[Leica] Elder Prostate Wisdom

[kcarney1 at cox.net (Ken Carney)]

My family practice physician suggested that I discontinue PSA screening 
after age 70, even though I had increasing scores over a few years but 
without a dramatic velocity.  That was fine with me since I had to 
abstain from alcohol or caffeine for three weeks prior to each test 
(alcohol, OK, but caffeine is another matter altogether).

Ken

On 2/22/2015 5:07 PM, Charlie Chan wrote:
> The PSA test is not a great screening tool. The PSA goes up in some men, 
> who have benign prostatic enlargement.
>
> PSA is, however, much more widely accepted as tumour marker for men with 
> diagnosed prostate cancer, when one can monitor for disease progression 
> with PSA.
>
> Prostate cancer is the male equivalent of breast cancer in women - i.e. it 
> is common and often dependent on hormones for growth (testosterone for 
> prostate and oestrogen for breast). Like breast cancer, there is 
> increasing acceptance that some patents with breast/prostate cancer may 
> not have biologically significant disease - i.e. that their particular low 
> grade, indolent tumour may not alter one?s remaining life expectancy.
>
> Prostate cancer is very common in older men. In post mortem studies on 
> men, who have died from other causes, 50% of men over 80 were found to 
> have a prostate cancer (which was undiagnosed and asymptomatic). Some men 
> will have low grade prostate cancer, which may not progress in one?s 
> lifetime, if untreated. However, the conundrum is that non treatment is a 
> difficult concept for many patients.
>
> I treat people with breast cancer. We have had the same dilemna with 
> ductal carcinoma in situ of the breast and some small low grade breast 
> cancer. Breast screening has increased the number of cancers diagnosed on 
> both sides of the Atlantic, but there is some quite powerful evidence that 
> we are detecting some breast tumours, which may not cause problems during 
> one?s lifetime (Archie Bleyer, NEJM 2012; Peter Gotzsche, Lancet 1999 for 
> instance).
>
> So the tricky problem comes in deciding which tumour is bad and which is 
> ok (and possibly able to be left). Undoubtedly we will have reliable ways 
> of assessing this in the next 10 years or so, with advances in genomic or 
> proteomic profiling. That may not help George at this moment in time, but 
> other more traditional ways of scoring prostate cancer (if indeed this is 
> what it proves to be, rather than a false alarm).
>
>
> Charlie
>
> Charlie Chan DPhil FRCS (that?s my other hat!)
> Consultant Surgeon, Cheltenham UK
>
>
>
> On 22 Feb 2015, at 22:39, Steve Barbour <steve.barbour at gmail.com> wrote:
>
>>> On Feb 22, 2015, at 3:58 AM, Douglas Nygren via LUG <lug at 
>>> leica-users.org> wrote:
>>>
>>> One of my doctors told me that every man's prostate will eventually kill 
>>> him. If we could live forever, our prostates would do us in nevertheless.
>>> That said, I read somewhere, if I am not mistaken, that the doctor who 
>>> invented the PSA no longer believes in it.
>> who ? why? is this documented?
>>
>>
>> s
>>
>>
>>> I reported such to my doctor who nevertheless thinks the test is a good 
>>> idea.
>>> "In tests we believe," should be printed on the dollar bill. It's like 
>>> military weapons in the hands of the police. If you've got them, you've 
>>> got to use them.
>>> If you don't test and the patient gets prostate cancer, you are liable, 
>>> I would guess.
>>> If your PSA gives a false alarms, your doctor is not in danger of being 
>>> sued.
>>> Personally, I abide by what the U.S. Surgeon General may have said, 
>>> namely, Science has proven that life is hazardous to your health.
>>> BTW, I do get my PSA checked.
>>> Cheers?? Doug
>>>
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>>
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