HealingWell
Search Close Search
☰

Biopsy decision.

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
1 2
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 6/25/2015 8:02 PM (GMT 0)
Jack, I didn't mean to make light of the fact that many men have treatment that they may not have needed. I was referring specifically to the idea of getting or not getting a biopsy with a PSA of 6 ish. I am not referring to treatment, and in fact, while I personally am not a big fan of AS for my own reasons, I've advised many people who've come here with their hair on fire, like me, to calm down and investigate all options including, where appropriate, AS.
So I am very aware that often men are overtreated.
But this is different, we are talking about diagnosis, not treatment. Even if a PCA3 and or fPSA came back with good numbers, I would still want to know why my PSA was 6, rather than wait to see if it got to 10 first.
JMHO, no disrespect meant.
Posted 6/25/2015 8:35 PM (GMT 0)
Glad to see you backtracked, Pratoman. PC over-treatment should not be taken lightly…especially by men experienced in PC coaching men inexperienced in PC.



Here’s another important misconception to clear-up:

lapilot said...

I had a multiparametric MRI and it didn't show anything, even though my biopsy showed GS 6 & 7. For what its worth, mpMRI usually isn't very sensitive when PSA is below 10, and your urologist doesn't feel any nodules or lumps.


That's a complete misconception.

It’s important to note for background that the purpose of a prostate biopsy for ANY man over 50 is NOT to determine if he has prostate cancer or not…because statistically, he probably does. Rather, the purpose is to determine if he has high-grade prostate cancer (statistically, he probably does not) which might need treatment.

The random biopsy has been the de facto standard for 25 years, and historically prostate imaging with CT, ultrasound or MRI has been too inaccurate for diagnosing PC..but that’s now history.

Today’s instance of multi-parametric (MP) MRI exceeds the accuracy of a random biopsy. The random biopsy misses high-grade PC 15% of the time, and 3% of men end up in the hospital with uncontrolled infections. Repeated biopsies can affect erectile function and incur an even higher rate of infection. More importantly, random biopsies over-diagnose 100,000 men annually in the US, leading to rampant overtreatment.

MP-MRI detects high-grade disease accurately and overlooks low-grade disease. Any suspicious lesions that are detected can be further investigated with a targeted biopsy.


A biopsy may be in TonyPal’s future…but if it’s taken as the very next step, it’s more likely to be a ticket to the Express…
Posted 6/25/2015 9:13 PM (GMT 0)
Jack, not wanting to hijack Tony's thread, maybe this would be better discussed in it's own space and time, but I have a question: what, in your mind, is the definition of overtreatment and is it really truthful to argue that a biopsy is, as you put it, "the onramp to the overtreatment express"?

This forum is a great antidote to overtreatment, and many of us have found ourselves calming down and getting rational once we started paying attention and did our digging. I've seen nothing but quality feedback to Tony in this thread, and to others who were getting shoved along into immediate treatment...and a great many readers who DID slow down and make rational choices....me included.

Another comment from someone who lives in rural mid-america, who is not in obvious easy reach of some of the major places: MP-MRI sounds like a great tool, and it will probably save a lot of heartache for a lot of men. But it's not available everywhere (yet). It's hard for me to keep quiet when I learned, as part of my research, that the nearest place I could probably have had one was too far away to be useful to me. Not all of us live near enough to MSK, or JH, or other places to avail ourselves of them. In many cases, we have to play the hand we're dealt, and that includes what facilities and treatments are physically available.

For me, I would never discourage a man from getting a biopsy. The issue, IMO, with overtreatment is what one does AFTER the biopsy comes back. This forum is a great resource to use for that information.
Posted 6/26/2015 7:14 PM (GMT 0)
halbert, this isn’t hijacking TonyPal’s thread. I’ve already answered his initial question, but he’s at a learning stage early in his education and can learn, as can you and others who read this in the future, from the ongoing discussion.

I don’t have “my” own definition of PC overtreatment. I’m not a medical doctor, but I simply re-use the concept from those in the professional prostate cancer care arena. Google it, if needed.

Then, you asked:

halbert said...
...is it really truthful to argue that a biopsy is, as you put it, "the onramp to the overtreatment express"?


Yes, and while I would have liked to have originally penned that term myself, I'm probably not that whip-smart, and alas I did not. This phrase is from one of those in the professional prostate cancer arena I mentioned...it's from the book by Dr Mark Scholz, one of the world’s most highly respected PC experts (and PC care provider to many here at HW/PC) in his book, “Invasion of the Prostate Snatchers.” The book is a great source of knowledge, halbert, if you’d like to learn more specifically about low-grade PC and how it differs significantly from the less frequently occurring high-grade disease.

Lastly, I would note that even if you live in rural mid-America, it’s still your CHOICE on what type of treatment and care you seek to pursue. Fifty percent of Americans live on a coast, and something like 3/4 live within 100 miles of one of the largest 25 cities. Your CHOICE to stay local is different than “the hand you are dealt.” It sounds likely that you are amongst the minority of men in the US would have to travel further than most for top care.

The NCCN Comprehensive Cancer Care facilities are spread across the country…they do that on purpose. (check this map out: http://www.nccn.org/members/network.aspx) Personally, I drove past countless community-level care facilities—where outcomes are notably not as good—to get to one of the NCCN CCC’s.

Regarding your final comment, you’ve missed the mark if you want to start educating men AFTER diagnosis…they’ve already be “labeled” at that point and are on the slippery slope…
Posted 6/26/2015 9:34 PM (GMT 0)
Jack, if you're interested in continuing the discussion, drop me an email. I think we're arguing the same point from different directions: I suggest we need better diagnostic tools more widely distributed and better understood to prevent overtreatment. The answer to overtreatment is not less screening but better interpretation of screening results.
Posted 6/26/2015 11:30 PM (GMT 0)
quote="halbert"] ... The answer to overtreatment is not less screening but better interpretation of screening results.

I think this is an area where computer image recognition can help. Instead of the subjective factor of individual pathologists, there can be distributed decision-making by as many pathologists willing to offer their expertise. IBM's Watson is a good first step.
Posted 6/29/2015 7:03 PM (GMT 0)

halbert said...
The answer to overtreatment is ... better interpretation of screening results.


I really don't believe this to be true. Nor does the medical community.


PSA mass screening has been widely rejected by every single professional medical society because of today’s reality on PC overtreatment. If smarter, more discriminating, treatment decisions were being made, nobody would have a problem supporting mass screening—overtreatment IS the root cause of the PC world’s bad name.
Posted 6/30/2015 1:46 PM (GMT 0)
At age 57 I'd do the biopsy. I did at that age too. You can worry about "overtreatment" once you know what you're dealing with.
✚ New Topic ✚ Reply
12