quoted text clipped - 9 lines] > during the 20's and 30's, not just in their 30's, (see Clinical Cancer > Research, Vol 1, Issue 5 473-480). Here is the abstract of the paper you reference: ------------------------------------------------------ Implication of cell kinetic changes during the progression of human prostatic cancer RR Berges, J Vukanovic, JI Epstein, M CarMichel, L Cisek, DE Johnson, RW Veltri, PC Walsh and JT Isaacs Johns Hopkins Oncology Center, Baltimore, Maryland 21231, USA. The daily percentage of cells proliferating and dying were determined for normal, premalignant, and cancerous prostatic cells within the prostate as well as for prostatic cancer cells in lymph node, soft tissue, and bone metastases from untreated and hormonally failing patients. These data demonstrate that normal prostatic glandular cells have an extremely low but balanced rate of cell proliferation and death (i.e., both <0.20%/day). This results in a steady-state, self-renewing condition in which there is no net growth, although the glandular cells are continuously being replaced (i.e., turnover) every 500 +/- 79 days. Transformation of these cells into high-grade prostatic intraepithelial neoplastic cells initially involves an unbalanced increase in the daily percentage of cells proliferating versus dying, such that net continuous growth occurs (i.e., mean doubling time, 154 +/- 22 days). As these early proliferation lesions continue to grow into late stage high-grade prostatic intraepithelial neoplastic cells, the daily percentage of cells dying increases further to a point equaling the daily percentage of proliferation. This results in cessation of net growth while inducing a 6-fold increase in the turnover time of these cells (i.e., 56 +/- 12 days), increasing their risk of further genetic changes. The transition of late stage high-grade prostatic intraepithelial neoplastic cells into localized prostatic cancer cells involves no further increase in proliferation but a decrease in death resulting in net continuous growth of localized prostatic cancers with a mean doubling time of >/=475 days. As compared to localized prostatic cancer cells, metastatic prostatic cancer cells within lymph nodes or bones of untreated patients have an increase in daily rate of proliferation coupled with a reduction in their daily percentage of cell death, producing net growth rates with a mean doubling time of 33 +/- 4 days and 54 +/- 5 days, respectively. Remarkably, there is no further increase in proliferation in hormonally failing patients, but instead an increase in the daily percentage of androgen-independent prostatic cancer cells dying within soft tissue or bone metastases. These changes result in doubling times which are two to three times longer (i.e., 126 +/- 21 and 94 +/- 15 days) in these lymph node and bone metastatic sites, respectively, compared to similar sites in hormonally untreated patients. These data demonstrate that the daily percentage of proliferation for either androgen-dependent or -independent metastatic prostatic cancer cells is remarkably low (i.e., <3. 0%/day), consistent with why antiproliferative chemotherapy has been of such limited value against such metastatic cells. These results also suggest that prostatic carcinogenesis starts in the second to third decade of life and may require over 50 years for progression to pathologically detectable metastatic disease. ------------------------------------------------------------------- Your statement is presumably based on the last sentence. Note that this does not tell us anything about how often prostate cancer would be detected in men in their 20s or 30s. It certainly doesn't support the contentions about the percentages of men at any age who "have" prostate cancer. It just suggests that the beginning of the process occurs quite early and may take a long time for progression to clinically detected metastatic disease, but it is only one thought thrown out. The article is primarily about something else. It is very easy to get confused about these matters. One has to exercise care about what it means to "have" prostate cancer. Remember that we have pretty good figures about the incidence of prostate cancer. It is usually estimated that about 16 percent of men in the US will be diagnosed with prostate cancer during their lives. That data is not consistent with the idea that practically all men "have" or will "have" prostate cancer. George Conklin is trying to argue that you will always find prostate cancer if you look hard enough. But millions of men have regular PSA tests, and some of those men have biopsies as a result. It is just not true that all these men eventually show clinical evidence of prostate cancer. It is not even true that over half the men who have biopsies are diagnosed with prostate cancer. > The reason for this seemingly slow growth rate is that apoptosis occurs > almost as fast as prostate cancer grows in our youth. As we age and the [quoted text clipped - 11 lines] > is why I beleive that Dr. Leibowitz and Dr. Tucker are on the right > track in the way they treat prostate cancer at all stages. I think you are taking one sentence from a research article out of context and leaping off into the wild blue yonder to support a theory which is not even hinted at in the article. The question is whether one can really control prostate cancer indefinitely by use of hormones. It does seem possible that if we castrated all men in their 20s, the prostate cancer rate might be much lower, but other than that, I'm not sure what you mean. I suspect that the authors (Walsh, et. al.) of the article you quote would not agree with you that your "systemic" strategy is a reasonable approach. Indeed the conventional opinion is that such a strategy doesn't work except to control prostate cancer for a limited period of time. But if you think your ideas may hold up, you should try to publish them in the medical literature. > Ed Friedman > This is why,in my opinion, the correct way to approach prostate cancer > is to view it as a systemic problem, where the solution is to change [quoted text clipped - 7 lines] > > Ed Friedman You first Ed. For me I have only one life and I want to make the best choice. Experiment on yourself if you wish, but not on me. I hope other potential cancer patients will think about this very carefully. It has nothing to do with culture or mindset as you put it, but it has to do with living cancer free. This is the goal. If you want to live your life with the thought of prostate cancer and could it be growing beyond control then take the path and the risk you prescribe. Annual biopsies, PSAs, and/or hormone treatments are not for me. Dale J. SignatureEmail: dalej2@mac.com > > This is why,in my opinion, the correct way to approach prostate cancer > > is to view it as a systemic problem, where the solution is to change [quoted text clipped - 12 lines] > For me I have only one life and I want to make the best choice. > Experiment on yourself if you wish, but not on me. The current system is one massive experiment with no controls. > > [quoted text clipped - 7 lines] > Why would I not want to know I have prostate cancer? Why, if I knew, > would I not want to treat prostate cancer or any cancer for that matter. If there was a good chance that the cancer would never bother you during your expected lifetime, then it would make sense not to treat it. For some men, that is exactly what the situation is. > I don't think anyone has a crystal ball that can predict the future of A > cancer if found to exist in your or my body. Seems like a no-brainer to > me. In any of these things, it is a question of balancing the potential benefits against the potential side effects of the treatment. Certainly, today, some men who don't need to be treated are being treated, and some of them suffer needless side effects. Unfortunately, there is no simple way to distinguish in any given case whether the cancer will likely remain innocuous during the man's lifetime. So we have to go by the odds as best we understand them. That is what a good physician should do for you: help you understand those odds. > Dale J. > >> Name any urologist, when shown a PSA 4+, can risk a lawsuit by not > >>insisting on biopsies and aggressive treatments? [quoted text clipped - 24 lines] > > > > Dale J. This is correct. The other problem is that no one seems to know if the serious cases which do need to be treated respond to current treatments or if the disease just marches on. With women, high dose chemotherapy (bone marrow transplants) shoved the symptoms underground for a few years more, but then the disease came back and was quickly fatal. This was a big surprise. This kind of work is not yet done for prostate cancer. Why? We men are not well organized. Women are. >>>> Name any urologist, when shown a PSA 4+, can risk a lawsuit by not >>>>insisting on biopsies and aggressive treatments? [quoted text clipped - 34 lines] > serious cases which do need to be treated respond to current treatments or > if the disease just marches on. That is a pretty meaningless statement since you haven't defined "serious". But it comes down to the same issue, comparing to a control group. Note that this particular experiment will never be done. You would have to get a group of men who have been diagnosed with "serious prostate cancer" defined in some way, and randomly assign them to treatment or no treatment. Aside from the fact that it would be extremely difficult to get men to participate, there are clear problems of medical ethics involved here. The existing studies compare men with moderate disease, which is an entirely different issue. Given the fact that no really rigorous study of this kind will ever be done, we have to be satisfied with indirect evidence. There has been research on the natural history of prostate cancer if left untreated., and lots of research on the effectiveness of treatment as a function of the specific features of the disease. It does appear to show that in really "serious" cases, attempts to cure the disease are not very effective. This evidence is used today to influence treatment decisions. Surgeons are reluctant to operate on patients with Gleason 8 disease or men with very high PSAs. They will usually only do it in relatively limited circumstances. The study which comes closest to what you describe is the Swedish study reported whithin the past year in the NEJM. There men were treated with radical prostatectomy or watchful waiting followed by hormone therapy where needed. In Sweden, men are not typically screened for prostate cancer, and it is estimated that these men were about 5 years further along when they were diagnosed than is typically true in the US. There was a statistically significant difference in deaths due to prostate cancer in the RP group within the average followup of 6 years. There was no statistically significant difference in overall deaths between the two groups, but because of the short period of followup and the actual numbers involved, that fact is not particularly significant. The main result of the study, which critics try to ignore, was that RP, in these special circumstances, was shown to be more effective at preventing death from prostate cancer within this short time period. They harp on the secondary result. It would be very foolish to claim that this study proved that there was no difference in overall deaths between the two groups. It was really entirely neutral on that issue. In any case, because the circumstances are very different, it is not at all clear what the Swedish study means about patients in the US. > With women, high dose chemotherapy (bone > marrow transplants) shoved the symptoms underground for a few years more, > but then the disease came back and was quickly fatal. This was a big > surprise. This kind of work is not yet done for prostate cancer. Why? We > men are not well organized. Women are. >>>EaZy GrOoViN, >>>There are no symptoms of prostate cancer unless it's advanced. Your [quoted text clipped - 13 lines] > Name any urologist, when shown a PSA 4+, can risk a lawsuit by not > insisting on biopsies and aggressive treatments? My urologist. I had a PSA of 4.5 and it had been slightly faster than the cut-off point of 0.75 ng/ml per year over a two year period. He did not insist on a biopsy but presented it to me as an option. The other option was to wait and see what happened in further PSA tests. Walsh, even in cases where a biopsy shows the existence of prostate cancer, does not recommend aggressive treatment in some men. He certainly doesn't recommend aggressive treatment in men with an expected life span of less than 10 years. Also, for some men approaching 70 with Gleason 6 cancers who also satisfy certain other diagnostic criteria, he recommends "watchful waiting" rather than aggessive treatment as an option. I've now presented two counterexamples, one of them who is often considered the prime advocate of surgery for prostate cancer. However, there are many other examples. > Since the PSA has never been shown to lengthen LIFE, it is a cultural issue > (not medical) that treatments are pushed despite no supporting data, excecpt > faith. Your statement seems to imply implicitly that PSA testing has been shown not to lengthen expected lifetime. But you should know that such a statment is false. No such thing has ever been shown. The only truthful content to your statement is that no strictly randomized propspective study has shown that PSA testing prolongs life on the average. However, there is indirect evidence that PSA testing is beneficial, at least in some cases. The most you can claim is that the facts are not currently known. Also, it is quite likely that whether or not PSA testing provides a benefit for any given man is highly contingent on the details that apply to that particular man. Prostate cancer is a complex disease, and any simple minded statement of this kind is bound to be misleading. > >>>EaZy GrOoViN, > >>>There are no symptoms of prostate cancer unless it's advanced. Your [quoted text clipped - 18 lines] > not insist on a biopsy but presented it to me as an option. The other > option was to wait and see what happened in further PSA tests. He had to recommend continued medical care, right? And that translates into radiation or surgery or both. > Walsh, even in cases where a biopsy shows the existence of prostate > cancer, does not recommend aggressive treatment in some men. He [quoted text clipped - 7 lines] > considered the prime advocate of surgery for prostate cancer. However, > there are many other examples. The problems remain: lack of science. Walsh can recommend anything he wants. Culturally men will always go for treatments and that is the whole point: any effect of treatments on lifespans is still unproven. > > Since the PSA has never been shown to lengthen LIFE, it is a cultural issue > > (not medical) that treatments are pushed despite no supporting data, excecpt [quoted text clipped - 3 lines] > not to lengthen expected lifetime. But you should know that such a > statment is false. Yes, that is correct. PSA has not been shown to lengthen life. No such thing has ever been shown. The only > truthful content to your statement is that no strictly randomized > propspective study has shown that PSA testing prolongs life on the > average. However, there is indirect evidence that PSA testing is > beneficial, at least in some cases. The most you can claim is that the > facts are not currently known. Which is what I said: PSA has not been shown to lengthen life. Also, it is quite likely that whether > or not PSA testing provides a benefit for any given man is highly > contingent on the details that apply to that particular man. This may be true, but it is also unproven. It is a cultural assumption. Prostate > cancer is a complex disease, and any simple minded statement of this > kind is bound to be misleading. When something is unproven, it is unproven. > "Leonard Evens" <len@math.northwestern.edu> wrote in message >>> Name any urologist, when shown a PSA 4+, can risk a lawsuit by not >>>insisting on biopsies and aggressive treatments? [quoted text clipped - 6 lines] > He had to recommend continued medical care, right? And that translates > into radiation or surgery or both. Please read what I said. At the time I consulted him, he presented two possible options. One was to continue with further PSA tests to see what happened, and the other was to have a biopsy then. I could have chosen either. He had no way to predict at that point what would have happened with the PSA. It could easily have fallen to significantly lower levels, in which case I would not have had a biopsy at that time and perhaps never. Of course, if it continued to rise, he probably would have recommended a biopsy. But according to your argument, he was risking a law suit. Suppose another PSA test 3 months down the line showed a PSA of 10 and the biopsy showed a Gleason 8-10 cancer. It is conceivable I would have sued him for his earlier recommendation. Apparently that prospect didn't prevent him from making the recommendation he did. It is beeside the point I was making here, but I did choose biopsy and it showed a Gleason 7=3+4 cancer. I am not a scientifically illiterate idiot, and I did try to find out what I could about such cancers. That Gleason is at the top end of what is considered curable according to current urological practice. There have been studies which showed for untreated Gleason 7 prostate cancer, the risk of metastasis within 5 to 10 years is pretty high. The data don't make it clear if the short term risk of metastasis is even over 50 percent in such cases, but there is of course always the question about long term risk. It is rational to want to avoid metastatic prostate cancer. Now of course, the prospects for a cure are uncertain, but there are also several solid studies on recurrence rates for such cancers. It seemed to me at the time, that, although I didn't know the precise odds, that I might very well live my life without any problems from the cancer, but the risk of advanced prostate cancer, in an informal sense, was too high for me to want to chance it. I also understood the risks of side effects and decided I could deal with them. On balance it seemed to me that trying to cure the cancer at that stage made sense. So far, some four years after surgery, I am doing pretty well. The cancer was organ confined, and in cases like mine, the likelihood of nonrecurrence within ten years is very high. Also, the side effects were something I can deal with and they don't seriously impact my quality of life. Had I not chosen treatment, I might have been perfectly fine right now with marginally better quality of life, but, on the other hand, I might be suffering the symptoms of advanced prostate cancer. The only treatment that is know to work for that is hormone therapy, which is of limited effectiveness and has very serious side effects. >>Walsh, even in cases where a biopsy shows the existence of prostate >>cancer, does not recommend aggressive treatment in some men. He [quoted text clipped - 11 lines] > wants. Culturally men will always go for treatments and that is the whole > point: any effect of treatments on lifespans is still unproven. Let me point out yet again that the kind of "scientific proof" you require is not available for lots of well established aspects of medicine. A good example is the link between smoking and lung cancer. No study has ever been done randomly assigning people to smoking and nonsmoking groups and then following them sufficiently long to see if there is a statistically significant difference in the incidence of lung cancer in the two groups. Yet no one today seriously doubts that smoking causes lung cancer. This example is not entirely analagous to the question about treatment for prostate cancer, but it does have one important common feature. both diseases have very long time horizons. It is very difficult to design adequate random studies of this kind in such situations. the current ongoing US studies follow theair patients for up to 12 years. But it is well known from other studies, including a recent study from Sweden, that significance differences between treated and untreated groups may develop for prostate cancer after that. Whenever I've raised that issue, you argue that "surely" there would be early indications of a difference. But that is argument through personal belief, and it is not scientific. There is no way to know about such things without actually doing the required followup. Also, any one study may be wrong for purely random reasons, so one needs other studies to confirm the results. Finally, choosing "lifespan" as the only criterion is not justified. There are many situations where one may choose one medical option as opposed to another although it won't extend one's life. There are other criteria which are also relevant. In the case of prostate cancer, avoiding metastatic cancer is a rational end, even if one doesn't necessarily live longer. >>>Since the PSA has never been shown to lengthen LIFE, it is a cultural > [quoted text clipped - 21 lines] > > Which is what I said: PSA has not been shown to lengthen life. Again, that is only in the limited context of a certain kind of randomized study. There is some indirect evidence which indicates that PSA testing does lower the overall death rate due to prostate cancer. One is the US evidence about the declining number of deaths due to prostate cancer in the era of PSA testing. Similar results comparing the Tyrol to other parts of Austria showed similar results. And other countries such as Sweden, which don't do routine PSa testing, have not had comparable declines. Of course, there can be other factors which explain these differences. That is the reason why biostatisticians prefer randomize prospective studies. But such studies are not always possible, and they have their limitations also. Your philosopy, if applied consistently, would be not to treat any condition unless that treatment had been shown by a double blind randomized prospective study to be effective for the population under consideration. You would ignore all other forms of evidence. That would leave precious little medical treatment available. That is certainly a consistent point of view, but when you make your statements you should explain precisely what you mean. That would let people judge whether they should pay attention to what you say. > Also, it is quite likely that whether > >>or not PSA testing provides a benefit for any given man is highly >>contingent on the details that apply to that particular man. > > This may be true, but it is also unproven. It is a cultural assumption. This again depends on what you mean by "unproven". In prospective studies, there is pretty clear evidence that not all prostate cancer is the same. While, it is theoretically possible that a strict randomized study of the kind you are willing to accept will show no differences according to factors like age, PSA value, Gleason score, etc., the indirect evidence suggests that this is highly unlikely. > Prostate > >>cancer is a complex disease, and any simple minded statement of this >>kind is bound to be misleading. > > When something is unproven, it is unproven. You really should stop using that term. Strictly speaking, you only have proofs in logic or mathematics. In that case, subject to possible errors in the proof, something can be considered either proven or unproven. In some science, one can consider something observationally verified to a high degree of confidence. But it will never be proven in the mathematical sense. The next experiment may show it to be false. In the treatment of disease, there is very little that can be considered proven or even experimentally verified beyond any doubt. Consider the case of prostate cancer. It is very hard to organize an adequately designed randomized study to test alternatives against one another. Usually, one applies certain statitistical tests which apply provided there are no systematic biases which have been ignored. But one can never be really certain about that. In addtion, in most such studies where something is considered highly likely, the confidence interval allows a 5 percent chance that the results happened purely by chance. In other words, if the law of large numbers applies, roughly one in twenty of such studies will produce an incorrect result. In such a situation, where even the best statistics can't provide certainty and where it is very difficult to be sure about the absence of bias in any study, one must use all the information available. And that includes retrospective studies and other information. You are clearly willing to do that where it supports your case. You quote annecdotal information that 8 percent of men in the 20s have evidence of prostate cancer, and 100 percent of men over 80 do. Do you consider that "proven". It certainly hasn't been proven by studies of the kind we have been talking about. As far as I can tell, it hasn't been established by any criterion whatsoever. Leonard, You've been brainwashed by the urology profession. From what your wrote it's obvious the urologists have you thinking exactly the way they want you to think along with many others whom I'm sure have the exact same opinion as you do. The urologists cannot get away with what they are getting away with otherwise. The rate of prostate cancer is about 100% in any man if he lives long enough. This is not due to unknown causes as the urology profession wants you to believe but is actually due to the professional ethics of the urology profession in how they choose to practice. All of you better wake up to what is going on here otherwise the mass slaughter by the urologists will continue. I would suggest you read Dr. Hennenfent's book. Regards, Everett >Leonard Evens wrote: >PSA is produced by normal prostate tissue. The only way to reduce the >PSA level to zero is to effectively destroy the prostate. Normal men >without any disease will have easily measurable PSA levels, anywhere >from 0.5 to 2.5 or even higher in older men. It would be crazy to apply >any treatment which reduces the PSA to zero without knowing that the >patient has prostate cancer, and no ethical doctor would do that. On December 29, EverettRWadsworth replied to Leonard Evens, in pertinent part: > .....................................The rate of prostate cancer is > about 100% in any man if he lives long enough. This is not due to [quoted text clipped - 3 lines] > going on here otherwise the mass slaughter by the urologists will > continue. I would suggest you read Dr. Hennenfent's book. Aha! Up until Everett's post, no one knew the cause of PCa. Now, thanks to him and, I reckon, Hennenfent, we are assured that the cause of prostate cancer is: urologists! Oh, I feel ever so much better. I have my own issues with a certain uro who botched my treatment, but I'm not prepared to claim that all or even most of them are killers, unethical (if that's possible) or otherwise. Hmmm. I wonder whether the reason I've never seen "Dr." H's name in any peer-reviewed publication (excepting Everett's rants which I suspect are not peer-reviewed) is the giant secret conspiracy that's suppressing the apostles. Um, if it's so secret, how is it that the Word is out? Regards, Steve J __ "A man's most valuable trait is a judicious sense of what not to believe." --Euripides I might have wrote this in a way you misinterpreted what I said. What I mean is urologists are a contributory cause to prostate cancer, not the sole cause as you might have interpretted from the way it was written. Regards, Everett >Stephen Jordan wrote: >Aha! Up until Everett's post, no one knew the cause of PCa. Now, thanks >to him and, I reckon, Hennenfent, we are assured that the cause of >prostate cancer is: urologists! If someone wants to use diet to treat cancer they have onle themselves their families and whatever to answer for either saving hassle and anxiety or a slow painful death.I wish them well,I would like to think that a Gleason score of 4+3 was an indicator of possible death ,can't give you figures on that I do know that the RP surgery has worked to the effect that I have had three straight clear tests[knock on wood],this surgery never would have happened without a PSA and biopsy is there a logical train here? not necessarily as there is only one me and no control group.Had a posting thing with a UK Doc's statement that PSA's don't save lives that is true and Diabetes tests don't either they just indicate types of treatment actuallt a good example as it is not either or but a medical plus diet approch for Diabetes as in all illness models we should try to move away from either or and try to find multiple approaches, Take Care, > Leonard, > You've been brainwashed by the urology profession. I assure you I am capable of independent thought. We happen to disagree about this situation. You are certainly entitled to your opinion, but you keep making assertions that just aren't true, or if they contain a kernel of truth are gross exaggerations. > From what your > wrote it's obvious the urologists have you thinking exactly the way > they want you to think along with many others whom I'm sure have the > exact same opinion as you do. The urologists cannot get away with what > they are getting away with otherwise. The rate of prostate cancer is > about 100% in any man if he lives long enough. We've been through this before. The last time it came up, I did a Medline/Pubmed search for data about this. I found that this statement, which is often repeated, has no scientific basis. It is true that on autopsy, prostate cancer does show up in a high percentage of older men, but the figure is far from 100 percent. In addition, there is a vast difference between evidence of prostate cancer on autopsy and a clinical case of prostate cancer discovered in a living man. > This is not due to > unknown causes as the urology profession wants you to believe but is [quoted text clipped - 15 lines] >>any treatment which reduces the PSA to zero without knowing that the >>patient has prostate cancer, and no ethical doctor would do that. |
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