Prostate-screening perspectives shared as another nears
Republic 1/8/10
Last fall I announced a prostate screening offered by Scottsdale healthcare. Robert Diepenbrock of Scottsdale sent me this follow up email.
“I had made appointments for a PSA test and a Cholesterol & Glucose tests, but was also able to have my skin checked for skin cancer, a test for osteoporosis, a fat percentage and waist circumference test and a review and evaluation of my test results by a physician.
During the event I was administered a Glucose test (the prick your finger blood test). I tested high. Based on this test result I have seen a physician and discovered I have Type 2 Diabetes. I'm treating it with a change in diet, exercise and medication (no insulin shots). If it hadn't been for the screening my condition could have gone on undetected and gotten worse.
I am truly fortunate to have attended this event and urge other men to attend the next event,” said Diepenbrock.
Phil Anderson responded as well.
“I had the robotic surgery in September, 2008 and I spent only one night in the hospital. I never had to wear more than a pad. That was for only about a month. My personal life with my wife has changed very little due to the fact with robotic surgery many of the nerves are able to be spared. I opted for the robotic way as I have a bleeding disorder, and this is much less invasive. I am a 70 year old man in fairly good health. My latest PSA test was in the negative zone. I know there are many options for prostate cancer and everyone must make their own decisions, but this robotic option, I feel is one of the best.”
Jack Szatkowski wrote me in September too late to get his comments in my column so I checked on him a couple of weeks ago.
“I had the seeding procedure in April, it has been and continues to be the most painful, miserable, and uncomfortable experience a person would want to go through. I am doing somewhat better; it is down to penis and urethra pain spasms and urinary retention. I just have to plan ahead when leaving the house.”
Hal Cope offers an interesting perspective.
I have been living under the ax of prostate cancer for years. In brief my PSA in 1992 was 2.5. Since that time it has climbed and climbed and climbed during which time I had biopsies upon biopsies.
Finally in 2001 with my PSA at 14.1 and with all biopsies and the Digital Rectal Examination [DRE] negative, I had the seed implant.
My PSA dropped to 1.4 then began its steady climb to 40.7 in April of 2008. It dropped to 34.4 in August, 2009. All DRE's were clear of cancer including the granddaddy of all biopsies 29 punctures with no visible sign of cancer. My doctor wanted to give me hormone shots to lower the number which I declined.”
Cope has his next check up this month. For many like Hal Cope, watchful waiting may be an option but you have to have regular check ups.
The next prostate cancer screening is January 23, 2010 from 8 AM to Noon in the US Airways Center at 201 E. Jefferson. Call (480) 964-3013 or 800-828-6139 to schedule your FREE Screening. Appointments required.
If you cannot get to this screening, schedule an appointment with your personal physician.
For both men and women, a regular physical examination with your physician is a good way to start this new decade.
Helpful sources:
Go to http://prostatecheckup.com to read other stories and learn more.
Go to my blog at http://prostatecancersupport.blogspot.com for previous columns and stories.
Sunday, April 25, 2010
Prostate cancer 4/9/2010
PSA testing for prostate cancer debated; disease remains a killer 4/9/10
There have been a lot of scary stories in the media about the role of PSA testing for prostate cancer. One writer told a health magazine that he wanted his cancer back. He had read the two studies published in the New England Journal of Medicine and wrongly concluded that routine screening is not necessary. Hidden near the end of the article is this statement, “Nobody wants to die of it. So I guess it was a good thing my prostate was taken out.”
The greatest risk factor for prostate cancer is age. This risk increases significantly after the age of 50 in white men who have no family history of the disease and after 40 for black men and men with a close relative with prostate cancer. About two-thirds of all prostate cancers are diagnosed in men age 65 and older. About 80 percent of men who have reached 80 have prostate cancer. Medicare will only cover men over 50.
My concern is that older men, particularly those who do not like the PSA [prostate-specific antigen] test and DRE [digital rectal exam], will see these stories and say why bother testing. We should do less treatments but better screening.
National Public Radio interviewed a staff member, Richard Knox, under the title: Prostate Test: Lifesaver or Big Mistake? Knox talked to Richard Ablin, M.D. from the University of Arizona. Ablin discovered the PSA or prostate-specific antigen and now says the PSA test has become a public health disaster.
Ablin uses the analogy of the prostate gland as a box with no top. Aggressive cancer, the rabbit, can jump out of the box and spreads. The nonaggressive cancer, the turtle, just crawls around and goes no where. He is correct that the PSA test cannot tell you which cancer it is or even if you have cancer.
The April issue of the Johns Hopkins Prostate Disorders Health Alert discussed the quality of life issues after Prostate Cancer Treatment.
“Because prostate cancer progresses more slowly than other types of cancer, men can take some time to carefully consider the various prostate cancer treatment options. A man should talk with his doctor about the relative risks and benefits of each treatment and consider consulting physicians from different fields [urologists, radiation oncologists, and medical oncologists] to get a broader spectrum of opinions.”
The New England Journal of Medicine published two now famous studies a year ago, one American and one European. They are still being cited to suggest that PSA testing is not that important. Dr. Ruth Etzioni in Biostatistics of the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center pointed out several issues that put the research in the proper context.
The interpretations of the results of these studies are incorrect. Etzioni says, “The American trial is not a study of true screened and not screened as was the European trial.” That is because nearly one third of the supposed “not screened” did have tests so the American cancer death rates cannot be compared to the European results.
“There was too much focus on the American trial. You cannot just look at the number of deaths from prostate cancer, since not that many die from the cancer. You have to look at the percentage drop in the number of deaths for those who were screened. The European results showed a 20% drop in cancer deaths which I think is significant,” said Etzioni.
One PSA test is insufficient to recommend additional tests.
In early March, The American Cancer Society revamped its recommendations for prostate cancer screening. In new guidelines released the Society says that men who choose to be tested should get an annual screening if their level of prostate-specific antigen, or PSA, is 2.5 nanograms per milliliter or higher. But men whose PSA is under that threshold can be safely screened every two years. Men with a PSA level of 4.0 or higher should consider getting further evaluation, such as a biopsy. Previous guidelines had suggested that men with a PSA of less than 4.0 should be screened annually.
Next week: What should you do about prostate cancer screening?
Resources:
http://content.nejm.org/cgi/content/full/NEJMoa0810696?query=TOC
This is the American study.
http://content.nejm.org/cgi/content/full/NEJMoa0810084?query=TOC
This is the European study.
http://www.nejm.org/perspective-roundtable/screening-for-prostate-cancer/?query=TOC
Go to this website for the physicians’ discussion of the studies.
There have been a lot of scary stories in the media about the role of PSA testing for prostate cancer. One writer told a health magazine that he wanted his cancer back. He had read the two studies published in the New England Journal of Medicine and wrongly concluded that routine screening is not necessary. Hidden near the end of the article is this statement, “Nobody wants to die of it. So I guess it was a good thing my prostate was taken out.”
The greatest risk factor for prostate cancer is age. This risk increases significantly after the age of 50 in white men who have no family history of the disease and after 40 for black men and men with a close relative with prostate cancer. About two-thirds of all prostate cancers are diagnosed in men age 65 and older. About 80 percent of men who have reached 80 have prostate cancer. Medicare will only cover men over 50.
My concern is that older men, particularly those who do not like the PSA [prostate-specific antigen] test and DRE [digital rectal exam], will see these stories and say why bother testing. We should do less treatments but better screening.
National Public Radio interviewed a staff member, Richard Knox, under the title: Prostate Test: Lifesaver or Big Mistake? Knox talked to Richard Ablin, M.D. from the University of Arizona. Ablin discovered the PSA or prostate-specific antigen and now says the PSA test has become a public health disaster.
Ablin uses the analogy of the prostate gland as a box with no top. Aggressive cancer, the rabbit, can jump out of the box and spreads. The nonaggressive cancer, the turtle, just crawls around and goes no where. He is correct that the PSA test cannot tell you which cancer it is or even if you have cancer.
The April issue of the Johns Hopkins Prostate Disorders Health Alert discussed the quality of life issues after Prostate Cancer Treatment.
“Because prostate cancer progresses more slowly than other types of cancer, men can take some time to carefully consider the various prostate cancer treatment options. A man should talk with his doctor about the relative risks and benefits of each treatment and consider consulting physicians from different fields [urologists, radiation oncologists, and medical oncologists] to get a broader spectrum of opinions.”
The New England Journal of Medicine published two now famous studies a year ago, one American and one European. They are still being cited to suggest that PSA testing is not that important. Dr. Ruth Etzioni in Biostatistics of the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center pointed out several issues that put the research in the proper context.
The interpretations of the results of these studies are incorrect. Etzioni says, “The American trial is not a study of true screened and not screened as was the European trial.” That is because nearly one third of the supposed “not screened” did have tests so the American cancer death rates cannot be compared to the European results.
“There was too much focus on the American trial. You cannot just look at the number of deaths from prostate cancer, since not that many die from the cancer. You have to look at the percentage drop in the number of deaths for those who were screened. The European results showed a 20% drop in cancer deaths which I think is significant,” said Etzioni.
One PSA test is insufficient to recommend additional tests.
In early March, The American Cancer Society revamped its recommendations for prostate cancer screening. In new guidelines released the Society says that men who choose to be tested should get an annual screening if their level of prostate-specific antigen, or PSA, is 2.5 nanograms per milliliter or higher. But men whose PSA is under that threshold can be safely screened every two years. Men with a PSA level of 4.0 or higher should consider getting further evaluation, such as a biopsy. Previous guidelines had suggested that men with a PSA of less than 4.0 should be screened annually.
Next week: What should you do about prostate cancer screening?
Resources:
http://content.nejm.org/cgi/content/full/NEJMoa0810696?query=TOC
This is the American study.
http://content.nejm.org/cgi/content/full/NEJMoa0810084?query=TOC
This is the European study.
http://www.nejm.org/perspective-roundtable/screening-for-prostate-cancer/?query=TOC
Go to this website for the physicians’ discussion of the studies.
Prostate cancer 4/16/2010
Prostate cancer is treatable; 27,000 men don’t have to die 04/16/10
Routine PSA screening a must despite advice from cancer society
Prostate cancer warning
While Prostate Cancer in its early stages may not have any symptoms, you should honestly ask yourself if you are experiencing any of the following:
• Difficulty starting to urinate
• Less force to the stream of urine
• Dribbling after you finish urinating
• Frequent urination, especially at night
• Blood or pus in the urine
• Blood in the semen
• Pain while urinating
• Pain with ejaculation
• Hip and lower back pain that does not go away over time
• Pain in the lower part of your pelvis
• Unintended weight loss and/or loss of appetite
______________________________________________________________________
Bob King about 61 years old became concerned when he was making four nightly trips to the bathroom. His dosage of Flomax was not working so went for a biopsy. One positive finding and a suspicious second spot raised concern for prostate cancer.
The Scottsdale resident did not rush to surgery but discussed his options with several urologists and friends who had had surgery.
Ultimately Bob had the surgery with this thought, “if your body tells you that there is a problem, then you have to deal with it.”
Gary Cruz also of Scottsdale, at age 57 found that he has several positive biopsies.
“My options were to do nothing, radiation, hormone therapy, radioactive seeds, conventional surgery or robotic surgery. I hated knowing that cancer was in my body and after some emotional conversations with my wife and son and my urologist. I decided to undergo the robotic surgery to remove my cancerous prostate,” said Cruz.
“Was I in a life and death situation? The simple answer was no but as I stated, I couldn't mentally deal with the fact I had cancer growing in my body, regardless of how slow it may have been and there is no evidence that it was or was not growing rapidly.”
Cruz said early detection saved his life. “Almost 27,000 men die from prostate cancer every year. It drives me crazy that most of those deaths could have been prevented with early detection. I'm a firm believer that men should start getting tested at age 40 on an annual basis,” he added.
What should you do about prostate cancer screening? If you are over fifty and you get an annual physical, add the PSA test to your blood work if it is not already included. They use the same blood sample for the cholesterol test.
The test that most men do not like is the digital rectal examination [DRE]. It probably saved Scottsdale resident David Tucker’s life.
“My case was simple. DRE revealed a lump, PSA went from 2.8 (for 3 years straight) to 3.6, biopsy had 3 hits in 10, and I was just 62.”
He elected surgery and has been cancer-free for four years.
Rabbi Ed Weinsberg writes a blog on prostate cancer and notes “Prostate Cancer screening has NOT been overtly encouraged by the American Cancer Society [ACS] for the past 15 years. Now the American Cancer Society has gone even further by asking patients and doctors to consider the danger of routine prostate cancer PSA screening, since the ACS implicitly claims such testing can easily lead to over-treatment.”
His conclusion is the same as mine.
“Even though at least 80% of prostate cancers are found early, scientists have yet to figure out which are likely to become aggressive. Is the ACS asking men to avoid treatment and simply assume they won’t be among the 27,000 prostate cancer patients who die every year in the US alone? It’s true that the odds of survival are in our favor. But prostate cancer remains the second leading cause of male cancer death after lung cancer.”
“Whatever its limitations, until a more precise biomarker is discovered, routine PSA screening is a must for most men, followed by a biopsy when indicated to determine if a man has prostate cancer. We men have a right and an obligation to ourselves to know what’s happening inside our bodies,” Weinsberg said.
So get regularly testing and keep good records. Doing nothing may make you a statistic.
Prostate cancer resources:
http://conquerprostatecancernow.typepad.com/
Rabbi Ed Weinsberg’s blog
Conquer Prostate Cancer: How Medicine, Faith, Love and Sex can renew Your life, by Rabbi Ed Weinsberg with Dr. Robert Cary
http://prostatecancersupport.blogspot.com My blog
Routine PSA screening a must despite advice from cancer society
Prostate cancer warning
While Prostate Cancer in its early stages may not have any symptoms, you should honestly ask yourself if you are experiencing any of the following:
• Difficulty starting to urinate
• Less force to the stream of urine
• Dribbling after you finish urinating
• Frequent urination, especially at night
• Blood or pus in the urine
• Blood in the semen
• Pain while urinating
• Pain with ejaculation
• Hip and lower back pain that does not go away over time
• Pain in the lower part of your pelvis
• Unintended weight loss and/or loss of appetite
______________________________________________________________________
Bob King about 61 years old became concerned when he was making four nightly trips to the bathroom. His dosage of Flomax was not working so went for a biopsy. One positive finding and a suspicious second spot raised concern for prostate cancer.
The Scottsdale resident did not rush to surgery but discussed his options with several urologists and friends who had had surgery.
Ultimately Bob had the surgery with this thought, “if your body tells you that there is a problem, then you have to deal with it.”
Gary Cruz also of Scottsdale, at age 57 found that he has several positive biopsies.
“My options were to do nothing, radiation, hormone therapy, radioactive seeds, conventional surgery or robotic surgery. I hated knowing that cancer was in my body and after some emotional conversations with my wife and son and my urologist. I decided to undergo the robotic surgery to remove my cancerous prostate,” said Cruz.
“Was I in a life and death situation? The simple answer was no but as I stated, I couldn't mentally deal with the fact I had cancer growing in my body, regardless of how slow it may have been and there is no evidence that it was or was not growing rapidly.”
Cruz said early detection saved his life. “Almost 27,000 men die from prostate cancer every year. It drives me crazy that most of those deaths could have been prevented with early detection. I'm a firm believer that men should start getting tested at age 40 on an annual basis,” he added.
What should you do about prostate cancer screening? If you are over fifty and you get an annual physical, add the PSA test to your blood work if it is not already included. They use the same blood sample for the cholesterol test.
The test that most men do not like is the digital rectal examination [DRE]. It probably saved Scottsdale resident David Tucker’s life.
“My case was simple. DRE revealed a lump, PSA went from 2.8 (for 3 years straight) to 3.6, biopsy had 3 hits in 10, and I was just 62.”
He elected surgery and has been cancer-free for four years.
Rabbi Ed Weinsberg writes a blog on prostate cancer and notes “Prostate Cancer screening has NOT been overtly encouraged by the American Cancer Society [ACS] for the past 15 years. Now the American Cancer Society has gone even further by asking patients and doctors to consider the danger of routine prostate cancer PSA screening, since the ACS implicitly claims such testing can easily lead to over-treatment.”
His conclusion is the same as mine.
“Even though at least 80% of prostate cancers are found early, scientists have yet to figure out which are likely to become aggressive. Is the ACS asking men to avoid treatment and simply assume they won’t be among the 27,000 prostate cancer patients who die every year in the US alone? It’s true that the odds of survival are in our favor. But prostate cancer remains the second leading cause of male cancer death after lung cancer.”
“Whatever its limitations, until a more precise biomarker is discovered, routine PSA screening is a must for most men, followed by a biopsy when indicated to determine if a man has prostate cancer. We men have a right and an obligation to ourselves to know what’s happening inside our bodies,” Weinsberg said.
So get regularly testing and keep good records. Doing nothing may make you a statistic.
Prostate cancer resources:
http://conquerprostatecancernow.typepad.com/
Rabbi Ed Weinsberg’s blog
Conquer Prostate Cancer: How Medicine, Faith, Love and Sex can renew Your life, by Rabbi Ed Weinsberg with Dr. Robert Cary
http://prostatecancersupport.blogspot.com My blog
Subscribe to:
Posts (Atom)
