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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
His main argument is the right for
information. Terry in his reaction
gives several good points that
depreciate the value of this
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.