Anybody see AP article on Prostate CA by Marilynn Marichione yesterday? Any point to PSA testing?

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mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 375
   Posted 2/26/2009 12:50 AM (GMT -6)   
My local paper just ran a story yesterday about doctors telling men who are screening for prostate CA to start taking finasteride (ie Proscar) to decrease the odds of prostate cancer by 25%. The most disturbing thing to me  about this article is the author's comments about Prostate CA and I quote ,"about 186,000 American men this year will be told they have cancer of the prostate. The disease is often diagnosed from a biopsy after a suspicious PSA blood test..........PSA can be high for many reasons, and there's no proof that screening saves lives-the reason no major cancer groups recommend it. Most men over 55 get the test anyway, then face a dilemma if cancer is found. It usually grows so slowly it is not life-threatening, but it can prove fatal.  Treatments often causes sexual or bladder control problems. "We still don't know if screening and aggressive treatment is a good thing,".........said American Cancer Society's chief medical officer, Dr. Otis Brawley
 
So all you guys out there, (like me), was it worth it to you to find out you had prostate cancer? Or would it have been better if we had just forgotten about taking the annual PSA test and went on our merry way with our lives oblivious to this condition. Honest answers please, I want to know how you feel about this...........................
my age=52 when all this happened,
DRE=negative
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/08, 2/12 cores positive for Prostate Cancer on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 3+3=6 both cores,
Clinical Stage T1C
 
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery,
No signs of spread, organ contained,
First post-op PSA=.01 on 10/15/08,
Second post-op PSA <.01 on 01/15/09,
Incontinence gone in early December '08,
ED remains, using daily Viagra and 2x/wk bimix/trimix injections for penile rehab


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4840
   Posted 2/26/2009 6:30 AM (GMT -6)   

To me - "An Ounce of prevention is worth a pound of cure."

One of the first things I read when starting my research-> Most men will die WITH prostate cancer versus dieing FROM it...I found that statement to be very good...

So all you guys out there, (like me), was it worth it to you to find out you had prostate cancer? Or would it have been better if we had just forgotten about taking the annual PSA test and went on our merry way with our lives oblivious to this condition.

Alot depends on your age....If I were 82 instead of 52 when the doc found the nodules, I probably would not have done anything...


Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
 
06/25/08 - Da Vinci robotic laparoscopy
Catheter in for five weeks.
Dry after 3 months.
 
10/03/08 - 1st Quarter PSA -> less then .01
01/16/09 - 2nd Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25382
   Posted 2/26/2009 8:29 AM (GMT -6)   
With what they found with me, it was agressive, and had all the signs of being fast moving. My dr. thought that without doing anything, I might only have been in the 5-7 year of survival group.

Being 56 and otherwise healthy, that would have been unacceptable, and had I not been faithfully getting PSA done yearly since age 50, I would have never known until it was too late. So I am thankful for the psa and a very diliegent local GP that knew my body and systems well.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/26/2009 9:00 AM (GMT -6)   
Dunno....seems like a question of do you want to fix that tooth cavity...or wait until it hurts. To me age is the biggest factor...I want to see my great grandkids so I vote Yes I wanted to know.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


JerseyG
Regular Member


Date Joined Feb 2009
Total Posts : 65
   Posted 2/26/2009 9:47 AM (GMT -6)   
I was 43 when I was dx. I had no other option but to treat it. I could not take knowing PC was growing inside me without taking some action. Slow-growing, fast-growing, they still can not reliably predict with certainty which type you may have. Like a lot of you guys I am otherwise very healthy and I plan to stay that way as long as I can. DaVinci Surgery for me was a no brainer.

Age now 44 (43 when dx)
 
Pre-op PSA:  0.9
Biopsy: 3/12 cores pos  20% 30% 50%
Gleason 3+3=6
Robotic RP:   Aug 08 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report: Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes
Post Op PSA: Dec 08 <0.1


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 2/26/2009 11:09 AM (GMT -6)   
That particular article is either the same one that was published several months ago and I recall discussed here or at other forums, or is piggy-backing on the earlier article which was controversal.  That someone would seriously suggest prevention isn't good personal behavior is troubling to hear/read.  But some people value their lives more than others do.  Count me amongst the men who don't want to surrender my life prematurely to a death preventable for probably most of us.  In the grand scheme of things, ED and incontenence are relatively insignificant issues.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0

 

Post Edited (Mavica) : 2/26/2009 9:13:47 AM (GMT-7)


apacker1950
Regular Member


Date Joined Nov 2008
Total Posts : 122
   Posted 2/26/2009 11:48 AM (GMT -6)   
It would be interesting to know what Drs. do when they find they have PC.  I would venture to guess that they choose similar paths to those we have.  Theory is one thing.  Reality is quite another.  At my age I chose to get it out.  If I had to do it over again I would probably do the same thing.  Thanks for the article.  Allan
Dx PCa age 54. Jly 05- PSA 8.1 Sept 05- PSA 10.7
Sept 05- Biopsy  9 of 12 cancerous, Gleason 3+3=6, T2
Bone scan and cat scan showed hot spot on hip bone.
Oct 05- bone biopsy, ouch.  benign , no cancer in bones.
Nov 05- PSA 15.4 Nov 18, 05- Nerve sparing open RP at Huntsman Cancer Center, by Dr. Robert Stevenson. 100% continence at 3 months. ED- Tried the big 3 pills with no results. Feb 06-Started VED, worked, but painful with constriction rings. May 06 started Trimix injections.
ED appears to be perminant but doing great with Trimix.


kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 2/26/2009 12:51 PM (GMT -6)   
Mavica is correct. We had this same discussion a while back.

Other things cause PSA to go up? Yes. I was told I had an 80% of having a negative biopsy. So I guess everybody on this board is a big fat loser because we could not beat those odds. Bummer.

For me, the PSA test saved my life. I had aggressive PCa, and it was right on the verge of breaking out of the capsule and heading off to who knows where. At the age of 52 or 53, do I want cancer cells flowing thru my system? Is that not going to eventually kill me? I had 3 highly regarded doctors in the area tell me to get it out of there as soon as possible. Am I going to ignore them?

I can understand people being concerned about being over-diagnosed or over-treated, but in my opinion you can NOT just ignore it. You need to be aware of it, make your decisions, and proceed with life. I understand that in many cases the choice may be to do nothing, but that should be an informed decision on the patient's part.

If PCa is so slow-growing, why do 500 men in the US die from PCa EVERY WEEK?

Just my 2 cents,
kcragman
Age: 53; 52 at DX
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late
Jan '08 - after I was rejected. Their lab said PSA 4.5.
Feb 2008: PSA 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were
cancerous and the 6th was suspect.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph node and nerve samples taken, and appeared to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.
Feb 2009: PSA at 9 months was undetectable.


Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 202
   Posted 2/26/2009 1:06 PM (GMT -6)   

I wonder about this issue.

Was the PSA a blessing or a curse to me.  I'll never know.  I do know that once I was told I had cancer, I had to do something about it.

It is interesting that the death rate from prostate cancer has not seemed to drop much since the PSA testing started.  I don't understand that.  Unless I'm mistaken and there has been a decrease in the death rate.


Age:54
PSA 5/22/06: 5.6
DaVinci surgery: 9/14/06
Gleason: 3+3
Organ confined, clean margins.
Both nerve bundles spared.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4240
   Posted 2/26/2009 1:14 PM (GMT -6)   

Hi All:

FYI, here is a link to a more extensive Q and A with Dr. Brawley on the subject of PSA screening:

http://www.cancer.org/docroot/SPC/content/SPC_1_Brawley_Prostate_Q_A.asp

My specific answer to mspt98's question is, yes, it was worth it to me.  I think knowledge is power.  I would much prefer to learn the truth, then deal with options, than to stick my head in the sand and not have any information.  Maybe, if I had never been tested, my cancer would not grow and I would have lived just fine never knowing.  Or, maybe it would have spread and I would have died an ugly premature death.  I preferred to know what I had, get properly informed, then deal with it.

Anyway, that's my take.

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 1/31/09.


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 2/26/2009 4:42 PM (GMT -6)   
It's hard to believe that the the Chief medical Officer would take PCa so lightly. If I listened to his advice I would probably be dead in 5 years. My biopsy report was such that the surgeon wondered why I wanted surgery. As you can see from my stats, I'm glad I convinced him to do the surgery.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 2/26/2009 4:52 PM (GMT -6)   
Greetings, everyone.  There is something about knowing you have cancer and doing nothing about it that I just couldn't deal with.  I can't believe that all the urologists out there who are treating prostate cancer would agree that screening is a waste of time.  As for me, once I found out I had it, I'm glad I chose the treatment I did and am not looking back.  David
Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
Great wife and family who take very good care of me


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25382
   Posted 2/26/2009 5:11 PM (GMT -6)   
From one David to another: And with your post surgery pathology showing a 4+3, it's a good thing that you did choose treatment while it was still contained. Good call.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/26/2009 8:10 PM (GMT -6)   
Sure looks likes PCa is the Jungle and combination of Twilight Zone, which is it? Which ones are idolent PCa and which ones are viralent forms and/or for how long of time period before it mutates/changes or becomes more defiant against drugs. Looks like many answers are the correct ones a diechotomy of parameters and choices, including monitoring or w.w. (watchful waiting) and therapies that are outside the box even.

Their is an abstract out of Sweden or Switzerland that compared similar sets of patients, treated for PCa and no treatment for PCa.....they were not found equal in this study. The treated patients did have better survival or maybe even fit the criteria of 'cured' as it may have been defined. Alot of cure rates are based upon 10 yr. survivals, maybe a few years ago that is all they could find for data, I might mention that failure of cured status can show up after 10 yrs.(so that is not a defined ending), and does in some cases...why? Perhaps the answer lies within the idea of 'micro mets' which Dr. Barken has mentioned concerning PCa. It is as wild and inconsistent in the World of PCa. Not enough is currently known to make the most righteous assessment of disease level and aggressiveness and also localization of PCa cells, so the treatments can lack or fail because of such. We have to look at our own comfort levels, own long term scenarios, own set of parameters and make our best judgements, and it should not be left to the doctor giving you all the inputs and decisions.
Get envolved, get education, get opinions, and look at everything and don't stop looking, especially for us in the non-cured/failed post treatments, psa threshold and stats.


 

Post Edited (zufus) : 2/26/2009 6:13:26 PM (GMT-7)


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 2/26/2009 8:26 PM (GMT -6)   
Hey MSPT,

After watching my dad die from prostate cancer, I decided if I was ever diagnosed with I would definitely do everything I could to get rid of it. No matter how small the amount of cancer that was in me, I wanted it all gone as quickly as possible. It took 18 months for dad to die after he was diagnosed. None of it was easy for him or for the family.

You asked how we feel about this topic. I feel that it is sheer lunacy to walk around knowing that cancer is growing in your body. Not knowing if it is aggressive or not. And not doing anything about it.

Jim
Age 74. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
50 mg Viagra + 1000 mg L-Arginine + .03 cc Trimix = Excellent Results
PSAs from  1/3/07 - 7/17/08 0.00. 
PSA on 1/28/09 - 0.02
Lung cancer dxed on 5/16/08.  Surgery on 6/25/08  T1N1M0 - Stage IIA  Finished 4 cycles of chemo on 11/7/08.
CT scan on 12/2/08 - in remission!!!
Next scan on 2/26/09.
"Patience is essential, attitude is everything."


Sleepytime
New Member


Date Joined Jan 2009
Total Posts : 12
   Posted 2/27/2009 1:36 AM (GMT -6)   
Europe under treats because only 1 in 10 has aggressive PCa and the USA over treats because at least 1 in 10 has aggressive PCa. The point is that 1 in 10 will have aggressive PCa and doctors still have no way of knowing which one out the ten is at risk. That is why a good doctor informs his patient of all the variables and options, and then lets the patient decide the best way to proceed. Because for the patient the risk is not 1 in 10... the risk is either he's the 1 or he's not the 1.

The issue for me is that when my pathology came back my oncologist told me I was not the 1 in 10, but the 1 in 100. And in my case PSA was an excellent indicator of aggressive PCa, even more so than the biopsies. I wish I would have asked for the thing to be removed when my PSA hit 10.

Shawn
Age 54 - 6'2" 200lbs
Overall Heath Condition - Good

PSA monitored every 3-6 months starting 04/01/04
Important readings and actions:
10/18/04 - PSA 03.48
05/24/06 - PSA 04.92 - 08 sample biopsy: negative
05/10/07 - PSA 16.84 - 14 sample biopsy: negative
09/02/08 - PSA 26.54 - 16 sample biopsy: positive - GS 4+3=7 - Stage T2b
11/11/08 - PSA 37.95
11/17/08 - PSA 40.98 - (doubling time less than 8 weeks)
11/21/08 - non-nerve sparing Laparoscopic radical prostatectomy

Pathology GS 4+5=9 - Stage T3b N0 MX - bilateral lobes - perineural and seminal vesicle invasion - surgical margins: negative - largest tumor 2.1 CM

Catheter in for four weeks - only minor stress incontinence after 6 weeks

01/19/09 - 1st post-op PSA: less then 0.1
01/30/09 - started hormone therapy

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