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Re: Why do Active Surveillance articles favor men 65+ with low risk diagnosis?

A friend asked me if there is a local urologist to avoid. I sure had an answer for him and I stated that "I now know more about the meaning of PSA test then the doctor". I feel good that I at least got a second opinion and did not base everything on a doctor that was telling me what I wanted to hear. This web site and John's Hopkins library have been excellent educational tools.

Re: Why do Active Surveillance articles favor men 65+ with low risk diagnosis?

Alan you say:

According to the American Cancer Society, a PSA level between 4 and 10 has a 25% chance of being prostate cancer ....

Some studies show that the percentage of men with a positive biopsy might be as high as 35% with a PSA over 4.0 ng/ml - but that would include men with a PSA of over 10.0 ng/ml. Either way, there are more men who will NOT be diagnosed with PCa after an elevated PSA than those who will.

That is one of the problems with PSA testing - the other being that about 15% of men with a PSA BELOW 4.0 ng/ml will be diagnosed with PCa - that is because the PSA test is NOT prostate cancer specific, something apprently not known by many in the PCa world.

Good luck to you all
Terry in Australia

Re: Why do Active Surveillance articles favor men 65+ with low risk diagnosis?

Hi Terry,

I am a little confused by your last post. When you said..."that is because the PSA test is NOT prostate cancer specific, something apparently not known by many in the PCa world", who are the "many" that you refer to?

The fact that PSA is not PCa specific should be obvious to anyone looking at the data. After all, if 25% of men with a PSA between 4 & 10 have PCa, then it should go without saying that 75% of them have an elevated PSA caused by factors other than cancer.

What is the doctor’s responsibility as far as PSA is concerned? The U.S. Preventive Services Task Force (& similar organizations around the world) have come out against automatically testing for PSA. Instead it is recommended that the doctor help his patient make an informed choice regarding the test by “discussing the potential but uncertain benefits and the known harms of prostate cancer screening and treatment”.

So, as more & more doctors follow these recommendations, many men opting to forego the test (like my brother) will not know what their PSA is and the doctor’s responsibility ends with making sure his patient has made an informed choice.

However, if the patient chooses the PSA test, any responsible doctor would inform the patient of the likelihood of cancer based upon his score, and make the patient aware of the importance of PSA screening every 4-6 months.

Alan in the USA.

Re: Why do Active Surveillance articles favor men 65+ with low risk diagnosis?

Alan,

The "many" I referred to when I said "......that is because the PSA test is NOT prostate cancer specific, something apparently not known by many in the PCa world....." are what at times seem like the majority of doctors, urologists and men. I see hundreds of stories each year - and have for the past fifteen years - and time and again men are rushed into early biopsy and early treatment on the basis of a PSA number (and often a single such number) that is marginally elevated.

For every man who has a positive outcome there are hundreds of thousands of men who have negative biopsy outcomes. Very few of these men post their experiences, because they are not diagnosed with prostate cancer, but they have undergone an unneccesary procedure, which is not without risk. And when they have their next PSA test and the number is still elevated, the chaces are that they will be offered another biopsy.

Some men will go on to have multiple biopsy procedures, based on their PSA levels until fnally there is a speck of material which can be labelled as 'adenacarcinoma'. And they can then worry about which of the many therapies on offer they need to treat this 'cancer'.

There seem to be very few doctors who will investigate potential causes of PSA elevation before ordering a biopsy; who will run a series of PSA tests to see what the results are.

I don't know if you have come across Dr Catalona in your Internet searches? He is highly regarded within the prostate cancer industry and is commonly regarded as the 'father' of PSA testing. It is said his Foundation benefits from the enormous royalties generated from the test. The FAQ page on his site is at Urological Research Foundation Here are some relevant quotes from that page:

The PSA blood test is probably the single most accurate test we have for the detection of prostate cancer.

When used properly, the PSA test can detect prostate cancer in a curable stage in the great majority of patients.

If the PSA is in the 2.5-4 range, the chances of finding cancer on biopsy are about 25%. If the PSA is 4-10, the chances of finding cancer are 35-40%. If the PSA is higher than 10, the chances of finding cancer are about 60%.

I recommend biopsy for ..... a PSA of more than 2.5.

All the best
Terry in Australia

Re: Why do Active Surveillance articles favor men 65+ with low risk diagnosis?

Hi Bruce,
It seems your point is that if you know your treatment is surgery when the time seems right based on the AS monitoring, may want to consider it sooner than later, to be safe. That is why I am most interested in Color Doppler or something equivalent to get a better overall picture of how much cancer exists in my prostate today, thanks!

Re: Why do Active Surveillance articles favor men 65+ with low risk diagnosis?

Yes Tom. My mind set is get surgery sooner than later and make sure you have a good experienced surgeon. For an example I had some leakage where the urethra was attached to the bladder. They adjusted the catheter and it stopped. The surgeon said he only put 4 sutures in. They have found to many sutures weaken the bond. I have no incontinence now and I am sure it is do to attention to little details.

Re: Why do Active Surveillance articles favor men 65+ with low risk diagnosis?

Bruce,

Would you care to share more detals of your diagnosis with us - number and percentage of positive cores, Gleason Score etc. I ask because these are all issues that are relevant in a decision making process. Relying on a PSA only can be misleading. Can you also confirm that, as implied by your post, you only had a biopsy after watching your PSA rise and fall for four years?

There are two points that are required to bring the point you are making into focus:

1. You say I now feel I had cancer 4 years prior to surgery... There is a general agreement that most varieties of prostate cancer (other than the aggressive forms) take between 15 and 20 years to develop to a stage when a random biopsy can identify the disease. So every one of us diagnosed with the disease was likely to have had the disease four years before diagnosis.

2. The second point is that there are no guarantees in any aspect of this disease. There are many studies that show that some men who see to exhibit that they are "cured" i.e.

they have surgery within six weeks of their intial diagnosis for what appears to be an early diagnosis,

they have post surgical pathology that shows no indication of spread beyond the capsule,

their PSA is undetectable after surgery

will still have a biochemical failure - a rising PSA up to 25 years after their apprently successful therapy. That is why we all have PSA tests for the rest of our lives after having been diagnosed with prostatee cancer.

Good luck with your journey
Terry in Australia

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