[Leica] Elder Prostate Wisdom

[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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