We've sort of wandered away from the original subject of this thread which, as I dimly recall, had something to do with whether PSA screening is a good or a bad thing. Put me down as being in favor of allowing screening as young as 40 and maybe before.
At the same time I understand that the needless anxiety produced in low-volume Gleason 6 men can lead to over-treatment, either because doctors are too aggressive in suggesting it, or because the anxious patients demand it (depending on your point of view) and, to address that problem, I would be agreeable to the idea of changing Gleason 6 to a hyphenated cancer. In addition to my prostate cancer I have two other areas where biopsies have reported "pre-cancer" -- in my esophagus where I have Barrett's syndrome and in the skin of my arms where I have had pre-cancerous neoplasms reported on my blotchy bits. The "pre-" in "pre-cancer" is quite reassuring. I am quite comfortable monitoring those conditions and I understand that if they progress more aggressive treatments may be needed. I'd like to see Gleason 6 cancer re-designated a "proto-cancer" or something like that to make the distinction clearer when counseling patients about
their pathology reports. It is still very much a concern and, if it appears in high volume it may warrant curative treatment, but that would help men diagnosed with low-risk cancer internalize their options.
My first PSA test was done only after
I had been hospitalized for a prostate infection at the age of 54 and my newly-acquired urologist wondered what else might be going on with me. So I am not an example of a man picked up by screening. My first PSA test was done while I had a diagnosed, symptomatic case of prostatitis and my urologist did the follow up test to verify that it went back down (which it did but less than he expected).
As for men whose Gleason scores go down on subsequent "confirmation" biopsy, I don't think the score going down means that much. It's not likely that a biopsy needle will serendipitously excise ALL the cancer present so the sensible presumption is that it was simply missed the second time. I had repeated biopsies (four in all) and I was diagnosed as a Gleason 6(3+3) on my third biopsy. My fourth (confirmation) biopsy was negative. My only indication that there was anything worrisome about
my results came from a second set of slides from my third biopsy that was examined by a different pathologist and was graded GS7(3+4) although he remarked that there was so little cancer present in the one positive core that he almost missed it. Both pathologists rated their two different slides from my only positive core ever as 3-4 percent of the sample. One called his slice Gleason 6, the other called his Gleason 7. It seems likely that if the second pathologist had looked at the same slide as the first one did that the Gleason 6 diagnosis would have stood. My PSA was never higher than 8 something. A bit high for my supposed small volume cancer but believable. I made my decision to seek surgery based on very little reason not to continue surveillance.
As it turns out I had a rather large Gleason 9(4+5) tumor and the rather-low PSA for the size of the tumor was probably due to the lower PSA given off by higher-grade tumors. I believe my cancer was mostly in the anterior apex where it is difficult to sample with a standard transrectal ultrasound guided biopsy.
So put me down as being for a fairly liberal use of PSA testing, even in fairly young men, since what you don't know can't save your life. You can also put me down as an extremely-conflicted vote for measures designed to reduce the anxiety for men diagnosed with low-risk cancer. The statistics are fairly compelling that they are being over treated. And yet... and yet... There is a strong possibility that irrational anxiety saved my life. So go figure.
Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012:
1)neg (some inflammation),
3)positive 1 of 14 GS6(3+3) 3-4%, 2nd opinion GS7(3+4)
Mild Pre-op ED
DaVinci RRP 6/14/12. left nerve spared
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
Start 24 mo ADT3 7/26/12
Adjuvant IMRT 66.6 Gy 10/17/12 - 12/13/12
Leaky but better, Trimix, VEDForum Moderator - Not a Medical Professional
Post Edited (PeterDisAbelard) : 3/11/2013 6:02:32 PM (GMT-6)