Don't screen over 75? Think again...

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Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/22/2009 12:08 AM (GMT -6)   
Thanks to Richard Wassersug on the PPML...
 
Recent studies have suggested that we stop screening at 75 and above for prostate cancer.  Studies show that benefits are dimished of treating the disease, so the highly publicized study has made it around the world telling us that the 75 year old won't likely benefit.  I have been on the fence about it recently.  Going against my instincts.  I originally was for screening at 75 then wavered it. 
 
OK I get to waver again, thanks to Richard. 
 
Richard's father is in his 90's has a PSA of over 20.  They know its likely prostate cancer.  So why test?  They want to know if it's in the family...I should have put this rgument together.  Doctors are so busy just talking about the patient, they spend little time talking about it's genetics. 
 
Case:
I was diagnosed at 44 by a chance screening in a physical.  I was the only one who had prostate cancer in our family.  Not my dad, not my brother and no one on mom's side.  My dad turns 75 this year.  His PSA is hoverig over 3.5,  Should he have been tested at 76 and had prostate cancer, I would have had a reason to be tested at over 45.  It is possible it would have saved a life.  Just not the study patient's life. 
 
Food for thought.
 
Thanks Richard...Amen brother...
 
Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 4/22/2009 12:13:58 AM (GMT-6)


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4823
   Posted 4/22/2009 4:56 AM (GMT -6)   
I have a long time 72 year old friend who's PSA was in the teens for years...2 or 3 biopsys came up clean till the last one...Since his 97 & 99 year old parents are both doing fairly well he has a high expectation of living 20 something more years...He went with radiation.....

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.
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/22/2009 9:46 AM (GMT -6)   
Steve,
I understand that there is a benefit for 75 year olds to be screened, but the benefits start to diminish at that age. My point is when thinking outside of the box, that test could help other members of the family as well. Knowing the genetics of PCa says that man's little brother could reap a benefit as could his sons.

Just a provoking thought.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


caring wife
Regular Member


Date Joined May 2008
Total Posts : 20
   Posted 4/22/2009 12:09 PM (GMT -6)   
My father-in-law was diagnosed at age 75. The cancer was in the lymph nodes. He was treated by removing his testicles. He got along really pretty well until about the last 8 years. The cancer is all through his spine, ribs, pelvis...he receives monthly Zometa infusions and now is taking ketaconazole. His lymph nodes in his lower abdomen were causing edema in his lower legs. Believe it or not...he is in no pain!!!! He always has had a good attitude. PCa will probably be his demise but he is now almost 91 years old. We feel very fortunate that his cancer was discovered at age 75 and that he was treated for it.
My husband is 60 years old.
RRP surgery April 14 2008
Gleason score 3 +4
PSA 6.8
Free PSA 6.5
Father and Grandfather had prostate cancer
Father is still alive..diagnosed with lymph node involement in 1993...He has received hormone therapy since then....just this year has bone mets.
Path report for my husband showed negative margines but extra prostatic extension.
First PSA done one month post surgery  results .04
PSA July 08 .04  Oct 08 .04  Jan 09  .04


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 4/22/2009 1:18 PM (GMT -6)   
Good job Caring Wife,

Writing us old guys off at 75 or at any other age is ridiculous. Testing and treatment need to be between the patient and his doctor, not to some researcher with no skin in the game. "One size fits all" medicine just doesn't work for prostate cancer because there are too many variables. Until there is a sure cure treatment, it needs to be up to the individual.

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 + .04 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 scans on 12/2/08 & 2/25/09 - in remission!!!
Next scan in May 09.
Biker90's Journey
http://www.caringbridge.org/visit/jimrobinson
"Patience is essential, attitude is everything."


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/22/2009 1:56 PM (GMT -6)   

For the record I am for testing men at all ages 35 and older.  I know the benefits are small for a 35 yearold, but to save even one life is of value to me.  I wanted to point out that if anyone was waivering on it, like I do from time to time, that the added benefit is fo our loved ones.  I won't waiver again.  Thank you all for the input.  Here is a discussion by the University of Iowa that i think is well written...

http://prostatecancerinfolink.net/diagnosis/screening-diagnosis/iowa-prostate-cancer-consensus/

Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2457
   Posted 4/22/2009 7:45 PM (GMT -6)   
Tony,
I tend to agree with your new position. At the age of 88, my Dad had all the symptoms of prostate cancer (problem with urination) but was never tested for it because of his age. Had he been tested and found positive, I would have kept a closer look at my PSA vilocity and may be detected my PCa before it got to the advance stage.
Age: 67
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09
Surgeon: Dr. Randy Fagin, Austin TX.
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Bilateral 10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
seminal vesicles clean
Lymph nodes: not dissected
1st PSA test 4/7/09 result <0.1


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 672
   Posted 4/22/2009 8:20 PM (GMT -6)   

 3/4 of my regular golf foursome was diagnosed with prostate cancer.  The oldest is a physically fit 78 year old who still skiis black diamond runs and is able to complete triathalons.  His urologist, who apparently did not know him, suggested that he ignore his prostate cancer and die of some other problem.  We were all angry enough to push him to seek other opinions.  He finally had  radiation treatment and despite some short term problems is doing great two years later.

Some medical providers just don't get it.  We are not statistics ! ! !


PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion identified
Few continence problems
PSA 90 day (-.01)  , (6 month -.01) , (9 month +.02) , (1 year +.02) ( 18 months +.02) (two years+.03)
One side nerve spared
still using bi-mix 
born in 1941

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