Redwing,
If he will do it, see if you can get your new friend in contact with(at his blog or via e-mail or here) Todd1963, just so he can know that his situation is not hopeless.
I know there have been heated battles here about
the PSA- yea or nay- subject before. So I am hesitant to even bring it up, but JackH, when you quote "“When cure is possible, is it necessary? When cure is necessary, is it possible?”, does that mean it is useless even trying to find out if a person has aggressive PC, because it can not be cured even if caught quite early?
If a person has an aggressive PC, is it useless to know this earlier rather than later, maybe MUCH later?
Todd1963 is of course just one case, just an
antidote so to speak. But I am sure he would argue that he has benefited from being diagnosed when he was, and that given the choice he would have preferred to have been diagnosed 2 or 5 years earlier via observation of a steadily rising PSA as the 1st clue. But then again, if when a cure is needed it is also impossible, has he benefited any from the attempt to cure or postpone? IMO, obviously yes. Of course, as he would say, he is probably not cured though one of his doctors has dared to use that term. But it seems almost certain he would be long gone without treatment, rather than being undetectable at 10 years. In fact, I would not be surprised if in his heart he figured he had only a year or 3 to live, rather than being undetectable at 10 years. So, OK,
maybe not cured for sure, but for sure has benefited greatly from treatment. I don't see how his odds of living even more years could not have been improved by being diagnosed at, say, PSA 4.5 and no mets yet, rather than at PSA 3216 with multiple mets to lungs, bladder etc? But without relatively early PSAs, how could he have been diagnosed before the clinical signs that got him diagnosed?
I feel the same about
my case, though in this instance it was my fault rather than lack of early PSAs. I was of the view that there was far too much aggressive treatment being done which was started by PSA testing, and besides I had prostatitis on and off for 30 years plus BPH, all of which could account for my rising PSAs from levels of between 1 and 2 in my early 50s. So when mine showed 4.1 or so for a life insurance physical, even though they red flagged it, I ignored it. No biopsies and overly aggressive treatment for me, by golly! I figured it's either my prostatitis or BPH or both. So after several years I go for a physical, mainly because I want to see about
some testosterone therapy, and he talks me into another PSA, and it is 9.1. Three weeks later at the Uro consult, and after Cipro just in case, it is 10.9 with a small firm area felt on DRE. I hesitated about
the BX- believe it or not the URO did not try to talk me into it, did not push me, but I had it done with G9 result. Surgical pathology G9/positive margin/SV+.
It is hard for me to see how I could not have benefited from being diagnosed several years earlier by paying attention to my rising PSA. Unless I simply was not going to be treated anyway, just let it run it's course. This was a self inflicted wound, but is it really much different than the current recommendations/ guidelines against routine screening? I only got PSAs due to routine screening. I am holding at .01 two years out with no recent increases. Even if it turns out I am not cured, which of course would not be surprising with my pathology, would I likely be doing just as well if I had not treated it? That seems very unlikely to me. Now of course, I know folks will say(or I guess they will) "no one is saying you should not treat an aggressive PC". But the question is: is it worthwhile to treat it early rather than later, maybe way later? Is it worthwhile to treat it while still contained rather than after it is out and even maybe after mets? If so, how are you going to catch it before mets without PSA testing?
I don't see how the PSA testing itself is the problem. The problem is the overly aggressive treatment that some docs push on patients who don't need it, and which some patients insist on because they are terrified of the word cancer. They can not comprehend that there exists a cancer that will probably not kill most people who have it. But because of that problem, do we just throw the small numbers of men who have aggressive cases and who will not be diagnosed until well advanced without the earlier PSAs under the bus? I guess so, if we accept the argument there is nothing you can do about
it anyway no matter how early you diagnose it. But is that correct? I don't believe it is.
Rather than shooting the messenger(PSA testing), wouldn't a massive public education campaign against overly aggressive treatment be a better approach? To keep folks from panicking when they hear the diagnosis of PC? But it really all comes down to: can an aggressive PC, caught early before it has left the capsule, be cured or not? Or if not cured, can life be extended significantly when treated early? In either case, can it?
Would Redwing's new friend not have been any better off if he had been diagnosed 2 or 5 or 10 years earlier?
Post Edited (BillyBob@388) : 3/11/2016 10:45:19 AM (GMT-7)