Current research suggests that one in six men will develop prostate cancer. For men over 50, the probability increases dramatically. That is why it is SO important for men to be screened yearly - early detection is indeed key to being able to treat prostate cancer successfully. The statement in the article:"When an increase in PSA test levels are detected, a biopsy is needed to determine the extent of the disease" while true, is simplistic. PSA levels can increase over time (which is referred to as velocity) which is a red flag or the PSA can be out of normal range, or it can be normal. An abnormal DRE can also indicate the need for a biopsy - as a man can have prostate cancer with a normal PSA and not have prostate cancer with an abnormal PSA. I believe comprehensive yearly screening should include both PSA and DRE, preferably by a trained urologist rather than the family physician.
"Even if not life threatening, cancer caught too late can result in a radical prostatectomy." I am not sure if this is a fair statement as it makes one think the biopsy can prevent surgery.
In my family member's case - cancer caught EARLY resulted in a radical prostatectomy - which saved his life...
The biopsy informs the doctors of the presence and extent of the cancer but is not a preventative, it is a diagnostic tool. The results of the biopsy will ascertain treatment options. While radical prostatectomy is rather controversial at the moment because of current opinions that it may be overused and a watch and wait protocol or alternative treatment may be appropriate - cancer is unpredictable. Some "watch and wait" patients (we know of one) experienced poor results as the cancer proceeded aggressively. Thankfully, after the year of watching and waiting, he elected to have the surgery and it was successful. On the other hand, if a man is diagnosed at 70 - the chances of him dying from natural causes may be much more likely than his passing away from prostate cancer and surgery probably would be inappropriate...
"This can lead to a decrease in quality of life resulting from complications such as impotence and/or incontinence, so it's easy to see why a far more modern approach is needed." In my opinion, this makes the surgery sound more negative then what it actually is: a decrease in the quality of life in these areas is better than loss of life. In addition, robotic nerve-sparing surgery has in many cases dramatically reduced the stated side effects. I am not minimizing these side effects, but robotic surgery has greatly improved the prognosis in these areas. If we are going to celebrate advancements in medical technology - the DaVinci robototic surgery procedure should be way up there in my opinion for these reasons as well as others.
The biopsy itself is very uncomfortable which has caused some men to dread it and at worst - to put it off - I am wondering if this new technology has made any improvements in that area?
Thank you for your excellent post Nancy. I just turned 71 and all four of my brothers have had prostate cancer (2 older and 2 younger than me). All four started with a sudden rise in PSA. Each opted for a different treatment, and all resulted in significant quality of life issues, but were a better option than death.
This new equipment used for doing a biopsy is of interest, but I question if the added cost/diagnostic-accuracy ratio is worth it. Medical bills for prostate cancer can already exceed a lifetime of earnings. This looks like one more thing to add to that cost.
Thank you for your comments, jhankwitz. Hopefully we are raising awareness and some men reading may realize that they need to get screened. Last year in the space of 3 months, our pastor (58 years old), my husband (58 years old), and two other men (one in forties and one in fifties) that attend our church were all diagnosed with prostate cancer. Our pastor and my husband had the same surgery - three months apart.
Here is a video from our pastor regarding his journey:
Notice at the end of the video he mentions that his Gleason score was a seven post- surgery rather than the six they had originally thought. I wonder if this new biopsy technology would improve the accuracy of the Gleason score - now that would be exciting - I agree with you that the cost is prohibitive, but that might make it worthwhile (Gleason is a combination of two numbers and is indicative of how aggressive the cancer is).
While this is a Design News forum, I would bet it is safe to say that a great many of our fellow forum readers fall into the category that they should be screened each year for prostate cancer. Jhankwitz, what a blessing that your brothers were able to be treated! Hopefully our conversation will serve to inform people how important it is for men to get screened. I am very thankful that my husband's cancer was found early and like our pastor, we believe it was contained to the prostate and the surgery removed the cancer. And just as our pastor mentioned, there are many treatment options available that depend on a variety of factors including age, level of fitness, and biopsy results. Side effects can be dealt with - but losing a loved one to prostate cancer is tragic when screening and treatments are available, especially when found early. Please get checked for your sake and the sake of your families!
@Nancy, thanks for the information. I was not aware of this postrate cancer being so common among men. This robotic biopsy device will help in early detection of postrate cancer. As always observation is superior to early intervention with surgery or radiation. It will allow people to live longer, live better and less expensively.
That statement that early detection could minimize the need for a radical prostatectomy caught my eye, too. That seems to be the opposite of everything I've read and experienced (5 years post surgery next month). Interesting machine, but I wonder what they cost. You know who will be paying for them - you and me.
Regardless, men should take this subject seriously. While PSA tests can have false positives, I haven't read of any complaints about false negatives. And a biopsy can catch prostate cancer before a DRE reveals anything. While the potential for decreased quality of life is there, being dead unnecessarily is a real bummer. Take charge of your health.
PSA testing has been getting a bad rap the last few years because of people's perceptions. A PSA number is meaningless. I work with a guy that has had a PSA of over 160 since he first got tested 15 years ago. He has no prostate problems.
My PSA has been fluctuating between 0.7 and 2.1 for about 20 years. Since all four of my brothers got prostate cancer, I have my PSA checked at least every 6 months. After my score of 2.1 last year, I had it checked again in 3 months and it was down to 1.2. All of my brother's cancers started with a fairly quick rise in their PSA scores, usually from about 1 to about 6 or 8 within a year. It's the change in the PSA number, not the number itself that is an indicator that something may be amiss and should be checked further.
Beware of drugs that lower your PSA score. PSA is not and does not cause cancer, so getting rid of this inexpensive early warning system may prevent you from knowing something may be wrong.
Last month's Consumer Reports lists the PSA test as an unecessary test. Not only that , but it states that standard treatments of Prostate Cancer saves about 1 life in 100,000 and the treatments results in the death or severe handicap for 4 out of 100,000. Discouraging to say the least.
It seems earlier detection only means a longer, survival after detection statistic - zero sum gain. The vast majority of prostate cancers are slow growing and are unlikely to kill. By the time most men reach age 80 they will have prostate cancer. The aggresive cancers kill quickly. "When in doubt, cut it out" doesn't work statistically.
Prostate cancers are very rarely treated in Europe. In the Americas, they are major profit centers for Hospitals.
The statement "The vast majority of prostate cancers are slow growing and are unlikely to kill" is easy to say - but would you be saying that if you were just diagnosed? Gleason scores rate not only the size but the aggressiveness of the cancer and there is a lot of documentation that would negate the statistics you are quoting. Age also plays a prime factor. Someone diagnosed at 80 years old will probably die from other causes, but a man in his fifties has a lot more time ahead of him and cancer is unpredictable. I respect Consumer Reports to buy a microwave but I would be hard-pressed to accept their medical expertise. There is a lot of controversy on this topic but I think opinions are formed depending on whether or not you are directly affected. The insurance companies are trying very hard not to cover therapeutic measures for post-surgery as well, which I regard as shameful. It seems to me that if they were going through it - they would change their tune.
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