Prostate cancer debate

Amber Zones, Wenatchee, Wash — Wed, 06 Aug 2008 03:12:49 GMT

I work in a Urology department that not only diagnosis, but also treats prostate cancer. To not have a PSA test is like telling women not to have a pap smear! This test is sometimes the ONLY reason a patient will come into the Urologist. And sometimes an elevated PSA does not mean you have prostate cancer. But to not be tested and to come back years later with wide spread boney metastasis is a very scary thought. To have a blood test and then a biopsy that literaly takes maybe 15min and you can drive youself home after, to make sure you dont have cancer is worth it. Yes, a side effect of surgery can be impotence and incontience. But there are also many ways to help and sometimes cure these problems. Prostate cancer is a liveable disease, when you get treatment. I make sure my dad and grandfathers get their's done! To not have men get this simple blood test is absurd!

Prostate cancer debate

JP Frank, Bangkok, Thailand — Wed, 06 Aug 2008 07:26:00 GMT

Its a real puzzlement. And there are so many conflicting diagnos' from both GPs and specialtists. I have had a PSA which varies from 4 to 8 and an enlarged prostrate which is being treated by oral medicines. However even without a biopsy(difficult to get my cardiologist to agree as I am on blood thining medicines) or other treatment. I have erectile disfunction which could or could not be related. My PSA differs wildly from test to test. Nowadays my doctors have adopted a wait and see attitude which seems to me to be , in the circumstances the best way and this has been going on for 2 years with no appreciable change in my psa....

Prostate cancer debate

Dr. Dennis R. Plank — Wed, 06 Aug 2008 12:17:30 GMT

Your report on prostate cancwer was very misleading.

Every man---35-70+ needs a a PSA test--which is a painless part of a blood test.

Then it ought to be carefully read and evaluated by a competent doctopr--comparing the current report to the previous test.

THEN the patient ought to see an urologist for a further evaluation.

YOU FURTHER PROSTATE CANCER BY LEAVING THE IMPRESSION THAT PSA TESTS ARE PAINFUL, EXPENSIVE, AND UNNECESSARY.

Your report was very faulty.

Prostate cancer debate

Stuart, Florida — Wed, 06 Aug 2008 13:17:44 GMT

Mr. Williams in his lead-in said that testing may do "more hard than good". This was misleading, it was the therapy and action taken after that test that is being debated not the test.

The lead in gave the completely wrong message to this important issue. The story fixed it, but why do such a misleading teaser? It did make me pay attention but is could have been done better I think. Thanks for the opportunity to discuss.

Prostate cancer debate

Rocky, Tulsa — Wed, 06 Aug 2008 17:31:31 GMT

I understand to well the problem of letting people in office decide what needs to be done, as opposed to allowing a doctor and the effected person make the choice.
I had a scare with prostate cancer, and when I wnet to my doctor, he wrote me a perscription, when I got to the phramacy to fill it I was told that since I was 49 yrs old, and not 50 yrs old I could not have the medicine. It seems someone other than my doctor or myself, had decited that it was ok to let men under fifty years of age die without being allowed to be treated. Since I'm not yet fifty I'm holding out for the last three months, and hope that I'll beable to get the medicine I need in time that I can live longer. I just hope that a rash of this type cancer strikes the D.C. area and that anyone ( male ) elected gets to enjoy this medical problem, and who knows maybe a law that prevents elected officials from getting the drug they need will be passed, and we can enjoy watching many, many funerals.

Prostate cancer debate

Bill Jenkins, San Diego CA — Wed, 06 Aug 2008 17:46:46 GMT

I just turned 60 and was diagnosed a couple months ago with prostate cancer. Without a regular PSA test and physical, I would not know that the cancer was there, and that it is on the verge of spreading. I will have surgery to remove my prostate and surrounding tissues if infected. I'm already on hormone therapy and may have radiation therapy if needed following surgery.

I am baffled by this decision which will only lead men to delay prostate exams. They are not fun, but necessary. And if I was 75 or older, I would want to know a dangerous cancer was growing inside me. Are we now saying to the older men, "Just fade away and die?" Heck, I want to make it to 90, no make that 100.

Prostate cancer debate

George (Westwood, Mass.) — Wed, 06 Aug 2008 22:25:39 GMT

I read about the conclusions/recommendations of this "widely respected panel" in my Boston Globe Tuesday morning (Aug. 5, 2008). I have not yet seen, but will get and read, the new guidelines published in the Aug. 5 issue of the Annals of Internal Medicine. From the newspaper report and the report on NBC nightly news it seem that the panel would just like to throw away any one over 70, with respect to prostate cancer, anyway.

I am 80 and two weeks ago had an ultrasound exam and prostate biopsy as a follow up to one the previous year and an increase in my PSA number this spring. The actual test took about 20 minutes and was more inconvenient than uncomfortable. It was a considerable relief that the pathology report came back negative on the 12 specimens taken. I will certainly hope to continue to have PSA tests and to discuss further testing, treatment options, if need be, and recommendations with my urologist, for whom I have great respect.

I do not feel that decisions (test or not to test) should be made by such a panel that does not know me or any other men individually, regardless of what they believe their statistics show. Leave those choices to my doctor and me.

I must ask how many of the panel members (and members of Congress for that matter) have, or will decline the opportunity to have tests like this?

Prostate cancer debate

Richard Velleca, East Providence, R.I. — Thu, 07 Aug 2008 01:07:30 GMT

I thought PSA testing was a no brainer within the medical community. I had surgery after an elevated PSA and a biopsy confirmed an area of cancer within my prostate. Given my age, 60, this was the appropriate course of action for me regardless of any side effects like ED or urinary problems which I'm dealing with now. I don't think you can chance things with any type of cancer since they are resilient and can return with a vengeance to another area of the body when you think all is well. Let's have our medical professional decide what is appropriate and not some congressional task force. Shame on you Robert Bazell!Your report was a disservice.

Prostate cancer debate

Jewett Brown — Thu, 07 Aug 2008 03:12:29 GMT

Brian, the idea of not even bothering to test for prostate cancer, there is only one word for that and that is insane! I am sure the Merv Griffin and former newscaster Ron Stone wished that they had been tested earlier. I didn't realize there was an aggressive prostate cancer until at age 58 I was diagnosed in April of 2007 and had surgery in May. The biopsy showed it to be a Gleason level 8. I am so glad this piece did not air before my tests.

Prostate cancer debate

Nan Mac — Thu, 07 Aug 2008 15:09:03 GMT

I think if we really want to beat prostate cancer, all men should have their prostates removed at age 50. By that time, you should have completed your child producing and had a great sex life for a few decades, so possible impotence shouldn't worry you. I mean, we are making heroes out of women who have healthy breasts removed because they MIGHT someday get breast cancer, why shouldn't we just extend this therapy to men?
The problem is that we have this fiction in our minds that with enough testing we can be 100% safe from death by cancer. We can't. These universal screenings of non-symptomatic, low risk individuals (and I include universal mammography here)are simply not saving lives. We wish they did, I understand that. And we just hate sitting around waiting for cancer to get us - we are a pro-active society. But magical thinking is not science. Sorry.

Prostate cancer debate

Thu, 07 Aug 2008 19:08:55 GMT

Your statement online is more objective than your TV comments. However, more people saw and were more influenced by your TV comments. Those comments will do a disservice to a high risk population of African American men who have a prostate cancer death rate that is 2 to 3 times greater than European American men. There was no mention of this risk group in your comments and the so-call expert panel (US preventive services) essentially ignores this important high risk group. I met with Dr. Kramer (who represents the National Cancer Institute and commented on the issue) 15 years ago when the study, PLCO (the prostate cancer screening study), was initiated to discuss the issue of racial disparity and his attitude was to wait until the PLCO study was finished. Well its 15 years later and his position has not changed nor has the disproportionate death rate. How much longer should we tolerate this disparity before our government changes its policy. I have published scientific articles and submitted grant proposals suggesting other endpoints to scientifically prove the value of PSA testing but it has fallen on deaf ears. This disparity is also very costly to our health care system. The above issues need to be discussed in a national forum to give balance to the debate.

Prostate cancer debate

George, Westwood, Massachusetts — Thu, 07 Aug 2008 22:34:38 GMT

Sirs: I submited a very reasonable comment last night Wednesday, August 6, at about 6:00PM, earlier than some of these shown above. I would sincerely like to know why my comment is not listed. I would not have bothered had I known you were picky.
The courtesy of an answer would be appreciated.
Thank you, G. N. Lester

Prostate cancer debate

George, Westwood, Massachusetts — Thu, 07 Aug 2008 22:37:04 GMT

Sirs: This is a question for your editor. I submited a very reasonable comment last night Wednesday, August 6, at about 6:00PM, earlier than some of these shown above. I would sincerely like to know why my comment is not listed. I would not have bothered had I known you were picky.
The courtesy of an answer would be appreciated.
Thank you, G. N. Lester

Prostate cancer debate

Samuel D. Bird, III — Sat, 16 Aug 2008 12:33:23 GMT

Men who have the PSA Test and all the subsequent surgery, radiation, chemo, hormone treatments, etc. and all the side effects they entail, can still get and die of prostate cancer anyway. And those that do nothing also die of prostate cancer but without the potentially awful effects of the treatment. The bottom line is that there is still no evidence that the PSA Test saves lives compared to those that do nothing. That means that the death rates from prostate cancer (testing vs non-testing) are the same. So why go through it?

Prostate cancer debate

Bob Braune, Papillion, Ne. — Sun, 24 Aug 2008 22:50:10 GMT

It is absolutely insane to suggest men should not have PSA tests or treat Prostrate Cancer. When cancer is in your body especially in the prostrate and it spreads it becomes a killer. Remember where the prostrate is located in the body in relation to other organs that sustain life. I had surgery 4 years ago. My Urologist who I hold in the utmost regard said my chances for reoccurance directly after surgery was 30%. 4 years later it is reduce to from 3-10% I elected surgery because I had cancer in my body. A cancer that was thought to be contained in my prostrate organ. I wanted it out of my body. No matter what the future brings I made the right decision and screening for this cancer is essential to good results. And oh by the way all you men out there that are approaching 50 just because you feel fine is not a good reason to not have a physical which includes a PSA test. Prostrate cancer has very minimal symptoms if any until it gets out of the prostrate and then it may be a very hard battle to overcome. Get a physical and make sure your doctors has your blood checked for PSA.

Prostate cancer debate

Bob Braune — Mon, 25 Aug 2008 22:42:36 GMT

Another lesson to be learned by my experience. At age 52 I went to my Family Practice doctor for a physical.I resisted making the appointment but my persistant wife, companion and best friend, who also is a Registered Nurse insisted. I went knowing I felt absolutely perfect with no issues what so ever. My physical included a blood test and the standard varity of other tests. A few day later my doctor's nurse called and said everything was ok (which I already knew). My wife asked me that evening what was my PSA level. I looked at her like a deer in headlights and said I did not know. The next day she called the nurse since she knew her personally and asked her to check my chart. The reply was that no PSA test had been performed. My wife sent me back for a blood test and my PSA registered at 4.1 with a follow up of 5.6 two months later. A biopsy confirmed prostrate cancer. When I received the news I was floored. My wife provided any guidance I asked for on how to treat my dilemma but told me the ultimate decision was mine and mine only. I read articles for days. I chose surgery because I was young and healthy but to say someone age 75 should not screen for this disease is still insane as I stated in a previous note. This man could live to be 100 but he won't if he does not treat prostrate cancer. Doctor's need to supply quality care as in screening for PSA over 50 and being a good resource for their patiences. They should not have the power to decide who to test because it is not their life. It is the patients. I am lucky I had a personal nurse who guided me toward preventative and quality care. Her guidance saved my life. In today's health care system everyone needs to take charge of their own personal healthcare there are resources out there you just have to find and utilize. Don't think it won't happen to you be prevenative

Prostate cancer debate

Samuel D. Bird, III — Fri, 29 Aug 2008 13:52:30 GMT

Not that many years ago the treatment for even a small breast cancer lump was a radical mastectomy --- total removal of the breast, chest wall muscles and underarm lymph nodes. Women were disfugured and disabled for life. Also, hysterectomies were considered automatic for ALL women past chld-bearing age. Because they proved to be unnecessary, these procedures today are considered almost barbaric. There are many doctors who describe the incidence of prostate surgery today as the "male hysterectomy." It is also considered to be "the most unnecessary surgery done today." Simply stated, most prostates never had to be removed --- and that is the defect of the PSA Test. Most prostate cancer remains dormant and harmless , but the PSA Test cannot determine that and, therefore, unnecessary surgery is the result. I know I can only imagine what it must be like to have to make a prostate cancer decision and I'm speaking only objectively about something that is extremely emotional. I am glad that there are so many prostate cancer survivors and that these survivors are totally content with their decisions.

Prostate cancer debate

P. Howard, California — Thu, 11 Sep 2008 18:37:04 GMT

Crazy to suggest that testing for the second leading cause of cancer death in men be discontinued. My father is 89, in excellent health with no prostate cancer. I watched my grandfather-in-law die a very painful at age 85 from prostate cancer. My boyfriend also died of prostate cancer at age 58, diagnosed at stage 4, metastasized in bones. He suffered greatly. It's a horrible way to die regardless of age.

Prostate cancer debate

P. Howard, California — Thu, 11 Sep 2008 18:41:57 GMT

To Samuel Bird, the difference in the revised treatment for breast cancer and the suggested revised treatment for prostate cancer is that breast cancer was never left to "watchful waiting." Since at this point there is no definitive test to show which prostate cnacer will remain dormant and harmless and which will spread to bones like wildfire and cause an excruciating death, active treatment should continue.

Prostate cancer debate

Steve Huntley Il — Sat, 27 Sep 2008 16:18:25 GMT

My concern is how these proposals will be utilised.
Will the insurance companies, (private or governmental),use them to declare that they will not cover testing and/or treatment of segments of the male population, based on these findings or those of the future.

Prostate cancer debate

Ed Dwulet , Los Altos, CA — Wed, 08 Oct 2008 18:32:56 GMT

To date there is only one long term study (recently released this year)-- read that again only ONE study -- that shows a minimal benefit to radical prostatectomy over watchful waiting. The study began in 1989 and comes from Sweden where men were randomly assigned to surgery or watchful waiting based upon positive DRE (no PSA testing involved). After 10 years 13% of the surgery group had died of PROSTATE cancer versus 18% of the watchful waiting group. If the results of this one study hold up and are proved repeatable this would mean that 20 people have to be treated with surgery(and all the debilitating side effects) to potentially save 1! One of the more interesting results of the study showed that "all cause mortality" for both groups was essentially the same and not statistically significant (in the 30% range) -- meaning that no matter what treatment is chosen after 10 years you are just as likely to be dead -- if not from prostate cancer than something else. This study should be required reading for anyone considering surgery.

Prostate cancer debate

Fran Butler, Middletown, N.J. — Sun, 26 Oct 2008 03:20:58 GMT

My husband was just diagnosed with prostate cancer that has metastized to the bones. He was hospitalized last year with other problems and at that time along with other blood tests performed a psa reading of 15.8. Our Internist told us that this test meant an enlargement of his prostate and when we got a chance to see a urologist. No urgency in her voice, no followup in the past year to see if my husband did go to the urologist. She probably saw him at least 15 times in the past year. When he started having pains in his arms and back this summer he went back to her and was told to use ben-gay and given liderdurm back patches. The pain got so bad in his back we went to the emergency room. The end result: prostate cancer with bone metastisis, stage 4 and a psa of 126. I am outraged that last year she did not explain what a psa was, let alone a psa of 15.8, especially since she told us to see a urologist matter of factly and did not call one in to consult with as he was already in the hospital. Doctors have to realize that some men and women don't know anything
about prostate cancer or the prostate itself for that matter. Please, for all you doctors out there, if you have a patient in the hospital for a score of other problems and his psa is 15.8, please take the time to explain what that means and that they need to see the urologist ASAP. This year at admittance my husbands psa was 126. He is now on hormone therapy and on oxycontin for the pain. Thanks for listening.
Fran Butler

Prostate cancer debate

Steve Burcham, Dandridge, Tn. — Sat, 01 Nov 2008 15:09:00 GMT

To p. howard, california, Thank you for your comments on this blog. I am returning to my doctor the first of December for a review of my psa and, if is is still elevated or more elevated, I am to have a
biopsy. The obvious concern, which you clearly identified, is the absence of a differentiating test for the two basic types of prostate cancer. This is certainly one of the critical items for the discussion I will be having with my internist if he recommends the biopsy. Again, thank you.

Prostate cancer debate

Cindy Brannan, Spring Lake, Michigan — Wed, 05 Nov 2008 19:48:57 GMT

Dr. Bazell,

Off topic, but unable to find your email address...

I have a question that maybe you can answer through your own research. Do you have an opinion or knowledge regarding the acai berry or the Mona Vie company?

Thank you!

Cindy Brannan
mrbckb@hotmail.com

Prostate cancer debate

George Biancarelli, MD Anaconda, Montana — Tue, 10 Feb 2009 00:13:41 GMT

30% of patients who have a, "High" PSA will be diagnosed with cancer. Of this 30%, one-third will die no matter what we do, one-third will be cured and one-third will die with it rather than from it. The only problem is trying to determine which third is which.

Prostate cancer debate

James Carnes, Atlanta, GA — Thu, 19 Mar 2009 00:03:07 GMT

There is absolutely no harm in having a PSA test. None. All you do is donate blood. What you do after that is up to you. An elevated PSA is only an indicator that you MIGHT have cancer. A biopsy can confirm or deny that. THEN you make a decision as to whether to treat or not to treat. It's your decision, but with a PSA and Digital Rectal Exam, at least you can make an intellegent decision. NOT getting screened is, well, NOT intellegent.

Prostate cancer debate

Bob Braune Papillion Ne. — Tue, 24 Mar 2009 01:56:03 GMT

I am a 5 year prostrate cancer survivor. I totally agree with James Carnes and George Biancarelli's comments. I was diagnosed at age 52 young enough that prostrate cancer could of broke through the prostrate gland and killed me just when I was ready to retire. Do I agree with PSA testing you are darn right exactly as Mr. Carnes has mentioned. No one knows what kind of prostrate cancer is agressive and kills but if it is your life I would bet you would want to be proactive with it instead of waiting to see how it plays out especially at a young age.