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About the Author
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch
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Remember the house that was on the cover of Eminem’s album Marshal Mathers LP? Well, it’s up for sale… again! The last time it was for sale they tried to get $500000 but now it’s a real bargain!
My husband ,76y,in moderate general health,diagnosed -Prostate cancer(30.7 1013)-Gleason 3+4=7a in/12/6 samples /25%/moderate differentiated acinares carcinoma
Kindly suggest the best choice of therapy.
Between 59 and 63 – my PSA slowly climbed from 3.5 to 4
URO Doc said DRE normal for my age. My physical at age
64 showed PSA doubled to 8. Biopsy disclosed cancer
mostly on right side with Gleason total at 8. After
consultations with a surgeon and radiation specialist,
and MRI, CT scans, bone scans etc. etc. – I went for what
I was TOLD had the lowest chance of side effects – EBRT.
First 8 weeks was fine – then with less than 4 days left
for treatment, the side effects started with a nasty
infection, but treatment continued, up to the point
I wound up in the ER with urinary retention and a catheter
was used to drain out over 2 liters!! The day I got the
Gleason results – I was also started on HORMONe / ADT .
I now have to self catheter 3 times and day, can not sleep
and completely impotent. I wish I knew home many years
I would have had if left alone. LIFE WAS GOOD. SEX WAS
GREAT! And I could PEE standing up !!
I was told by a doctor that most man at the age of 40 will have prostate problem of some sort. That is why we need to be taking care at very early age. Is that true? Anyway, its a very interesting article.
I agree with Roger Magyar:
“This paragraph is incomprehensible:
‘Over the study period, fewer and fewer men were diagnosed with advanced, late-stage prostate cancers that had spread beyond the prostate gland. This reflected the growing use of prostate-specific antigen (PSA) testing to diagnose prostate cancers earlier and earlier. In contrast, the proportion of high-grade cancers, as measured by the Gleason score, remained relatively stable rather than gradually becoming more aggressive.'”
I read it several times trying to figure out what the writer meant. Please clarify.
I have a personal interest in this because my father-in-law died of prostate cancer, and I’m anxious that my husband doesn’t get it. He has had the PSA test several times, but I wonder if it’s very useful.
The quoted statement seems to say that advanced cancers are not bering found as much because PSA testing has identified them earlier, but aggressive cancers are being found at the same rate. The aggressive cancers are being found early (i.e., when they are “born”), rather than transforming into aggressive cancers over time.
This paragraph is incomprehensible:
“Over the study period, fewer and fewer men were diagnosed with advanced, late-stage prostate cancers that had spread beyond the prostate gland. This reflected the growing use of prostate-specific antigen (PSA) testing to diagnose prostate cancers earlier and earlier. In contrast, the proportion of high-grade cancers, as measured by the Gleason score, remained relatively stable rather than gradually becoming more aggressive.”
Aren’t advanced, late-stage cancers that spread the high-grade, aggressive cancers that kill people? Does the word “aggressive” in the last sentence of the paragraph mean a growing proportion or a growing cancer?
If fewer men have advanced, late-stage prostate cancer because of PSA testing, then fewer men are dying. But two large studies, one in the U.S., the other in Europe, revealed that is not the case. That is why the U.S. Preventive Services Task Force recommended in May of 2011 that PSA testing not be used for anyone as a screening device.
What is the paragraph I quote attempting to say? If it means that the enormous amount of expensive, unnecessary, and harmful treatment of prostate cancer provided by the American medical industry has attacked prostates with high-grade or low-grade cancers in roughly the proportion nature has produced those cancers, it is not surprising that the proportion of high-grade cancers has remained stable. Unfortunately, that stable proportion has come at a very high cost for patients who did not have high-grade cancers but receive treatment anyway.
If the paragraph is attempting to say something else, I would like to know what it is.
I am a 68-year old healthy male who has been getting PSA Tests since 1999 when I was 54 years old. Over these years, I have been tested 20 times (sometimes twice a year) and the overall mean is for all tests .998. with a standard deviation of .654. Note that I have been taking propecia during these years that I know cuts the score about in half.
I twice reached my highest score of 2.4 in 2005 and 2007. A second follow-up test in 2007 came in as .7. Since then, my psa scores have been as follows: .3 (2008), .3 (2009), .39 (2010), .6 (2011), 1.08 and .87 (2012), and 1.62 (2013).
During 2005, I had a one-time discharge of some blood and my urologist performed a prostate biopsy which was negative. I also had surgery to remove a growth in bladder and my urologist took a biopsy on my prostate then and both growth and prostate biopsies were negative—I think this was in 2007.
I should mention also that during all of these years, I also had digital rectal exams and they were fine.
My urologist wanted to do a third psa test in 2012 after I had scores of 1.08 and .87 but I did not return to have these done.
It seems apparent to me that my psa score has a high degree of variability over many years and I don’t understand why I should get psa’s done for such scores or even with my current score of 1.62.
Assuming a digital rectal exam is normal, how high would my psa score have to be before any biopsy would be called for? Indeed, given my previous negative results from biopsies, I am not sure what value the simple psa test has for me? What about the urine test for PCA3 or T2-ERG or a free-PSA test?
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