PSA tests

[amillet]

Another thread brought up the issue of routine PSA tests for prostate cancer.  17 years ago my GP ordered a routine PSA test during an annual physical exam.  Results showed a higher than normal #.  Biopsy showed cancer cells and I underwear radical prostatectomy.  Urologist said I was his youngest prostate cancer patient.  Two years later my 3 year year younger brother had the same experience, so he became our urologist's youngest.  PSA has been undetectable since.  So, there are times when a PSA test paid off. If you have any family history of prostate cancer, regular screening beginning early might be a life saver.  I was 48 then.  Just qualified for Medicare last month.

[Bennett]

About 15 years ago I noticed an upward trend in my annual PSA tests. Even though the last test results were still in the "normal" zone, a plot of the test results over a ten year period showed a continuous and accelerating increase. I saw a Urologist, who arranged a biopsy. It was cancer with a higher Gleason score than expected. Bottom line: radiation approximately - 45 sessions, and hormone therapy. Special Issuance for seven years, now removed, and all is well. I know the PSA tests are out of favor today, but being aware of the trending may well have saved my life.

[neilpilot]

6 minutes ago, Hyett6420 said:

Sorry to be obtuse, but what In medical terms is a PSA test, I am from the UK so we must call it something different over here as I can't find it in our NHS documents. 

Thanks

andrew

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/509191/Patient_info_sheet.pdf

[flyboy0681]

Two years ago my PSA doubled inside of six months to 3.9. My urologist stated that protocol calls for a biopsy, which I had performed. As you guys know, the two week wait is just awful. Thankfully there were 13 negative cores.

The PSA eventually came down to normal levels, but it took well over a year. My urologist couldn't explain it.

 

Edited May 17, 2016 by flyboy0681

[Piloto]

On 5/16/2016 at 10:50 AM, amillet said:

Another thread brought up the issue of routine PSA tests for prostate cancer.  17 years ago my GP ordered a routine PSA test during an annual physical exam.  Results showed a higher than normal #.  Biopsy showed cancer cells and I underwear radical prostatectomy.  Urologist said I was his youngest prostate cancer patient.  Two years later my 3 year year younger brother had the same experience, so he became our urologist's youngest.  PSA has been undetectable since.  So, there are times when a PSA test paid off. If you have any family history of prostate cancer, regular screening beginning early might be a life saver.  I was 48 then.  Just qualified for Medicare last month.

Congratulations on your Medicare. Now you can go on and get that colonoscopy rating. Done it twice.

[Yooper Rocketman]

Mine was steadily climbing over about 3 years and, when it went over 4, I was advised to go in for consultation and probably a biopsy.  My sister, a retired doctor, told me she wished I had NOT gotten the PSA test based on anything besides symptoms (which I didn't have any serious prostate symptoms).  She said the US is one of the only advanced countries in the world still performing this test as a routine screening.  She gave me some diet suggestions and advised to NOT go in for any further testing for at least a year.  My doctor was perturbed and when I finally went in for a physical a year later, I had the PSA test done prior to my appointment (which required an argument with the nurse..."we don't schedule the test until after the physical and then you need to schedule another appointment with the doctor"....let's get this right, doc wanted another screening at 6 months and now you won't schedule it?  No that's not how it's going to work!!).  Anyway, my score was lower than it had been for the last 4 years and the doctor never said a word.  I asked him, "did you notice the PSA score"?  He comments "oh".  No questions on how I got it down, no concern that he almost had me getting a battery of tests and a biopsy for a non-issue.  Seems it would be nice if the medical field was interested in alternative ways to good health, yet so many keep their heads buried in the sand.  I also learned there is a hospital in Georgia with a very advanced method of treating "true" prostate cancer in a much less invasive way, with much lower post surgery issues commonly seen from standard practices.

If anyone wants more info that my sister provided, let me know in a PM and I will try to find it.

Tom

[DXB]

This is a really tricky issue, and I am NOT a prostate cancer expert, but I do know there is far from consensus among real experts on this topic. No question PSA testing has some value in certain contexts, and people have been helped by it.  But exactly who should get PSA tested, how often, how to define trends, and when to investigate further is presently clear as mud.  So it's common for patients to get confusing, differing advice and naturally get frustrated. Heck I'm a cancer doctor, and I'm unsure on getting PSA screened myself.  

A major issue is that many of the cancers you pick up have minimal potential to harm, unlike the surgery or radiation used to treat them, and criteria to sort out the bad ones from the trivial ones are far from perfect.  With a concerning test number, you're also in the unenviable position of having to decide what to do in absence of consensus among experts. Clearly in some situations it's best for the MD to provide info and guidance without a strong biasing recommendation, even though it's frustrating for all involved.  After all, the patients usually come to you because they want to know what to do, not to hear some fuzzy double talk.  I face this issue daily for patients with a different cancer type where there's widely disparate opinions on preferred treatment, in absence of compelling data to backup the viewpoints.  

[Bravoman]

My wife, who is an internal medicine physician and a professor of medicine has mentioned to me a couple of times that more people die with prostate cancer than from it and that many times men are rushed into radical prostate procedures by urologists. From what I understand from her there is growing consensus that  the PSA test is not an evidenced based test, particularly the way it is routinely given in the U.S. I for one would do everything possible to avoid any type of invasive treatment or removal of the prostate given the adverse consequences which I understand can be severe.

[Ratherbflying]

10 hours ago, Yooper Rocketman said:

My doctor was perturbed

Well, you have to understand... there is a LOT of money at stake here.

But congratulations on taking control of the situation and your health. You dodged a bullet there. Sisters are a blessing.

[DXB]

5 hours ago, Bravoman said:

more people die with prostate cancer than from it

This is exactly the issue-  most men dying in their 80s and 90s have what looks like cancer in their prostates, but it never impacted them.  And PSA testing would have pointlessly picked up a large fraction of these and led to unwarranted and potentially risky interventions.  Also screening tests work best when the disease of concern is common in the population being tested.  If aggressive prostate cancer is rare in a given population (e.g. in all men over 40), then the test will inevitably pick up many more of the common cancers that don't matter over ones that do.   If you pick a different population (e.g. a select subset of younger people with known genetic susceptibility to develop agressive cancer), the story could be quite different.  But there's no consensus on the populations that should be tested presently- probably better genetic tests will ultimately sort this out.

Certainly universal PSA testing led to entrenched financial interests that helped perpetuate it.  But there's also a lot of folks out there who are driven to sort out these challenging issues and get it right.  I wouldn't totally throw out the baby with the bathwater here.

[Andy95W]

21 hours ago, Bravoman said:

My wife, who is an internal medicine physician and a professor of medicine has mentioned to me a couple of times that more people die with prostate cancer than from it and that many times men are rushed into radical prostate procedures by urologists. From what I understand from her there is growing consensus that  the PSA test is not an evidenced based test, particularly the way it is routinely given in the U.S. I for one would do everything possible to avoid any type of invasive treatment or removal of the prostate given the adverse consequences which I understand can be severe.

Strange that this whole topic came up when it did.  My father (85) was just diagnosed with prostate cancer.  Biopsy results of multiple samples, plus PSA, plus tactile indications.  His urologist has suggested an aggressive schedule of radiation, reduction by surgery, and even reducing testosterone production (I didn't want to ask) to further limit cancerous growth.

My question is, does this seem appropriate for an 85 year old man who, by family history, will probably live to 90 or 95?  

And then again, would his quality of life increase for the next 10 years if he goes through with it?  I don't think libido has much to do with it anymore.  I get the impression he is more interested in electronics and computers, at this point.

Thanks.  You all have more expertise in this area than me.

[amillet]

My surgeon was the head of the urology department at the University of Washington. He had undergone a radical prostatectomy himself within the year prior to my surgery, so I knew I was getting a straight answer to the question "what would you do if you were in my shoes".  I had talked to more than one of my clients who were in their 60's or 70's whose prostate cancer had spread beyond the prostate and resulted in a very messy situation requiring radiation and hormone therapy.  I am still confidant I made the right choice.  If I had been 70 instead of 47 I probably would have made a different choice.

[Yooper Rocketman]

Here are a series of links my sister, a Board certified MD and strong believer in natural alternatives to traditional medical practices, sent me when my PSA became a concern. One comment she told me verbally in the beginning was to do my own research on the web, but look for ".org" sites, not ".net" sites, as the dot org sites are not trying to solicit your medical business or procedure.

As Bravoman noted, (or his wife quoted), more males will die WITH prostate cancer than FROM prostate cancer.  My uncle told me he had prostrate cancer quite a few years before he died, and he elected to leave it alone.  He died at 93 from non-cancer factors.

Tom

http://www.medicalnewstoday.com/releases/302825.php?tw  

 

 

interesting article. Helps make screening more accurate. Not sure where you are on the 6 months span but hoping PSA goes down on recheck.  Make sure to get the blood test done before any prostate exam.

 

 

 

New hope for potential prostate cancer patients 

 

 

https://www.sciencedaily.com/releases/2014/10/141025152543.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine+%28Health+%26+Medicine+News+--+ScienceDaily%29

 

				New hope for potential prostate cancer patients   It has been more than 30 years since the last major advancement in prostate cancer screening technology, and the latest advancement is now available in the United S...
				View on www.sciencedaily.com	Preview by Yahoo

 

 

Cheryle Sullivan

 

Website: www.tbijourney.com

 

Facebook Page: TBI Journey

 

I saw this on ScienceDaily: Fighting prostate cancer with tomato-rich diet http://www.sciencedaily.com/releases/2014/08/140827100218.htm?utm_source=feedburner Sent from Yahoo Mail on Android

 

 

 

[DAVIDWH]

PSA tests are a bit of a sticky wicket. AS we age, usually prostatic hypertrophy takes place with a concurrent increase in PSA. (Perfectly normal)

In my case an elevated PSA with a subsequent neg. biopsy, returned a few months later with same symptoms and same results of elevated PSA and another neg. biopsy.

Again, a few months later with enlarged prostate with subsequent elevated PSA. When urologist begin to schedule another biopsy, I asked how many biopsys at a 5K cost are we going to do?  His idiotic reply was "We don't stop until we have done at least five". When I asked why don't we just do a TURPS and be done with it, his reply was "Its not that easy".

I walked to the receptionist, picked up all records and departed.  The following week had TURPS performed by dept. head at KU med. center and returned home. Now, no symptoms of hypertrophy, urgency or frequency, and perfectly normal PSA's.

AS Galileo might have said while  being persecuted by the Church of Rome for abandoning the geocentric for the heliocentric (sun at center) of our universe,

it all depends.  I know it is hard to believe, but  Aristotle was totally wrong on this one. With this in mind, it is easy to see how PSA's are frequently misused, misguided and

wrongly interpreted.

[Bennett]

Early on in this thread I told my story about PSA testing, and subsequent radiation treatment. I was about 67 when the treatments were started. I'm 81 today, and in great health. My grandfather died at age 94 of prostrate cancer, and my father died at 97 (just got tired of living), and my great grandfather and his father all lived to their late 90s. No guarantee for me, of course, but after my PDA scores were rising, I was not going to take chances. I did not want to have prostrate cancer worries on my mind for the next two decades (with luck), and so I had the biopsy that revealed an "aggressive" cancer. Sure the statistics about more men dying with prostrate cancer than dying from it may be valid, but as an individual I really don't give a damn about the statistics. I would urge discussions with you trusted medical advisors as to what course of action you should decide to take for yourself. A lot of literature out there, and some of it is bogus. We probably pay more attention to learning how to use our new avionics boxes than to pay attention to our long term health

[Tom]

33 minutes ago, Bennett said:

as an individual I really don't give a damn about the statistics.

Imagine spending many, many, many thousands of hours of your life dedicated to learning about statistics in order to help other people with those statistics, only to find that most peoples' philosophy doesn't give a damn about your statistics.

"Mav, you have the number of that truck driving school we saw on TV?  Truck Masters, I think it was?"

 

[flyboy0681]

On 5/18/2016 at 8:34 AM, DXB said:

This is exactly the issue-  most men dying in their 80s and 90s have what looks like cancer in their prostates, but it never impacted them.  

Is there any other organ in the human body that attempts to kill it's host given enough time?

 

[Tom]

2 minutes ago, flyboy0681 said:

Is there any other organ in the human body that attempts to kill it's host given enough time?

 

The Heart #1, lungs #4, brain #5.   Just ignore #3.

[flyboy0681]

Just now, Tom said:

The Heart #1, lungs #4, brain #5.   Just ignore #3.

I meant by generating a carcinoma. I should have been more clear. My urologist has stated more than once that given enough time, the prostate will become cancerous. Is there any other organ or gland that will do the same?

[DXB]

23 minutes ago, flyboy0681 said:

Is there any other organ in the human body that attempts to kill it's host given enough time?

 

Unfortunately pretty much all of them do if given enough time.  The folks who study the fundamental mechanisms of aging make fun of the cancer and heart disease researchers, saying that these are really just diseases caused by aging.  

Also, mathematical models predicting what would happen if you could magically eliminate all cancer and heart disease suggest it would only add 7 years of longevity on average. Other aging related degenerative disease would get you pretty fast anyway.  So the aging researchers have a point...

[smccray]

Get 'em checked boys.  Catch it early.  My father in law caught reasonably early at 52, cancer tested non-aggressive, and he chose treatment instead of a prostatectomy.  Now at only age 63 he's stage 4 without any more options.  They're trying a few things but it's all experimental at this point.  Last PSA test was 677 with cancer detected in the bones.

Don't mean to bring down the mood, but he's only 63.

[flyboy0681]

2 hours ago, Hyett6420 said:

ok, can i ask a personal question which i am sure is pure to most guys hearts.  does "IT" still work after the treatment?

A close relative of mine was diagnosed at 50 and had nerve sparing radical prostatectomy surgery. Ten years on he reports that he's solid as a rock.

[Bennett]

ok, can i ask a personal question which i am sure is pure to most guys hearts.  does "IT" still work after the treatment?

Yes. I chose radiation as I have had friends who went the surgery route with poor results in function.

[amillet]

Nerve sparing surgery also.  Yes it still works.