Category: Diagnosis

The Paradox of a Man’s Most-Feared Test, the PSA | The MIT Press Reader

On By DanIn Diagnosis, Prostate Cancer3 Comments

https://thereader.mitpress.mit.edu/the-paradox-of-mans-most-feared-test-the-psa/

I found this to be an interesting article about the PSA test and all the controversy that comes with it and its use.

As someone who has lived with PSA tests in their life for eleven years, I can relate to much of what she’s said in her article. Just read through this blog and you’ll see that PSA anxiety is a very real thing.

But in those eleven years, I’ve also learned that the PSA test is merely a tool used to give you a data point. It’s just one of many data points that should be used in your decision-making process, either before initial treatment or after. Like any tool, you must be trained on how to use it properly.

There is no such thing as a “good” cancer. However, I do believe that prostate cancer is far more nuanced than many other cancers. When you hear those three words, “You have cancer,” the near universal response is, “Get it outta me! Now!” But with prostate cancer, that many not be the appropriate response in some cases. That’s where patient education at diagnosis has to become much better. It’s a huge paradigm shift for a cancer patient—and even some medical professionals—to realize that doing nothing (aside from routine monitoring) can be an option in certain cases.

That’s something that I’ve learned over the years.

I’ve been blessed to have a type of prostate cancer that has been so slow growing that it’s allowed me to be around for eleven years after diagnosis. Would I do anything differently? I may have postponed my surgery a little longer to watch what my PSA was doing over a longer period to establish a trend. However, given that the doctors felt a tumor during the digital rectal exams, that told me that I was dealing with something more than a few random cancer cells. There was a mass, and it needed to come out.

Obviously, I’ve made the choice to monitor as my PSA has slowly increased over the last six years since becoming detectable again, even though some were quick to recommend salvage radiation therapy. With luck the PSMA PET scan on 30 November will reveal whether that was the dumbest decision of my life or whether I may be able to continue on my current plan of doing nothing but monitoring or whether it’s time for salvage radiation.

Lastly, a few other things that I’ve learned in the last eleven years is that every patient’s case is unique and that even the medical professionals can’t always agree on the best course of action. You just have to do your own research and go with the best information you have available to you at the time. It’s your body, your life, your choice.

Be well!

Month 61 – Letter to the Newly Diagnosed

On By DanIn Diagnosis, Prostate Cancer, Recurrence8 Comments

A few weeks ago, one of my blog’s readers, a three-time cancer survivor, emailed me with a suggestion for a post topic: An open letter to the newly diagnosed, offering insights and support based on my own experience. I found the idea intriguing, so here goes…

Dear Newly Diagnosed Cancer Patient,

“You have cancer.” Three little words that will change the lives of you and your family forever. It’s terrifying. It’s bewildering. It’s overwhelming. It sucks.

Oregon Sunset 2Cry a little. Cry a lot. But strive to get through the initial shock and emotional reaction as quickly as you can. You’ve got work to do.

Don’t bother trying to answer the question, “Why?” You’ll spend too much energy to never get the answer. You’ll need to focus that energy on what’s ahead.

Don’t be ashamed that you have cancer. Have open and honest conversations about it with those around you; don’t bottle it up. Find a tidbit of humor in the situation and inject it into the conversation. When you do, people will feel more comfortable around you. Recognize, however, that some people will find being around cancer too difficult and will withdraw. Let them go, for their sake and yours. Most will return once they’ve had time to process what’s happening.

Relationships will be put to the test and may change. Remember that this isn’t all about you. It’s about those closest to you, too, and sometimes it can be more than they can bear. You’ll have to be the strong one for them. Don’t be surprised when some of your most casual acquaintances become your biggest supporters. Embrace them.

Become your own advocate. Research, research, and research some more. You may have the best medical team in the world, but question them. While they’re highly trained medical professionals, they’re still human. They may have their own self-interests in mind. If you ask a radiation oncologist what the best treatment option will be, he or she will likely say radiation. If you ask a surgeon, the answer will likely be surgery. You have to be comfortable with what’s right for you, knowing all the potential risks, side effects, and complications.

Seek out other patients who have had your cancer, whether a friend, a family member, or in a support group (or even through a blog). They can be the greatest resource available to you. They can tell you their first-hand experience and how the cancer and the treatment impacts their daily life. Recognize that each case is unique, so take their input with a grain of salt and realize you may not have the same result.

You can research and consult with your medical team until the cows come home, but at some point you’re going to have to make a decision. You. It’s your body and your life. You have to be comfortable that your research was thorough, and that you’ll make the best decision possible with the information at hand at that point in time. Then place your trust in your medical team to do the best they can.

You will be stressed. You’ll have “cancer” on the mind 24/7. Figure out ways to distract yourself from the cancer thoughts even for a few hours. Go to a movie, take a drive through the country, take a hike—whatever works for you. The stress can wear you down physically. Get plenty of rest after those sleepless nights; watch your nutrition. You’ve got to be as healthy as you can going into the challenges ahead.

All of this is far easier said than done. I know. Friends and family will offer assistance; take them up on their offers. They’re not there to pity you; they’re there to offer genuine help and support. Don’t let pride get in the way.

While we all hope for the best possible outcome, the harsh reality is that not everyone survives cancer. Make sure your affairs are in order, especially advanced medical directives, and that your family understands  and will honor your desires.

Being told you have cancer is not the end; it’s the beginning of a process.

In my case, I was diagnosed with Stage IIb prostate cancer, and the diagnosis was the beginning of my process to determine what treatment option was best for me. But even if you’re diagnosed with late Stage IV cancer and are considered to be terminal, it’s still the beginning of the process to figure out the best options for your remaining time.

Lastly, even if your cancer allows for successful treatment, cancer will always be in your thoughts long after the treatment ends. I’m five years out from my diagnosis and treatment, and a little “recurrence cloud” follows me around every day, as I wonder whether or not the cancer will return. Once you introduce cancer into your vocabulary, it’s there for good, whether the actual disease is there or not.

I wish you and your family all the best as you begin your own journey.

Dan

Month 53 – Cancer Sucks

On By DanIn Diagnosis, Prostate CancerLeave a comment

It’s not been a good month for my friends.

One learned that her husband was diagnosed with colon cancer and the other learned his mother was diagnosed with lymphoma.  Cancer sucks.

Another friend who’s been through her own cancer battle shared this article on her Facebook page, and it’s worth the read, even if you’re not newly diagnosed.

The Things I Wish I Were Told When I Was Diagnosed With Cancer

I wish my friends and their families well as they go through this new journey.

As far as my own journey is concerned, I’m living my new normal just fine every day.  Quality of life is good.

And that’s about it for this post.

Four Years Since Diagnosis

On By DanIn Diagnosis, Prostate CancerLeave a comment

It’s been four years since sitting in my urologist’s office and hearing those life-changing words: “You have cancer.”

It’s been quite the journey, and this blog has helped me get through it.  Sometimes, I think that I should stop blogging and close that chapter of my life, but that chapter will never be closed.  I don’t obsess about having had cancer, but I don’t shy away from the topic either.  Increasing education and awareness is important, and I’ve been on a quixotic mission to do just that, one reader at a time.

Obviously, I’ve decided to continue blogging, otherwise I wouldn’t have moved my blog here to its new home.  I hope you find it to be a little easier to read and navigate than the original on BlogSpot.

On an unrelated topic, today is Veterans Day, so I wanted to pause to thank all of my fellow veterans and their families for their service and sacrifices.  And for those who celebrate Thanksgiving, I wish you a happy time with family and friends.

Month 35 – No News…

On By DanIn Diagnosis, Prostate Cancer, Side EffectsLeave a comment

…is good news.

I really don’t have anything to report this month.  Zip.  Zilch.  Nada.  Nichts.  That’s good.

The only thing that I can offer up is the little trip down memory lane.

It was three years ago this week that I went for my routine physical and my doctor felt the mass during the DRE, kicking off this journey.  It was an unnerving day that began a whole series of wait-and-see events–appointments, tests, waiting for results–and trying desperately not to let my mind try to get too far ahead of the facts.

Other than that, everything else is pretty much status quo.

Next month’s update will be on 12 November instead of the usual 11th.  That’s because I’ll get my next PSA results on the 12th, and I thought I’d just consolidate the updates into one.

Keep your fingers crossed…

Month 34 – Perspectives on Prostate Cancer

On By DanIn Diagnosis, Prostate Cancer, Research1 Comment
September
is
National Prostate Cancer Awareness Month

Well, I really don’t have much of an update from a personal perspective.  Things are pretty much status quo, which is good.

I was amazed, however, that since the last post, this blog has surpassed the 10,000 page views mark, with readers from around the globe.  It’s astonishing to me given my original intent when starting this blog.

Speaking of readers, one of the blog readers (a fellow prostate cancer patient and now friend), forwarded me the article below shortly after my last post.

Again, there have been so many changes in guidance on testing and treatment in the last year that it will make your head spin.  If I were newly diagnosed today, I’m not sure what I would do.

I take that back.  One thing I would do is slow the decision-making process down and research, research, research.  But even at that, at some point you and your physician(s) are going to have to make a decision based on the best information available to you at that point in time, and there will always be some element of risk in whatever decision you make, no matter how thoroughly researched.

Does that mean that I rushed my own decision and regret having had the radical prostatectomy?  Generally speaking, no and no.

Yes, I could have kept on researching, but near the end, my head was ready to explode from all of the information that I had gathered, and that was taking an emotional and physical toll on me.

And, had my quality of life post-prostatectomy been not as good as it is, then I may have had a bit more regret about having had it.  Of course, any man would like to have full erections without drug assistance and no stress incontinence.  But my issues are relatively minor in the grand scheme of things and have little or no impact on my daily life.  That’s pretty good considering…

So read the article for a thought-provoking perspective, and use September to educate yourself and the guys in your life about prostate cancer.

*    *    *

From Bloomberg

What If What You “Survived” Wasn’t Cancer?

What If What You ’Survived’ Wasn’t Cancer?

By Virginia Postrel – Aug 18, 2013
You’re feeling fine when you go for your annual physical. But your mammogram looks a little funny, or your PSA test is a little high, or you get a CT lung scan and a nodule shows up. You get a biopsy, and the doctor delivers the bad news: You have cancer. Because you don’t want to die, you agree to be sliced up and irradiated. Then, fortunately, you’re pronounced a “cancer survivor.” You’re glad they caught it early.

But maybe you went through all that pain for nothing.

For decades, the reigning theory has been that the earlier a cancer is spotted and treated, the less likely it is to be lethal, because it won’t have time to grow and spread. Yet this theory infers causality from correlation. It implicitly assumes that cancer is cancer is cancer, even though we now know that even in the same part of the body, cancer is many different diseases — some aggressive, some not. Perhaps people survive early-stage cancers not because they’re treated in time, but because their disease never would have become life-threatening at all.

This isn’t just logical nit-picking. Thanks to widespread screening, the number of early-stage cancers identified has skyrocketed. In many instances — including types of breast, prostate, thyroid and lung cancers — more early diagnoses haven’t led to proportionate decreases in mortality. (New drugs, not early detection, account for at least two-thirds of the reduction in breast-cancer mortality.) The cancers the tests pick up aren’t necessarily life-threatening. They’re just really common. So more sensitive tests and more frequent screening mean more cancer, more cancer treatment and more cancer survivors.

“We’ll all be cancer survivors if we keep going at the rate that we’re going,” says Peter Carroll, the chairman of the department of urology at the University of California at San Francisco and a specialist in prostate cancer.

Distracting Doctors

In a well-intended effort to save lives, the emphasis on early detection is essentially looking under the lamp post: Putting many patients who don’t have life-threatening diseases through traumatic treatments while distracting doctors from the bigger challenge of developing ways to identify and treat the really dangerous fast-growing cancers.

“Physicians, patients, and the general public must recognize that overdiagnosis is common and occurs more frequently with cancer screening,” argues a recent JAMA article by the oncologists Laura J. Esserman (a surgeon and breast-cancer specialist), Ian M. Thompson Jr. (a urologist) and Brian Reid (a specialist in esophageal cancer). They argue for limiting the term “cancer” to conditions likely to be life-threatening if left untreated.
That’s going to be a tough change for a lot of people to swallow. For patients and the rest of the public, getting tested offers a sense of control, encouraging an almost superstitious belief that frequent screening will ward off death. (A few years ago, when the actress Christina Applegate was making the talk-show rounds urging young women to get breast MRIs, my own oncologist told me he was getting calls from women who thought the tests would not merely detect but prevent breast cancer.)
Early detection of non-life-threatening cancers also produces a steady supply of “cancer survivors,” who work to support cancer charities and make their efforts look successful. There’s an entire industry devoted to celebrating “breast cancer survivors” in particular, and many women are heavily invested in that identity. It offers a heroic honorific as a reward for enduring horrible treatments. A term originally coined to remind cancer patients that their disease need not be fatal has become a badge of personal achievement.

Fearing Mistakes

Physicians, meanwhile, fear making a mistake. It seems safer to treat someone who doesn’t really need it than to miss something potentially fatal. But, warns Esserman, director of the Carol Franc Buck Breast Care Center at UCSF, “the cancers that grow and spread very quickly are not the ones that you can catch in time with screening.” If anything, emphasizing early detection misdirects research and funding. “We have to come up with better treatments, we have to figure out who’s really at risk for those and figure out how to prevent them,” she says. “We’re not going to fix it with screening.”

There are plenty of scientific unknowns. Take the commonly diagnosed breast cancer called ductal carcinoma in situ, which accounts for about a third of new U.S. diagnoses, 60,000 a year. In these cases, the cells lining the walls of milk ducts look like cancer, but they haven’t invaded the surrounding breast tissue. DCIS was a rare diagnosis before the introduction of mammograms, which are highly sensitive to milk-duct calcifications, and the JAMA article labels it a “premalignant condition” that shouldn’t even be called cancer. Arguably, a lot of women who think of themselves as “breast cancer survivors” have survived treatment, not cancer.

Yet oncologists who identify DCIS have been surgically removing it (and in many cases the entire surrounding breast) for 40 years, so it’s hard to know how dangerous it actually is. “Since we really don’t know the true natural history of DCIS we do not know if DCIS always progresses to invasive cancer or not,” says Colin Wells, a radiologist at the University of California at Los Angeles specializing in breast imaging. “There are some reasons to think not, but this needs to be worked out” with further research. If DCIS does spread to invade breast tissue, the question remains whether that cancer threatens to go beyond the breast, becoming lethal if untreated.

By contrast, we do know that a lot of prostate cancer isn’t dangerous. Autopsy studies show it’s quite common in older men who die from unrelated causes. “Out there in the street, if you remove the prostates in men over the age of 50, 30 to 40 percent would have some kind of cancer,” Carroll says, “most likely, low grade and low volume.”

Distinguishing Tumors

Thanks to more sensitive tests, he notes, the prostate “cancers we’re detecting today are totally different than the cancers we saw two decades ago. And our ability to distinguish these tumors is much better. We have the wherewithal now to be able to tell a patient that your cancer is highly likely confined to your prostate, of small volume, slow growing, and something that may not need immediate treatment at all.”

Carroll has more than 1,000 patients under “active surveillance,” getting regular PSA tests, imaging and biopsies. Only about one in three turns out to need treatment within five to 10 years. (An additional 10 percent opt for surgery simply because they get tired of all the tests or can’t take the anxiety.) The program is also working, Carroll says, to “decrease the burden of testing,” ideally by eliminating the need for repeated biopsies.

Prostate cancer illustrates the cultural barriers to abandoning what Esserman calls today’s “scorched earth policy.” Despite the widespread awareness that many prostate cancers aren’t life-threatening, many physicians are determined to find and treat it any time a PSA score comes in a little high. “I saw a gentleman this week who had had 12 biopsies, no cancer, and they said there must be cancer in there and they did 24,” says Ian Thompson of the University of Texas Health Science Center at San Antonio, who is one of the JAMA authors.

A prostate-cancer diagnosis is still terrifying to patients and their families. Thompson describes many of his conversations with patients — and especially with their wives — as “talking them off the ledge.” When he tells patients they’re likely to be fine without immediate treatment, they often worry how they’ll explain the good news to their children or neighbors. People expect a cancer diagnosis to entail trauma.

Although Carroll thinks calling slow-growing prostate tumors “cancer” is important to encourage vigilance, Thompson wants to change the nomenclature, using the term IDLE (indolent lesions of epithelial origin) to describe low-risk cases where waiting isn’t likely to make a difference. Just using the word “cancer,” he argues, creates unnecessary suffering.

“The number of people that will die from those slow-growing prostate cancers is really low,” he says, but the unacknowledged costs of giving them a cancer diagnosis are huge: “the person who can’t sleep for two weeks before his next test results, and all the follow-up biopsies and all the lost wages, and the people who can’t get life insurance because they now have a new cancer diagnosis, the person whose firm says, ‘Well, we’re concerned you have cancer and therefore you can’t be promoted to this job.’”

It’s a compelling case, but changing the vocabulary finesses the fundamental cultural issue: the widespread and incorrect belief that “cancer” is a single condition, defined only by site in the body, rather than a broad category like “infectious disease.” Someone doesn’t develop “cancer” but, rather, “a cancer.” How frightening that diagnosis should be depends on which one.

Month 30 – Genetic Test & PSA Guidance

On By DanIn Diagnosis, Prostate Cancer, ResearchLeave a comment

This will be a long post because there have been several important stories in the news about prostate cancer recently.

*    *    *

The first report talks about a new genetic test that will better classify the aggressiveness of prostate cancer, and that will allow patients and their physicians to better guide their treatment decision.  This progress is quite exciting.

New Test May Help Guide Prostate Cancer Treatment 
(Full text below in case article gets deleted by NBC News.)

Being able to know the aggressiveness of the cancer may give men on active surveillance greater peace of mind, and it may allow those who are recently diagnosed to choose active surveillance as their treatment option, avoiding the potential risks of long-term, significant side effects that can come with radiation or surgery.

Of course, the test is new and unproven in the real world yet.  Still, it is a step in the right direction.

The second article talks about the American Urological Association’s (AUA) change in guidelines concerning PSA testing, making the testing less frequent.

Urologists Recommend Less PSA Testing for Prostate Cancer
(Full text below in case article gets deleted by NPR.)

Funny that this article about PSA screenings would come out just before my next post-operative PSA screening (scheduled to get the results on 20 May).  I’ll have to ask my urologist what his thoughts are on all this.

*    *    *

What do I think about all of this?  Well, I’m glad that there is more and more research that is bringing the diagnosis and treatment of prostate cancer into better focus.  Don’t get me wrong, I still think there’s a long way to go, and if prostate cancer research had half the attention and support that breast cancer research does, we could make so much more progress at a more rapid pace.

What would I do if I were diagnosed with prostate cancer today given these and other recent developments in prostate cancer diagnosis, classification, and treatment?  Would I have skipped the radical prostatectomy?  I don’t know.

What likely would have happened is that I would have slowed the decision-making process down to allow for more time for research and reflection.

When you hear “cancer” for the first time, your immediate response is to say, “Get rid of it!”  That’s they way we’ve been conditioned all of our lives.  But now with these advances, we’re getting to the point where the initial response can be, “Can I live with it?”  But it’s going to take researchers and the medical community considerable time, effort, and facts to convince us that “Can I live with it?” should be the appropriate response.

*     *     *
Pricey new test may help guide prostate cancer treatment
By MARILYNN MARCHIONE
updated 5/8/2013 9:55:14 AM ET 2013-05-08T13:55:14
A new genetic test to gauge the aggressiveness of prostate cancer may help tens of thousands of men each year decide whether they need to treat their cancer right away or can safely monitor it.
The new test, which goes on sale Wednesday, joins another one that recently came on the market. Both analyze multiple genes in a biopsy sample and give a score for aggressiveness, similar to tests used now for certain breast and colon cancers.
Doctors say tests like these have the potential to curb a major problem in cancer care — overtreatment. Prostate tumors usually grow so slowly they will never threaten a man’s life, but some prove fatal and there is no reliable way now to tell which ones will. Treatment with surgery, radiation or hormone blockers isn’t needed in most cases and can cause impotence or incontinence, yet most men are afraid to skip it.
“We’re not giving patients enough information to make their decision,” said Dr. Peter Carroll, chairman of urology at the University of California, San Francisco. “You can shop for a toaster” better than for prostate treatment, he said.
A study he led of the newest test — the Oncotype DX Genomic Prostate Score — is set for discussion Wednesday at an American Urological Association meeting in San Diego.
The results suggest the test could triple the number of men thought to be at such low risk for aggressive disease that monitoring is a clearly safe option. Conversely, the test also suggested some tumors were more aggressive than doctors had believed.
Independent experts say such a test is desperately needed but that it’s unclear how much information this one adds or whether it will be enough to persuade men with low-risk tumors to forgo treatment, and treat it only if it gets worse. Only 10 percent who are candidates for monitoring choose it now.
“The question is, what’s the magnitude of difference that would change the patient’s mind?” said Dr. Bruce Roth, a cancer specialist at Washington University in St. Louis.
One man may view a 15 percent chance that his tumor is aggressive as low risk “but someone else might say, ‘Oh my God, let’s set the surgery up tomorrow,'” he said. “I don’t think it’s a slam dunk.”
Also unknown: Will insurers pay for the expensive test without evidence it leads to better care or saves lives?
The newest test was developed by Genomic Health Inc., which has sold a similar one for breast cancer since 2004. Doctors at first were leery of it until studies in more groups of women proved its value, and the same may happen with the prostate test, said Dr. Len Lichtenfeld, the American Cancer Society’s deputy chief medical officer.
The company will charge $3,820 for the prostate test and says it can save money by avoiding costlier, unnecessary treatment. Another test for assessing prostate cancer risk that came out last summer — Prolaris by Myriad Genetics Inc. — sells for $3,400.
Both companies can sell the tests without Food and Drug Administration approval under separate rules that govern lab diagnostics. Myriad Genetics has published nine studies on Prolaris involving more than 3,000 patients. Genomic Health has not published any results on the prostate test, another thing that makes doctors wary. Yet it has a track record from its breast cancer test.
About 240,000 men in the U.S. are diagnosed with prostate cancer each year, and about half are classified as low risk using current methods. Doctors now base risk estimates on factors such as a man’s age and how aggressive cells look from biopsies that give 12 to 14 tissue samples. But tumors often are spread out and vary from one spot to the other.
“Unless you can be sure your biopsy has hit the most aggressive part that’s in the prostate, you can’t be sure” how accurate your risk estimate is, explained Dr. Eric Klein, chief of urology at the Cleveland Clinic, who led early development of the Oncotype prostate cancer test.
For one study, researchers used prostates removed from 440 men. They measured the activity of hundreds of genes thought to be involved in whether the cancer spread beyond the prostate or proved fatal. A second study of biopsies from 167 patients narrowed it down to 81 genes, and researchers picked 17 that seemed to predict aggressiveness no matter the location in the tumor.
A third study used single needle-biopsy samples from 395 UCSF patients scheduled to have their prostates removed. The gene test accurately predicted the aggressiveness of their cancer once doctors were able to see the whole prostate after surgery.
Using one current method, 37 of the 395 men would have been called very low risk and good candidates for monitoring. Adding the gene test put 100 men into that category, said another study leader, Dr. Matthew Cooperberg of UCSF. The gene test shifted about half of the men into either a lower or a higher risk category.
“It went both ways — that was the remarkable thing. In any category of risk it added independent information compared to the standard criteria we use today,” Carroll said. “More work needs to be done, but, in my opinion, this is a very good start.”
However, Dr. Kevin McVary, chairman of urology at Southern Illinois University School of Medicine and a spokesman for the Urological Association, said the test must be validated in more men before it can be widely used.
“It’s not there yet,” he said.
UCSF just got a federal grant to see how men choose treatments and whether this test might sway them.
“We throw all these numbers at them. Are they really going to make a better decision?” Cooperberg said.
Dean Smith, 60, a retired marketing executive from Mill Valley, Calif., is following his doctor’s advice to monitor the cancer he was diagnosed with in March. He said a gene test may have made him more comfortable with that decision.
At least six of his friends suffered side effects ranging from urinary leakage to inability to have sex after having their prostates removed.
“I would suspect that having cancer and having to live with it would be very difficult for them,” but it doesn’t bother him, Smith said. “I will die from something other than prostate cancer, I guarantee you.”
*    *     *

Here’s a link to the American Urological Association’s latest guidelines for the detection of prostate cancer:

Detection of Prostate Cancer

(I’ve added a link to the AUA in the “Helpful Links” section, too.)

Urologists Recommend Less PSA Testing For Prostate Cancer

by Scott Hensley

May 03, 2013 2:49 PM

Terry Dyroff, of Silver Spring, Md., had a PSA blood test that led to a prostate biopsy. The biopsy found no cancer but did give him a life-threatening infection.

The men and women who often treat prostate cancer are now recommending that the blood test commonly used to screen for it should be given a lot less often.

The American Urological Association released new guidelines that, if they’re heeded, would dramatically reduce the ranks of men who would be candidates for PSA testing.
The prostate-specific antigen test can catch cancer early, but it frequently gives false alarms or identifies cancers that don’t require treatment.
So the urology specialists now say this about screening for prostate cancer:
  • Men under 40 shouldn’t get PSA tests.
  • Men ages 40 to 50 shouldn’t be tested, if they’re at average risk for the disease. Those at higher risk — such as African-American men and those with a family history of prostate cancer — should talk it over with their doctors.
  • For men 55 to 69, the test makes the most sense. The AUA panel recommends a shared decision by doctors and patient about the test. Once testing begins, the panel says it should be given every two years, rather than annually.
Finally, the group says men over 70 and with less than a 10 to 15 year life expectancy can probably skip the test.
Johns Hopkins urologist H. Ballentine Carter, chair of the guideline panel, acknowledged to USA Today that some men and doctors may be hesitant about less screening.

But the evidence reviewed by the panel supports the stance. PSA screening can prevent about 1 death from prostate cancer for every 1,000 men screened over a decade, the guideline says. But there are dangers from testing, including false positives and side effects from subsequent testing and treatment, including infections, impotence and incontinence.

“The public is very enthusiastic about screening, partly because of our messaging,” Carter told USA Today. “The idea that screening delivers benefits may have been overexaggerated.”

Almost a year ago the influential U.S. Preventive Services Task Force issued its own guideline saying healthy men should no longer get routine PSA tests.

The urologists disagreed then — and now. But the conversation has now shifted to how few men should get tested instead of how many.

Update at 3:55 p.m. ET: Dr. Otis Brawley, the American Cancer Society’s chief medical officer, and a longstanding critic of PSA testing, praised the urology group’s work in an email to Shots:

“I believe that the American Urological Association should be commended for a very careful evidentiary review and developing a statement that is truly consistent with the state of the science.

“The past 20 years represents some of the worst in public health in that we widely disseminated a screening intervention before adequately assessing it. I welcome any effort to explain to men the uncertainty, potential harms, and potential benefits of PSA screening. Use of this test should be a decision made by the individual patient in collaboration with his healthcare provider. The American Urological Association statement combined with the American College of Physicians statement of last month should mean the end of mass screening for prostate cancer.

“Now the American Cancer Society and five other independent organizations are calling for shared or informed decision making regarding use of this test.”

Two Years

On By DanIn Diagnosis, Prostate CancerLeave a comment

It was two years ago today that the word “cancer” officially became part of my personal vocabulary.

It certainly was an emotional day, and the ensuing treatment option research and selection was one of the largest emotional roller coaster rides I’ve been on.  Still, the surgery has been a success in eradicating the cancer, but not without some costs.

I don’t think there’s a day that’s gone by where I haven’t thought about having had cancer, but it’s not always in a bad way.  In other words, I don’t dwell on it.  Instead, my thoughts around cancer are focused more on increasng awareness and sharing my experience.  Yes, there are practical thoughts about stress incontinence and sexual function, but those are minor and part of every day life now.

The other thing that I really don’t give much thought to at all is the chance of recurrence.  Yes, it’s a little cloud that follows me around, but I certainly don’t lose sleep thinking about the possibility.  I’d much rather focus on doing the fun things in life now, on the off chance that the cancer does return later.

None of us would have chosen this path for ourselves.  But we can choose to educate ourselves after the initial diagnosis; evaluate all of our treatment options and select the one that best fits our own personal situation; understand and accept the risks; and then live with the outcome knowing that we made the best possible decision with the information we had at the time, and with the support of our families and friends.

The operative word, of course, being “live.”

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Wow.  Hard to believe, too, that this little ol’ blog that I started initially to keep friends and family informed, has had over 7,000 views in those two years.  Mind-boggling.
That said, however, the reason I kept the blog going was to share my experience with others diagnosed with prostate cancer, so I guess I’ve succeeded with that.
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I go for my next PSA screening this week, with the results given to me early next week.  Keep your fingers crossed.