An interesting fact learned today...Thoughts?

One of our medical oncologists says that he doesn't get his PSA checked. This is because he isn't impressed with any of the treatments and so would not change his lifestyle (vegetarian, athletic). He would not have chemo, would only have radiation if he had pain from diagnosed PCa, and would never take ADT. I guess this is a theme that is more common than one might expect (or not). A cardiologist/family friend we know also says he would never be treated with ADT and doesn't get his PSA tested either. As a point of interest, Don's GP saw that his PSA went from 1.5 to 4.0 in six months and said this was just fine as "4 is the cutoff." He was presumed to have BPH until his collarbone started hurting. We went to another doctor, who did a PSA test that came out to be 32. Dx widespread mets. I wonder if the former doctor has his PSA tested...

Post Edited (Moonlitnight) : 9/10/2014 6:43:12 PM (GMT-6)

quincy17 said...
Hi Ms Worry Wart,
Whenever I hear someone say that about the PSA test all I can do is think about my own first test. I was 52 at the time and the PSA was a 511. Of course that brought in the big guns or at least a needle biopsy which presented with a 12 out of 12 cores positive and a Gleason 9. In short a very aggressive cancer. Now I may not be cured but I sure as heck have enjoyed the extra years of life that the test has afforded me. I agree with those who say this is an example of a Dr. That doesn't manage his health very well. . . . Q

I'm still not convinced that he is a doctor that doesn't manage his health well. Actually, I almost wish that he had convinced us of that.

Yes, Mr. WW's prognosis wasn't the best either...but, we're still here and hopefully for a very ling time.

Jerry L. said...
MSWW,

I don't agree with it at all. I know several G9 guys that caught the disease early...for example, diagnosed 10+ years ago with a G9 biopsy followed by surgery and undetectable ever sense. Know a few stage 3 G9s that had surgery, radiation, a year of HT...and have gone years with no sign of PC. Some PC needs aggressive treatment...call it overtreatment, call it whatever you want...aggressive cancer should be dealt with asap. How does anyone know they have aggressive prostate cancer if they don't know their PSA trend. Sorry, doctor, it's not as black and white by saying men either can be cured or not just by the nature of the PC variant. There are a bunch of gray guys that can either catch this thing early enough or hit it hard the first time to provide the best chance for a durable remission.

I put his comment in the same category as the USPTF recommendation.

This month is PC Awareness Month. What would he like the average Joe to be aware of?

I find it crazy for a doctor not knowing their PSA baseline and their yearly trend...but again, that's just me...Just my 2 cents...


Jerry

I agree! And I know a G7 with mets, although they suspect a true G9 if pathology was available.
I just never expected to hear him say that!

Thanks for all of the replies. I enjoyed reading each person's thoughts.

I was surprised to read that many others have doctors who also forego the PSA test. It still shocks me, yet when he explained it, it sort of made sense. The flip side of that is that he has been treating my husband in a very aggressive manner. That sort of speaks to me as well. No need to read between the lines on that one after he mentioned all that he did.

I would have to say that his statements were not only almost identical to John T's, but were also pretty much in line with what JackH quoted.

Indeed....things that make ya go "Hmmmmm."

MSWW

There is tons of controversy about using the psa for diagnosing and screening for prostate cancer. Even the creator of the psa test says it shouldn't be used for that. But I think there is little controversy about using the psa test to monitor the dsease after therapy, especially after surgery. Does his doctor see the value in using the psa test as a valid cancer marker for patients after therapy? That's the real question for your husband with respect to the psa test.

Post Edited (Jerry L.) : 9/11/2014 4:41:53 AM (GMT-6)

PDA,

The patient community has demanded action--perhaps in ignorance of the true, unique nature of this disease, as you wrote of earlier. Do something! Cuts, burn or poison. After all, this is "cancer."

So the medical-industrial complex, in a nod to this sentiment, has said "Fine, you want treatment. We've got treatment."

We can treat the heck out of you.

We wouldn't be doing this to ourselves, but you asked for it.

And then we will treat you some more for the side effects that the primary treatment causes.

Too true Jackh,
I am being treated minimally, but Lupron is a poison just like you said. I freely chose this treatment over the possible effects of a G9 aggressive cancer. Same as folks choose their poisons,etc over other cancers . . .. Q

RCS,

I'll be sliding into a response to your comment sideways, so you'll have to bear with me at first.

When I was diagnosed with prostate cancer, arguably nothing much had happened. Just a dab of unwelcome information had been added to my mighty brain. In response to that information I developed insomnia (without sleeping pills I slept three hours a night, with one pill that went up to four hours and doubling the dose to two pills gave me four and a half.) I developed a tremor in my hands and a number of other anxiety-related conditions. It wasn't a rational, well-thought-out reaction, it was more like an allergic reaction. But it was real, palpable and it sucked.

I don't claim to have been harmed by the diagnosis because it was the stimulus that caused me to seek surgery for what turned out to be a large Gleason 9 tumor on my post op pathology report. (Upgraded from a trivial amount of Gleason 6 (3+3) or 7(3+4), depending on which pathologist you believe, on biopsy.) So I don't claim to have been harmed, in net, because the good (as currently hoped for) outweighs my six months of mortal terror.

I suspect my reaction to diagnosis was fairly typical, at least for a large number of guys. And I will assume that my reaction to an elevated PSA result prior to diagnosis was also typical. That reaction was to worry -- to be less happy in my quiet moments. The anxiety wasn't crippling but it was enough for me to consent to a biopsy in hopes that I could make the worry stop. Again, because the diagnostic cascade, with it's associated rising anxiety, led to my treating a dangerous disease, I don't claim to have been harmed by the process. Because I am JackH's one-in-a-thousand. (There are lots of us here. A disproportionate number of us find our way to HealingWell.) But quite a few guys were harmed.

So you are right, there is no risk in the test. The needles are clean and the stick heals in minutes. It's telling the patient the results that is risky. If they are compulsive worriers (like me) then there will be a significant downside. For those who go through the wringer and never choose treatment -- rightly or wrongly -- there is no upside; no disease was cured. They would have been happier -- better off -- if they'd never been told.

JohnT,
I read your signature, but one bit has me confused. You have down 12 biopsies, was that cores or procedures. Mt biopsy was so painful that I'd have to be knocked out on propofol before I would consent to another one. If you would clarify this for my befuddled mind I would appreciate knowing why, if so happens, 12 procedures were necessary. Thanks . . . Q

Quincy
Cancer was found on my 12th biopsy, a 26 core biopsy that showed < 5% G6. All my previous biopsies ranging from 8 to 16 cores were negative. My 13 th biopsy was a confirmation biopsy with guided CDU that found the true cancer.
These occurred over a 10 year period in response to psa that kept rising from 4 to 40. I just had to find the right doctor who knew what he was doing, and that took 10 years and 5 doctors. It really opened my eyes to the fact that most urologists don't have an in depth understanding of the biologic nature of PC. They understand the anatomy and mechanics, but not the biologics, how it grows, how it manifests through biological markers.

Thank you, JohnT,
Yours is the first case that I have read about that required so many biopsies. My Dx'ing uro. retired soon after my procedure and in almost 8 years have yet to see another one. Our town of 100,000 has but one uro so you can imagine what getting an appt. is like. I'm glad to read that you are pretty much clean, and I no longer feel remiss in not seeing a uro through this battle . . . Q

Your baker's dozen of biopsies speaks volumes about what you believe.

Ed