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Posted 3/11/2009 1:24 AM (GMT 0)
Just happened to see this article about PSA use in PCa diagnosis and thought people here might be interested. I am not presenting it as my opinion, but, as I've seen many posts with PSA confusion, I thought it relevent.

Rich

"WASHINGTON—As many as two of every five men whose prostate cancer was caught through a PSA screening test have tumors too slow-growing to ever be a threat, says a new study that raises more questions about the controversial tests.--------

http://www.boston.com/news/health/articles/2009/03/10/more_evidence_prostate_tests_overdiagnose_cancer/
Posted 3/11/2009 1:56 AM (GMT 0)
The PSA test saved my life. I had a jump in psa followed by surgery with a gleason of 8. the DRE did not detect anything abnormal. i am a STRONG advocate of PSA testing!
Posted 3/11/2009 3:38 AM (GMT 0)
Yes, yes this is the question! Did all of us guys here with low amounts of prostate ca and low gleason scores jump the guns with treatment, either surgery or some type of radiation? I DUNNO? So far my PSA is undectectable after 6 months from surgery, incontinence gone, ED remains, have to use bimix/trimix injections for sex. I don't have a good answer for guys like us. All I know is that I didn't want continued PSA monitoring with followup biopsies the rest of my life. THERE IS NO CLEAR CUT ANSWER TO THIS QUESTION!

Posted 3/11/2009 2:33 PM (GMT 0)
Me too. PSA testing saved my life, without a doubt. Rather men be tested then found cleared, then to delay testing and allow PC to grow and foster. Had my GP not convinced me to start getting PSA testing done on my 50th birthday, would have never known about my PC and its seriousness until it was way way too late. It's just a simple blood test, no big deal. And with me, never had an abnormal DRE at any point, and never had any other symptons of prostate troubles. Yet having said that, my cancer was building up steam, and was real, real close to not being contained when it was detected.

David in SC
Posted 3/11/2009 3:17 PM (GMT 0)
2 out of 5 chance is way over the acceptable odds for me. I'm glad that I had a PSA test. Who knows where I would be now without it. 2 out of 5 chance???? I like my odds a lot better now. Allan
Posted 3/11/2009 3:39 PM (GMT 0)

PSA Test saved my life as well!! Normal practice is to get a dre and psa test after 40 if you have family history. I took PSA test at 36 came back high, the DRE showed nothing.

Also people need to keep in mind biopsy not fool proof either, needles could miss the cancer. My biopsy on one side showed nothing but after removal it showed cancer in that side as well.

My doctor said you are lucky that it was detected on the other side.

LIVESTRONG!!!

Posted 3/11/2009 4:58 PM (GMT 0)

I guess I just don't get the logic.  If 2 out of 5 had tumors that would never have been a threat, that means that 3 out of 5 had tumors that WOULD have been a threat.  DUHHHH...

So, for me I have the same answer that I always have given when asked about the advisability of PSA testing.  Knowledge is power.  I was not happy to find out I had PCa.  However, when learrning of my grade and % I was very glad to have found it early so I had lots of treatment options.  If I had the right stats I would have chosen active surveillance but I was not so lucky.  So, now I feel fortunate to have had docs who insisted on PSA testing and recognized when things didn't look right.

There is a very sad post today called "PSA over 400" from someone whose uncle just had his first PSA test at age 63.  The outlook is grim.  I wonder if his doctor was one of those who didn't believe in PSA testing for fear of overdiagnosis...

Tudpock

Posted 3/11/2009 6:15 PM (GMT 0)
Tudpock, all to save taking a simple blood test perhaps. That would be short sighted at best if that is what the doctor or the patient thought.

David
Posted 3/11/2009 6:37 PM (GMT 0)
Maybe someone's posted the information, but in the time I've been reading this forum I don't recall reading a comment from someone that they had surgery only to later learn that they had been cancer-free, and that the M.D.'s made a mistake. I doubt anyone here has read the report being quoted in the linked newspaper article, but it disturbs me that the head of the American Cancer Society seems to be critical of the Prostate Cancer testing/procedures and early action. At 58 years of age, I was not disappointed to have the opportunity to remove the cancer from my body. I don't doubt we'll be reading more of the details of all of this and I await that further information.
Posted 3/12/2009 12:07 AM (GMT 0)
PSA testing saved my life as well. My PSA never reached the magic number 4, but it did jump from 2.7 to 3.5 which set an alarm that led to a biopsy showing a very aggressive cancer.
Posted 3/12/2009 1:20 AM (GMT 0)
"two out of five". How do they come up with stats like that? Is there a way to determine if one man's cancer is / was slow growing and "WILL NOT" be the cause of death vs. another "WILL BE"?
Posted 3/12/2009 1:25 AM (GMT 0)
Never had a Psa test until I was 56 and then had two in one week. First one was 13.5...thought it was lab error, second one 14.5. Prostate, through DRE was, as the doc said, "Generous." PCa never entered my mind, as I thought I was a walking Flomax commercial. Subsequent testing proved otherwise. Since that time I have learned so much about this albatross that I usually wind up talking with my friends about their need to be tested. Believer in testing? You betcha.
Bob
Posted 3/12/2009 1:01 PM (GMT 0)
Selmer, I just read the second article, word for word, and couldn't disagree anymore than I do. It looks like it was written by people that have no exposure to PC in anyway. Their baaic assumption is wrong, and they did nothing to prove their point in my opinion. The facts are simple, early PSA testing saves lives, period. Earlier testing for all men, say 40-45 will save lives. Reaching out harder to the African-American community will save lives. Lowering the threashold for a biopsy from 4.0 to something less will save lives. Look how many men just in our group here were dx. with PSA well below 4.0. To me, jmo, watchful waiting for someone elderly or someone dealing with other complex medical maladies can make perfect sense. But if your health is generally good, and let's say you are under 70, and you have a proven dx of PC, from biopsy's, then it means you have PC. The pathology from the biopsy is just an estimate, it may be much more serious or aggressive than small samples indicate, and is often that way. So watchful waiting with a proven dx to me, imo, risky and perhaps even foolish, as cancer doesn't go away on its own. It's all about containment, not whether a person wants to avoid treatments or the side affects of treatment. I honestly think there are those that don't truly understand the mechanics and horror of having cancer. Perhaps they are in denial. Denial itself can be a form of watchful waiting. It is frustrating with PC in particular. I was in good health prior to dx at age 56. No prostate problems, no ED problems, great sex life, there are still times that I wished I had never been checked for years on the PSA tests, but then reality sinks in, and it scares me that I could still be living now, with an unknown and unchecked PC agressively growing in me, and sure would have been more shocked to hit age 60 one day and find out that I had a full blown T4 situation and cancer in my bones.

David in SC
Posted 3/12/2009 3:01 PM (GMT 0)
coxjajb

That is a good point. There is no way to detect whether a tumor will continue to grow and cause problems down the road. I saw the same segment on the new and it made no sense to me. Who cares if 40% of prostate cancer tumors will not cause a problem? If there is currently no *reliable* way to detect the bad from the "good" tumors then listening to anti-psa advacates is useless.

Posted 3/12/2009 3:40 PM (GMT 0)

All this discussion aroused my curiosity, which led me to the American Cancer Society website. I'm not computer savvy enough to post the site, but go to cancer.org and search "what are the key statistics for prostate cancer".

The good news, according the above site, is that 1 in 6 will be diagnosed with PC, while 1 in 35 will die from it. The mortality rates are far better than some cancers. They show 100% survival at 5 years (for glandular carcinomas).

The bad news. It is the 2nd leading cause of cancer deaths in men. An estimated 28,660 American males died from PC in 2008.

My take on this? 28,660! Choose whatever treatment option you're comfortable with. But test your PSA and, when signs of trouble appear, have the stinking biopsy!!! How can not knowing be a good thing?

Posted 3/13/2009 2:32 AM (GMT 0)

I seldom come out from under my rock to post, but I visit this site daily.  I believe active surveillance is appropriate for many of us. It is not necessarily, as suggested above, a state of denial. I have been diagnosed with prostate cancer.  I know it will not go away on its own.  In my case, it doesn't mean that I must do something immediately. Neither is active surveillance risky or foolish for those of us that choose it.  It might be risky or foolish if I were in a state of denial.  I'm not, and I find those terms a little insulting.  Just as some men are very fortunate to recover continence and erectile function quickly after treatment, some of us, through luck of the draw, get a diagnosis that doesn't necessarily require immediate action.  I'm well aware that clinical staging and Gleason sum from biopsy can vary significantly from post-operative pathology.  I get PSA tests and a DRE every 4 to 6 months.  My doctor and I know to look for PSA velocity changes and she will notice a change in the DRE.  A yearly biopsy looking for a change in percentage of core involvement, number of cores involved, or Gleason sum will alert us to any need to change course.  I've been fortunate in not having any increase in any of those numbers.  I believe that PSA testing is important, particularly in establishing a baseline and recognizing a velocity change.  Researchers can and will debate the statistical significance of PSA testing in relation to death rate, lead time to death rate, or number of lives saved per number of interventions.  They've got research and grant dollars to secure.  My hope is that they will concentrate on developing reliable predictors or diagnostic tests so that choice of treatment (including active surveillance) is not such a craps shoot. 

Boo

       

Posted 3/13/2009 7:20 AM (GMT 0)
I had no symptoms whatsoever, DRE normal the PSA test was the trigger which sent me to the Urologist and the biopsy confirmed Pca, so I support the PSA test 100%.

Regards Mal.
Posted 3/13/2009 1:14 PM (GMT 0)
My post would be an exact duplicate of maldugs' - no symptoms whatsoever.

After surgery I was told it had bulged out, and if I had (not had the PSA test, and) done nothing for a year, it probably would have broken out, spread, and I might very well have been too far gone to save. Of course that is all speculation. But - tomorrow is the one year anniversary of my cancer diagnosis, and I feel MUCH better sitting here knowing that I am cancer free, as opposed to knowing nothing and dying from the inside out.

Just my opinion,
kcragman
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