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When people hear the word cancer they
experience a death sentence. This may
be justified for lungcancer and several
other cancers but certainly not for
localized prostate cancer.
Prostate cancer is a inflated term
with no clinical meaning. While a lung
cancer patient has symptoms and feels
week and wasted, the man with localized
prostate cancer feels nothing except
the fear for a misnomer. The only
evidence for disease are numbers in
reports. This changes when the doctor
comes in with cutting, icing or burning.
The damage he creates makes a once
healthy man now real patient.
Depending on the study and methodology
used, between 30-70% of all men older
than 40 years harbour prostate cancer.
For men in their forties the figure is
some 15-30%, for men in their eightees
it is more than 80%. Until the advent
of PSA-tests they walked around
happily unaware. Since routine PSA
bloodwork entered the scene in the
early ninetees, many men undergo
biopsies which capture part of this
huge reservoir innocent tumors. I
call them PSA-victims.
How can this happen? As I pointed
there is the semantic problem of the
very word cancer, which is at the
root of it and very hard to get rid of.
This issue is exploited by those who
have an interest in it: urologists,
pharmaceutical industry,the bureaucrats
of national preventive agencies and
the media. It's very easy for them to
produce horror stories for which they
have the nonsolution of early detection
and treatment.Success guaranteed.
A patient with localized prostate
cancer is an easy and rewarding job
for the urologist. The patient is as
a rule healthy and not sick or a risk,
operations can be easily sceduled
without problems and last but not
least he has a source of continuous
income from controls for many years
to come.
But you argue, there are men dying of
prostate cancer! You are right. I
agree with Terry that some 3% of all
male deaths are due to prostate cancer.
I would add that some 2/3 of these
deaths occur after the age of 75.
Besides you should consider that
1 in 2 men over the age of 40 is
walking around with a prostate cancer
in his body. This puts the issue
into perspective, I hope.
I would suggest a shift in attention
and resources. This would mean
abolition of PSA's as a standard
test in bloodpanels. This would greatly
reduce the cascade of unnecessary
actions. The free coming money could
go to better care and treatment for
those with metastatic disease.
To achieve this will require a huge
effort. I count on your help.
While I certainly agree that PCa is not the hazard it is made out to be for many men, I have to strenuously disagree with the idea of doing away with PSA testing. A person needs to know if there is a potential problem and can take some corrective actions. I do not think that everyone needs to run out and get sliced, fried, or iced. There are changes that can be made in lifestyle that will slow the progression of the diease, or lower the chanse of getting it.
If some of these tests are not done, than more men will go along blissfully unaware they might have a problem, and you will get more with advanced metastatic disease.
The problem with the PSA test and biopsies are not with the information given but the use of the information. For people diagnosed with low grade PCa, the standard protocol should be Active Surveillance, not rushing to get it out. Doctors do play on peolples fear of the "C" word to urge treatments that are not necessary at that time. Dave's recent story about his diagnosis and his need to get it out then finding out he does not have cancer is a great cautionary tale for all men diagnosed with a gleason 6 cancer or below.
Undertake changing the standard of care to show that low grade PCa is not something that needs to be acted on in an invasive manner, and you will accomplish something. Advocating not even testing will not help the situation.
I strongly disagree that the PSA should be discontinued. It's still the decision of each person how they want to proceed. But as the research is showing there are proteins that cancer cells send out that communicate to other normal cells telling them that somethings happening and they should start growing. That is the essence of metastasis. Not just adjoining tissue but in places far from the site. This research on how cancer cells communicate is going on right now. Cancer cells are like thugs and they're recruiting all the time. Therefore, it's your decision to sit with these "bad boys" talking it up inside or you can remove them or radiate them as best you see fit to shut them up.
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Replying to:
Henk:
While I certainly agree that PCa is not the hazard it is made out to be for many men, I have to strenuously disagree with the idea of doing away with PSA testing. A person needs to know if there is a potential problem and can take some corrective actions. I do not think that everyone needs to run out and get sliced, fried, or iced. There are changes that can be made in lifestyle that will slow the progression of the diease, or lower the chanse of getting it.
If some of these tests are not done, than more men will go along blissfully unaware they might have a problem, and you will get more with advanced metastatic disease.
The problem with the PSA test and biopsies are not with the information given but the use of the information. For people diagnosed with low grade PCa, the standard protocol should be Active Surveillance, not rushing to get it out. Doctors do play on peolples fear of the "C" word to urge treatments that are not necessary at that time. Dave's recent story about his diagnosis and his need to get it out then finding out he does not have cancer is a great cautionary tale for all men diagnosed with a gleason 6 cancer or below.
Undertake changing the standard of care to show that low grade PCa is not something that needs to be acted on in an invasive manner, and you will accomplish something. Advocating not even testing will not help the situation.
Henk: So, what is the answer? The word CANCER is to say the very least: OMINUS. I think, and I am no expert nor a doctor, but the PSA test is a start I think. Speaking of doctors, my hometown urologist, the one who dx me with PC in January, HAS NOT, AT ANY TIME SINCE THEN, CALLED, WRITTEN OR INQUIRED ABOUT MY WELL BEING. He has though, billed my insurance. . . he didn't waste any time. For all he knows, I could be wasting away. Dave (the "Dave" that was mentioned in this post(s)
Any discussion on PSA testing on the Internet tends to get a bit aggressive and emotional and some of the basics get overlooked – or are simply not understood by those taking part.
As I have said time and again, I have no medical degrees (unlike Henk) but I have learned a fair bit in the 11 years plus since I was diagnosed.
The most important issue to know about PSA is that it is NOT prostate cancer specific. That is to say that an elevated PSA does NOT mean that a man has prostate cancer, although many men with an elevated PSA will be found to have cells identified as cancer cells in their prostates (about 35% being the maximum number identified after multiple needle biopsy).
The second important facts is that some of the most aggressive forms of prostate cancer are associated with low volume PSA – a PSA test will come back as ‘normal’ for these men, who are in fact at far greater risk than most of them men with a slightly elevated PSA and a low Gleason Score.
The third leg is that a study has demonstrated that there are more men with what we currently term prostate cancer who DO NOT have an elevated PSA than there are men with an elevated PSA and prostate cancer.
This is why people like Henk – and many other doctors – are saying that PSA testing in itself is not the answer in dealing with prostate cancer. It may be a helpful tool in identifying potential problems, but it misses more dangerous tumours than it identifies and hides the urgency of finding other and better markers.
Fred strenuously disagrees with my
proposal to skip PSA from routine
bloodpanels.
His main argument is the right for
information. Terry in his reaction
gives several good points that
depreciate the value of this
information.
To be clear I want to stress that
I mean PSA's done in standard blood
panels. There is a place for PSA
in the context of the clinical
evaluation of a urinary symptoms.
The other good indication for a
PSA test is monitoring response
after the institution of treatment.
I do agree with many of things Terry has said. However, as grossly imperfect as it is, the PSA test is unfortunately what we have. If I am understanding your position, we should not do anything (as imperfect as it may be) to try early diagnosis of PCa. You seem to be advocating waiting until it metastasizes to check whether you have it or not and then start some sort of treatment. If this is wrong, please correct me.
There definitely needs to be a better test for PCa, as well as better imaging of the prostate. More money needs to be funneled into research in these and other areas and men need to get together and demand more funds be allocated to prostate research. Breast cancer receives significantly more funds for research for a form of cancer that is diagnosed just as often and results in about the same number of deaths. I do not advocate taking funds from Breast cancer research, but for adding additional funds for Prostate cancer research.
However until new tests come along,we have to use the tools we have. Again it is what we do with the information once we receive it. There should be more education regarding what is considered low grade possibly indolent PCa. I cringe when I read the posts of someone who has been diagnosed with a Gleason 6 with very small amounts of "cancer" one month and the next month has the prostate removed or fried. I agree totally that it is over treated and AS or WW should be advocated to patients by the doctors not just mentioned dismissively by most. I would also like to see an elephant fly but unfortunately I don't think either will happen.
The point is that depending on
the autopsy study 30 to 70% of
men older than 40 walk around
with PCa, but only 3% of them
die of it mostly at old age.
The PSA test and follow up work,
cannot capture and pinpoint these
3%, hence it's useless.
The only thing that makes sense
is to wait for symptoms and treat
these symptoms. Symptoms need not
to be directly metastasis, miction
problems will be the first sign
in the majority of cases. This
was the situation until the ninetees
before the advent of PSA.
The only alternative would be
to remove prostates preventively
at say the age of 40 in all men.
However even this would not work
either since micrometastatic
disease will be present in some
individuals that cannot be
pinpointed in advance.
The proof for this that in RP
specimina pathologically graded
as pT2, the best case scenario
("we got it all"), still some
3 to 10% progress depending
on the study you believe.
I still must disagree. It is not the knowledge that causes problems, it is what you do with it. If you know you have a rising PSA, you can be checked for other urinary tract problems, if you find from biopsy you have PCa you can undertake certain lifestyle changes to arrest its progression with out undergoing anything radical. If you know you do not have to wait for symptoms to make beneficial changes. I have cut down on red meat, added vitamins, drink pomegranate juice, and am losing weight. If these work(some say yes some say no-only time will tell) the fact that I knew there was a problem and could take corrective action could either stop further symptoms or delay them.
The failure rate of RP is too high whether it is 5% or 35%, if people would take a deep breath after a Dx and study and learn, then I firmly believe that knowing is power. I have the power to make changes to possibly avert further symptoms, metastases, complications etc because I know.
