Prostate cancer advice

[M.Mouse]

A very good friend of mine had a PSA test recently with slightly raised reading of 4.5% (I think it is %). He had a biopsy and now learns that he has indeed developed cancer. He is due to have a MRI scan to make a fuller assessment.

He is just over 50 years old and is obviously quite shocked and worried. Not least at the prospect of having his prostate removed and losing all erectile function as a consequence.

I have done a search and can find no previous discussion of the subject on PPRuNE.

Any advice/links or private messages would be gratefully received and duly passed on to him.

[airborne_artist]

MM

Sorry to hear of your friend's condition.

Best to look at http://www.prostate-cancer.org.uk/

[wobblyprop]

Sorry to hear that.

your friend may also find this useful besttreatments.co.uk (http://www.besttreatments.co.uk/btuk/conditions/5950.html)

[Milt]

Prostate

PSA is just a number. So many thingummises per thingummy.

At age 50 anything over 4 means investigate.

Big hurry to ensure that the nasties don't escape into the lymph system. Otherwise it goes to the bones and gets horrific.

If biopsies positive then Bone Scan will tell if it has escaped and PSA will be elevated above 4..

Recommend only valid options at age 50 are

1 Radical prostotectomy - cut the thing out. Nasty op.

2 Radiation over about 6 weeks

3 Cryo surgery - insertion of liqid nitrogen through special probes.
Freezing kills all nasties. Nerve sparing - reasonable.

4 Brachy Therapy. Latest a fairly simple procedure - almost outpatient. Computer control of high intensity radiation pellet
progessivelly through pre inserted small tubes for short perods of time depending on nastiness of nasty.

Get a few opinions from a few urologists as each will have HIS favourite barrow to push.

Go hard over in researching the subject. It will pay off.

Mine was a cryo about 6 years ago. Pleased with result.

[Hobo]

Having seen this post I was browsing the net and came across this, which may be of interest?


Article published 10/9/20004

Stanford University

Stanford researcher declares 'PSA era is over' in predicting prostate
cancer risk


STANFORD, Calif. - The PSA test, commonly used as a screening tool for
detecting prostate cancer, is now all but useless for predicting
prostate cancer risk, according to Stanford University School of
Medicine researchers. A study of prostate tissues collected over 20
years - from the time it first became standard to remove prostates in
response to high PSA levels to the present - reveals that as a screen,
the test now indicates nothing more than the size of the prostate gland.

"The PSA era is over in the United States," said Thomas Stamey, MD,
professor of urology and lead author of the study published in the
October issue of the Journal of Urology. "Our study raises a very
serious question of whether a man should even use the PSA test for
prostate cancer screening any more."

The PSA test measures prostate specific antigen, a protein normally
produced by the prostate gland. Stamey published the original findings
in 1987 in the New England Journal of Medicine showing that increased
blood PSA levels could be used to indicate prostate cancer. However,
through the years, Stamey has come to believe that the PSA test is
actually not a useful predictor of the amount or severity of prostate
cancer. He said elevated levels of that protein actually reflect a
condition called benign prostatic hyperplasia, a harmless increase in
prostate size.

Stamey explained the change in correlation over the years by noting that
the tumors encountered 20 years ago were generally so large they
generated PSA levels high enough to provide a reasonably good measure of
cancer severity. Now that screening is more commonplace in this country,
many cancers are being caught earlier and are usually smaller - not
generating enough PSA to be a good indicator of severity.

Prostate cancer is the most common cancer in men. Stamey cited a 1996
study in which researchers examined the prostates of healthy men who
died from trauma, finding that 8 percent of those in their 20s already
had prostate cancer. The American Cancer Society estimates that nearly a
quarter of a million cases of prostate cancer will be diagnosed in the
United States this year alone, and one in six men will be diagnosed with
the disease at some point in their lives. Stamey said prostate cancer is
a disease "all men get if we live long enough. All you need is an excuse
to biopsy the prostate and you are going to find cancer."

However, the risk of dying from prostate cancer is very low compared
with lung cancer, which is the leading cause of cancer-related death in
men, he said. "Almost every man diagnosed with lung cancer dies of lung
cancer, but only 226 out of every 100,000 men over the age of 65 dies of
prostate cancer, which is a rate of .003 percent," he said, referring to
National Cancer Institute statistics.

Stamey explained the basic dilemma as such: men whose PSA levels are
above 2 ng/ml frequently undergo biopsy, which will almost always find
cancer, but this does not necessarily mean that prostate removal or
radiation treatment is required. "What we didn't know in the early years
is that benign growth of the prostate is the most common cause of a PSA
level between 1 and 10 ng/ml," he said.

To figure out the PSA test's usefulness in determining which cancers
warrant radiation or surgery, Stamey and his team from Stanford's
Department of Urology set out to document what was actually found
following prostate removal, such as the volume and the grade of the
cancer - two indications of the cancer's severity. They then compared
those findings to aspects that could be determined prior to surgery,
such as how many of the cancers could be felt by rectal examination and
the patient's blood PSA level.

For the study, they used prostate tissue samples collected by professor
John McNeal, MD, who has examined more than 1,300 prostates removed by
different urologists at Stanford in the last 20 years. The researchers
divided McNeal's data into four five-year periods between 1983 and 2004
and looked at the characteristics of each cancer. They found that over
time, there was a substantial decrease in the correlation between PSA
levels and the amount of prostate cancer - from 43 percent predictive
ability in the first five-year group down to 2 percent in the most
recent one.

However, the Stanford researchers concluded that the PSA test is quite
accurate at indicating the size of the prostate gland, meaning that it
is a direct measure of benign prostatic hyperplasia. And Stamey pointed
out that it is still very useful for monitoring patients following
prostate removal as an indicator of residual prostate cancer that has
spread to other parts of the body.

"Our job now is to stop removing every man's prostate who has prostate
cancer," said Stamey. "We originally thought we were doing the right
thing, but we are now figuring out how we went wrong. Some men need
prostate treatment but certainly not all of them."

If the PSA test is no longer useful, the question remains as to the best
course for detecting prostate cancer. Stamey recommends a yearly digital
rectal exam for all men over 50. "If a cancer is felt in the prostate
during a rectal examination, it is always a significant cancer and
certainly needs treatment," he said.

Unfortunately, he added, even large cancers often cannot be felt during
rectal examination. His group is currently working on finding a blood
marker that could indicate more aggressive forms of the cancer that can
invade the body.

Other researchers who contributed to this work are Mitchell Caldwell,
Rosalie Nolley, Marci Hemenez and Joshua Downs. The study was funded by
donations to Stamey's Prostate Cancer Research Fund at Stanford.

[Pappa Smurf]

A subject close to my heart.

At the age of 44 i found out i had it.
Been piddling all the time for ages and finally decided to get the finger up the kyber when i went for something else.Trust me to find a doctor with the biggest finger in the country.Sure enough,it was enlarged so on with the blood test.First try was a psa reading of 268.He thought it was a balls up so did it again a week later.This time 286 so off to the big smoke to see a specialist.Biopsy was great fun-----like getting shot up the backside with a spear gun.

Sure enough--the big C.Next a bone scan which showed it had filtrated into the bone.
Verdict-----terminal cancer.That was 11 years ago and still going strong.
Said it was a waste of time removing it as that has side effects(piddling your pants) so put me on 3 pills a day plus jab in butt once a month.Do that for a year and stop until psa gets back up to 10(usually about 5 months),then get back on them again.

Of course the old fellow doesnt work anymore but being divorced it didnt worry me.Well at first it did but all urges go and its the last thing on your mind.Plus it got me into trouble all my life and now it saves me heaps of hassels.

Old man had a reading of 13--only small area--and had it removed by going up the eye of the old fellow followed by 6 months radiotherapy.That makes ya sh1t through the eye of a needle for 6 months and hes had bowel trouble ever since----that was at 75 ,now 89.

When he had his done 6 other old chaps were all getting treated and everyone was on different treatments.That was 14 years ago ,so they were probably experimenting a bit.

A lot have normal prostate cancer with a psa around 25 and they do nothing to them except a check up from time to time to see if its rising.Even a doc with that reading isnt too worried about it.

In my case i had aggresive cancer which just kept rising so i had to do something.Asked the quack for a bone scan last year to see how it was spreading and he said nothing would show up while my medication was keeping psa at .01

Also know another guy who couldnt handle the medication and didnt want his nuts out(other choice).He became unwell ,went for a bone scan and it showed up in his shoulder and ribs.Decided to have the family jewels removed and the scan showed nothing and at 75 hes gone farming again.

So even if it sounds bad there is no need to panic about it ,but at 50 you probably wont get to 90 if its gone walkabout.

I think most of the deaths from it are from people who dont go for a check up when they know something is amiss ,those that are scared and the ones who still want to throw the leg over and cant face not being able to crack it------my opinion anyway.

Must admit when i found out, that word "terminal" stuffed me for 3 months until i realised its not a sudden thing.Of course 11 years later i realise something may happen one day.

The funny thing is without the urge etc ,i still have realistic dreams.so the alarm clock has been binned.

Some docs want the money to,and want to operate ,but in most cases its a waste of time.

[PickyPerkins]

Hobo

……… Thomas Stamey, MD, professor of urology and lead author of the study published in the October issue of the Journal of Urology." ………….. Almost every man diagnosed with lung cancer dies of lung cancer, but only 226 out of every 100,000 men over the age of 65 dies of prostate cancer, which is a rate of .003 percent," he said, referring to National Cancer Institute statistics.
Dr. Stamey may be a very fine doctor but he doesn’t seem to be able to work out percentages correctly.
226/100,000 = 0.3% (or 0.2% rounded to one decimal place), not 0.003%. http://home.infionline.net/~pickyperkins/pi.gif

[M.Mouse]

Thanks very much guys ( I presume there are no ladies contributing). All very useful and passed on to a very grateful friend.

[Jenny P P]

I have a question of you men. Is it really such a terrible thing to contemplate, having the digital examination?

My husband will not entertain the thought. He doesn't go to doctors much anyway, and is basically healthy and no way is he going to have that test. He is in his early 50s.

Like most mature women, I have pap smear tests, mamograms and have had babies, what's the big deal in a digital examination?

Serious answers only please.

[Milt]

Jenny P P

Tell that husband of yours we of more maturity think he is stupid.

If his blood test for PSA is elevated much above 4 then he is at risk.

Eventually the poor doctor has to don the rubber glove.

So

DRE

Digital Rectun Examination.

The first one is a shock to the system as one's senses of propriety are being invaded.

The doctor usually takes care to say such things as
"This will violate me more than it will you but we have to know don't we.?"
Imagine the poor sod having to do that to earn a dollar. So he is right!!

Soon you start to realize that "this is being done for my welfare is it not?"

Then later if you have concerns you start to think
"gee I wish he would check it out, - how else will I know?"

And then it becomes quite clinical.

Doctor how did it feel to you today?
"Well it's abnormal and a bit enlarged."

Oh buggar.Next is the collection of some biopsies.

Bloody hell he's going to shove that ultrasonic thing up there.
And there is a nurse in the room!!!!

Oh well they can't undignify me any further so why don't I ask if I can watch on the monitor?

Hey that is interesting isn't it. ?

What am I seeing doctor or nurse?

And you do this sort of thing all the time?

DON"T delay it if you have doubts - It's the first day of the rest of your life.

Tell us that you have helped him to overcome his initial reticence.

[M.Mouse]

Not the most pleasant sensation but it doesn't bother me in the least anymore than it bothers the doctor who has seen it all before and probably many times.

I was in hospital for another matter a year or so back and had the rubber glove treatment as a matter of course. Funny thing was I was in casualty and a couple of concerned friends were with me. They couldn't stop laughing when the doctor came through the curtain carrying a rubber glove and a pot of vaseline!

Your husband is putting his pride and fear of embarrassment before his wellbeing.

Show him this thread and tell him from us it doesn't hurt a bit.

[Pappa Smurf]

Theres only one concern when getting a digital examination---make sure the doc hasnt got 2 hands on your shoulders.

Just remember the old saying-----most men die with prostate cancer ,not from it.
Of course most are getting on in years anyway.

About the PSA reading----i thought anywhere between 4 and 7 was normal .I was told after 10-12 it can start filtrating to the bones.
My specialist doesnt want to even see me---as long as meds keep it down then its not hurrying things up.

As mentioned previously,it the aggresive P/C that is the killer ,and as with mine im still going strong after 11 years.

If you pee a lot (excluding times when drinking beer),have to get up more than once in the night,have trouble starting to pee or only have short pees when you are busting to go ,then head to the docs for the bad news.

They say a blood test is not 100% accurate,but in 99% of cases it is ,so if your scared of dropping your pants just have the needle for peace of mind.

No one gives it a thought until a friend gets it.When i was diagnosed most of the guys in town headed off to the docs-----he was cursing me.

[eastern wiseguy]

Jenny P P


Like your husband I would have rather have suffered in silence....then I got a totally unrelated health problem and the procedures involved in that made me realise that to die from ignorance and embarrassment would be plain STUPIDITY .Now almost one year down the line I had my first DRE ....uncomfortable...a bit.....undignified ...well a bit also ...but I contented myself with the fact that I had the better view..and it could damn well save my life.Tell him to stop buggering about...

EW ..with a mildy disturbed bum!

[Thomas coupling]

Well...bugger me? You learn so much on this site;)

[rt66doc]

Having done more than my fair share of DREs, I can tell you it's definitely not on my short list of favorite ways to spend an afternoon. All my colleagues agree.

Most docs are familiar with Dr. Stamey's findings but continue to order PSAs nonetheless. Hey, who wants to be the first on the block to stop ordering the blood test and have a (former) patient or his attorney come back later to advise that Dr. Z down the street found CA and the gent has six months to live?

The trend these days is toward "Evidence Based Medicine" so maybe more docs will eventually follow along with Dr. Stamey et al.

Speaking of evidence based medicine, here's one to chew on: there is no hard evidence that regular colonoscopy detects more colon cancer than does simple annual fecal occult blood screening. I don't know about you but I know how I intend to implement that gem of research. Of course the gastroenterology guys are not big on this as it has a chilling effect on their Golden Goose.