The debate rages on, but evidence that the widely-used PSA test for prostate cancer screening leads to unnecessary and quality-of-life diminishing treatments continues to emerge. The latest study, conducted by doctors at Dartmouth and the University of Connecticut, analyzed
data on prostate cancer collected by the National Cancer Institute and
population data from the U.S. Census. WebMD reports that from 1986 to 2005, PSA testing resulted in the diagnosis of about 1.3 million prostate cancers that would never otherwise have been detected, and that more than 1 million of these patients were treated with surgery or
radiation,which often leaves patients impotent and/or incontinent.
WebMD reports that over that time, deaths from prostate cancer declined. And so, taking a conservative
approach, the researchers assumed that PSA detection of early prostate
cancers — and not improvements in treatment — was responsible for the entire
drop in prostate cancer deaths. In that case, the researchers found, PSA testing would have saved about 56,500 lives. But some
943,500 men would have been "overdiagnosed."
WebMD also reports that Martin Sanda, MD, director of the prostate cancer center at
Beth Israel Deaconess Medical Center, studied 342 men who
deferred treatment for at least one year after prostate cancer diagnosis.Half the men remained untreated for nearly eight years; the other half
eventually opted for treatment an average four years after diagnosis. These men
were compared with men who chose immediate treatment after diagnosis. The envelope please: Among those who held off on treatment, 98 percent survived. With immediate
treatment, the rate of survival was 99 percent.
I am always nervous when doctors anticipate an individual’s reaction to bad news. I would rather have the information and make an informed decision. The real problem is that treatment has not kept up with detection. The PSA can determine that one needs a biopsy and the biopsy shows whether one has cancer. What one cannot determine right now is whether the cancer is slow or fast growing. Slow–you watch and wait, fast–you get treament right away. If you don’t know if it is fast or slow, what should one do? Fast can kill one quickly, in just a few years. The slow one might never even show symptoms, I understand. Still, I would rather know I got it and make up my own mind.
I recently had a biopsy (ten samples) and a catscan. The biopsy came back with positive cancer. The catscan was administered by someone who injected me with something that caused my tongue to become extremely hot to the point of pain for 2 minutes, also my face was very hot. I’d like to know if this was normal or was I given an overdose of whatever it was.
I was diagnosed with prostrate cancer several years ago, and it was decided that a radical prostrate operation was needed. The operation wen fine, but the recovery was the worse experience in my life. After the catherter was removed, it was no more than 5 hour later and I could not urinate. I had to go to ER to have a cath put back in. This went on for 6 weeks, in and out of ER’s and Doctors office. I returned to Arizona sitting on a air donut, with a cath. The specialist there put me on a program cathing myself over a period of eith weeks. It was disgusting but it finally was corrected and I was able to urinate normally. Even though I have a penal implant, the operation destroyed enough blood vessels to render me impotent. I am now 73 and just think about sex.
To R. Ward — —
1. There are a lot of 73-year-olds out there who only “think about sex”.
2. There is no “r” in prostate. P-r-o-s-t-a-t-e
Good luck to you. Ed in Fl
I think the question is what was the health of the 98% who were not treated and survived. Fighting stage 2-4 prostate cancer with hormones and radiation is life altering. If the 98% were are healthy as the 99% then the implication makes sense but I highly doubt that was the case. Over 30% of people who have their prostates removed find the cancer was more advanced than the biopsy. So the question is are you in the 30% or not. Until there is a good way to tell you have to make your own call. I chose to have the operation and was in the 30% so in a sense testing saved my life at 52. General concensus is based on life expectancy. If its 20-30 years then have the operation. Yes there are side effects but better than being dead. If expectancy less than 10 years then do nothing. 10 to 20 years is the gray area.
Gentlemen I was treated for prostate cancer in 2001. I was told by my doctor that he wanted to put me on homones and have the prostate removed here in my area. I went to MD Anderson for a second opinion and was told that their gold standard was surgery. I was told since I was young enough that the best seed implant doctors were in the Seattle area. Through my research I found the best surgical doctor was at John Hopkins Hospital in Baltimore. Well, I found out Dr. Walch is very selective and will not operate on anyone whose cancer is not within his guidelines. I had my cancer treated at the rcog clinic in Atlanta, Ga. They have the best cure and complication rate in the world, better than Dr Walsh better than the seed implant Doctors in Seattle and better than MD Anderson. We had men from socialized medicine countries like New Zealand, England and The Netherlands there for treatment because in their countries they were told to go home and live with it until you die. Men, do your own research, its your life. Check the wedsite at http://www.rcog.com for good information about prostate cancer. I am in my 9th year with cancer and after 10years you are considered cancer free. I have had no complications. Again men do the research. I would highly advise the clinic at RCOG. We have a reunion at RCOG to meet old friends that we met at the clinic and the guy from New Zealand one year brought his whole family to the reunion for them to meet the doctors that gave him a new lease of life.
PSA testing for men has its advantages and disadvantages. It has been found that man undergoing PSA testing to avert prostate cancer, nearly fifty men have to go under treatments which was not needed and a some of such men would face grave troubles with the treatment. So one should take proper care and should have knowledge on it.
The first doctor (urologist) who told me my PSA was increasing also told me that there are as many as ten reasons for the PSA to increase, but he did do a biopsy which was negative. Then I was told by my next urologist that it is possible for the biopsy to simply miss the cancer and it might take 3 biopsies to actually find the cancer. So he did a biopsy which also came back negative. The next thing was that my PSA went down a little, and both the second urologist and my primary Dr. both told me that if the PSA goes down it means that it is not cancer.
In spite of this the second urologist called me on the phone said I should have another biopsy – I told him that I wasn’t interested. Then the next visit to my primary, I was told that my PSA went down again, so I was really glad I had said “no”. I am 73 also and as far as I am concerned, at this point in time I do not have prostate cancer.
I might add that I did have cancer in my right kidney and the kidney was removed almost 6 years ago. This was done by the first urologist.
I believe that the PSA test saved my life, My number was rising each year not much but still rising, My Dr, didn’t like the 3.9 PSA number and recommended a Urologist, my biopsy revealed abnormal cells on one side in 5% of the tissue, At the time I was 55, I opted for the Radical surgery. The catheter was the worst part of the ordeal, I wanted to Kiss that Dr, when he removed it, I have been trouble free for more that ten years now last PSA 0.00 and I am extremely grateful that we have the PSA so for me the controversy is mute point, Maybe I was one of the “Lucky Ones” I was pretty much back to normal within six months of the surgery no Viraga , We have been married for forty six years so the sex thing isn’t as important or as often but still enjoyed.
I think that the PSA test is an excellent measure of one prostates health and should not be discounted as irrelvant as some suggest.
Mr. Cowhig,
My situation is very similiar to your my prmary care Dr. said my PSA was a little higher than he liked to see 3.8 and referred me to Uroligist the PSA was taken again there and had risen to 4.5 he then over a period of7 months took 3 biopsy the first two were suspious cells the third was positive for cancer there were ten samples taken each time on different areas of the prostate. There is prostate cancer in my family with my Uncle and some non cancer tumor with my grandfather. I am now 6 months since the surgery and yes when the catheter was removed I felt a lot better that was the worst part of it. I am slowly getting back to normal. When they removed my prostate it was twice the size of a normal on and after it was sent to the lab it was positive for cancer, I am 54 now and this testing in my opinon is very important I have seen two people in the last two years that were close tom die from cancer, other types and it is very painful. A man I work with had the same surgery done in Febuary of this year and has had good results as you.
The PSA testing should not be discounted and I think that more education with men is needed to make them aware.