NON SUPPORT FOR PCa TESTING

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Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 9/14/2009 7:21 AM (GMT -6)   
"No major scientific or medical organizations, including the American Cancer Society (ACS), American Urological Association (AUA), US Preventive Services Task Force (USPSTF), American College of Physicians (ACP), National Cancer Institute (NCI), American Academy of Family Physicians (AAFP), and American College of Preventive Medicine (ACPM) support routine testing for prostate cancer at this time."

This is a quote taken from an update (July 30, 2009) on the American Cancer Society website titled "Can Prostate Cancer Be Found Early?"

this is the link:
http://www.cancer.org/docroot/cri/content/cri_2_4_3x_can_prostate_cancer_be_found_early_36.asp

I just found it this morning while doing a little research about testing. I have read it 3 times and the ramifications of this either elude me or scare the hell out me for others that will follow the path that we are all on.

I sure would welcome some other views and opinions on this. It sure seems to speak volumes to me about the lack of support for PCa awareness and the call for testing.

Sonny
60 years old
PSA November 2007 3.0
PSA May 2009 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

Surgery set for September 17th, 2009 with Dr. Mani Menon at the Henry Ford Medical Center in Detroit.


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 9/14/2009 7:32 AM (GMT -6)   
Such comments have been disceted several times in other topic-specific discussions, I'm recalling.  What certain "organizations" advocate, or don't, hasn't been of particular interest to me.  I think the medical practicioners don't follow in lock-step with the organizations and that they're doing a lot of testing with men - and that's how my primary care physician handled my situation by testing me starting at 50 years-old and becoming more suspicious when I was 58 and the PSA test results started to change. Rather than rely on others we men (and women) need to take control of our own health care and raise the questions, have the discussions, continue to probe . . . with those who care for our health needs. 

Age:  60 (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 (1/2 light pads per day)

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; 4/09: 0.0; 9/09: 0.0

 


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 9/14/2009 7:52 AM (GMT -6)   
Mavica,

You a make a good point. I think it is a really strong point that needs to get out that "WE" as individuals, have to take a much stronger role in our health and well being.

It just seems to me that it makes it a little more difficult when organizations like this say they do not support the testing and establishment of baselines.

When most guys find us here at HW they are already diagnosed and at a point when some sort of action needs to be taken. Finding out things a little earlier because of pro-active involvement seems to open a whole other set of alternatives.

Thanks for the input.

Sonny
60 years old
PSA November 2007 3.0
PSA May 2009 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

Surgery set for September 17th, 2009 with Dr. Mani Menon at the Henry Ford Medical Center in Detroit.


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 9/14/2009 9:48 AM (GMT -6)   
I think ALL of us on this board, as well as all PCa boards are passionately opposed to any organization that claims psa testing is a waste of time. For me, if I didn't get tested in late 2005, by now I would be feeling the affects of metastasis and looking at maybe 2-3 years of remaining life. There is nothing more shocking to find out TOO LATE that you have cancer, when a cheap test like the psa test, done yearly, would and HAS saved a ton of men from an early demise. 
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09) (Pomegranate???)
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


RacingOyster
Regular Member


Date Joined Aug 2009
Total Posts : 31
   Posted 9/14/2009 10:10 AM (GMT -6)   
All I can figure is that the organizations against routine testing feel that the tests may lead to unnecessary treatment. I understand that some PCa is slow-growing and may not ever get to the point of being life-threatening, but there is clearly some PCa that is very aggressive and needs to be treated promptly. I would like to know more, and make my own decisions, than know less and count on the percentages to break my way.

Living in the northern Atlanta suburbs.

Good health and no symptoms when my annual physical uncovered an elevated PSA.

Diagnosis at age 55: PSA 4.6 - positive biopsy 3 of 12 cores - Gleason 3+3=6.

Open Radical Retropubic Prostatectomy with bilateral lymphadenectomy on 6/18/2009.

Pathology report after surgery showed negative margins, cancer contained in capsule.

PSA at 4 weeks after surgery <0.1 (all other problems are minor considering being cancer-free)

Catheters required on-and-off for 34 days after surgery due to recurring urinary retention.

Currently using 3-4 pads during the day, dry at night (10 weeks after surgery).

 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 9/14/2009 11:21 AM (GMT -6)   
Actually, when I read the entire page it seemed very well reasoned to me.

The advice quoted is against testing all men regardless of age.
The recommendation is
For men of average risk, offer screening at age 50
For African-American men and those with a close family member with PC
offer screening at age 45
For men with more than one family member with PC, offer screening at 40
In each case, if the man asks the doctor to make the decision, screening should start.

This is talking about routine annual screening. I did not see that it addressed baseline screening, something which we strongly advise for all of our sons.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/14/2009 1:23 PM (GMT -6)   
At the PCRI event this past weekend, nobody was in agreement with Otis Brawley and the ACS.  We generally viewed his constant interviewing on TV to be a counter productive poison.
 
Here are some facts:
The AUA does call for anual testing generally.  But they do when there are risk factors involved.  The AUA recently released a new call for PSA baseline tests at the age of 40 for all men and 35 for those with high risk factors.
USPSTF ~ This wonderful group is responsible for the recommendation about a year and a half ago that doctors stop testing men over 75.  This caused quite a stir that the advocacy groups looked into the panel ~ There were no urologists, no prostate cancer oncologists, two lawyers, and a large group of folks making recomendations for Medicare.  For me they can say whatever they want, I just won't expect to hear what I think I should.
NCI and ACP ~ They pretty much are inline with the AUA.
AAFP and APCM ~ Who?   None of us need our family practisionors after a diagnosis of prostat cancer anyway....Or Otis Brawley...
 
Again another poorly researched article...
 
Tony
 
 
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/14/2009 2:46 PM (GMT -6)   
My new radiation oncologist made an interesting observation on her nearing 30 years experience. She said it sure seems like the most agressive cancers seem to be with the younger men and women. With PCa, she said the worse cases she had worked with are men in their 40s and early 50s, and thats why PCa should be treated early and agressively in that age range. Most of the indolent cases she had worked with were men in their mid 60s to 70s. She said she had experienced the same thing with breast cancer in women, with the worse cases being with women in their 20s and 30s.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl., agreed to start radiation, does not rec. HT at this time, mapping on 9/21/9


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 9/15/2009 5:24 AM (GMT -6)   
Purgatory said...
My new radiation oncologist made an interesting observation on her nearing 30 years experience. She said it sure seems like the most agressive cancers seem to be with the younger men and women. With PCa, she said the worse cases she had worked with are men in their 40s and early 50s, and thats why PCa should be treated early and agressively in that age range. Most of the indolent cases she had worked with were men in their mid 60s to 70s. She said she had experienced the same thing with breast cancer in women, with the worse cases being with women in their 20s and 30s.

David in SC

David,
 
The reason for that is cells divide more rapidly in younger people. Its like when you break a bone: at 20 years old it may take 6 weeks to mend. At 70 years old it may take 12 weeks to mend. Rapid abnormal cell division will result in more aggressive cancers.  
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09) (Pomegranate???)
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/15/2009 6:45 AM (GMT -6)   
Joey, that very well may have a bearing on it. But on the other hand, when you are young, you sometimes aren't as prone to illness and disease (obvious exceptions of course). 2 of the 3 radiation oncologists I have met with feel that cancers are almost 100% genetically generated, basicially at conception in your DNA, which would include those people who have cancers run in their families. I still feel that the exposures in my life in my 20s to really carcenigenic fluids and materials would have had to had an effect on why it seems like Ive become a cancer magnet over the years.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl., agreed to start radiation, does not rec. HT at this time, mapping on 9/21/9


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 9/15/2009 4:16 PM (GMT -6)   
Four years ago, in preparation for my 52 year physical (My first since turning 50) my doc submitted a blood work requisition for me. If he had checked off the PSA box in addition to the usual cholesterol, sugar etc., I might be writing this reply while wearing big boy pants instead of diapers and making hay tonight with my wife rather than Augie. Instead, he followed some lugnut's recommendation and skipped it. I didn't know any better. At age 56 I had my first routine PSA test for life insurance. It was 17+! Thank you Metropolitan Life for saving me - even though you b*stards won't give me insurance.

Hey Docs, if you are drawing blood anyway, tick the box, Please! An early warning might improve the guy's quality of life beyond measure.
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
----------------------------------------------
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
----------------------------------------------
One Month Status:
Potency - 9/7 7 weeks Still no activity
Incontinence - 8/20 3-4 full pads per day
9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea, I know)
Post Surgery PSA - 9/3 6 weeks - 0.05


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/15/2009 5:16 PM (GMT -6)   
One more thing on this ~ the American Cancer Society has over 100 prostate cancer handouts that conflict with the advice of their medical director...Just thought I'd mention that. Has anyone noticed that Dr. Brawley and I would not get along well? I would have to take a number to do that anyway. At the PCRI event last weekend, ACS had a booth with tons of prostate cancer brochures. Almost all the documents said that the only proactive defense in prostate cancer was screening.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 9/15/2009 5:32 PM (GMT -6)   
Hey Tony,
You know how the local schools have bottle and can drives for the cheerleading team or whatever? How about if we start a drive to save full diaper pads from incontinent PCa survivors that did not get their PSA checked during their 50 year physicals? They could be shipped to the good doc for his study.
Just kidding... I think.
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
----------------------------------------------
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
----------------------------------------------
One Month Status:
Potency - 9/7 7 weeks Still no activity
Incontinence - 8/20 3-4 full pads per day
9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea, I know)
Post Surgery PSA - 9/3 6 weeks - 0.05


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 9/15/2009 5:45 PM (GMT -6)   
Hi Tony.  Somehow I don't think most of us would get along very well with that guy.  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 9/16/2009 5:49 AM (GMT -6)   
I just read in the newspaper today that University Associates of Rochester are offering free prostate cancers screening at their office during September. I don't know what this entails but you can check it out by going to their website uarochester.com

This might be a good opportunity for someone who has a doc that is reluctant to order a PSA.
Jeff
(Full disclosure statement: I have no business interest in UAR)
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