Comments on: Prostate cancer screening

By: Dr Dan

Dr Dan — Wed, 25 Mar 2009 15:46:58 +0000

I’m afraid plaintiff’s attorneys and juries do not always read the NEJM. A colleague of mine, who happened to be the senior doctor in our group of family physicians, was successfully sued by a patient on whom he performed a physical exam without ordering a PSA. A year or so later the patient developed metastatic lesions from the cancer that was not clinically palpable at the time of the exam. My partner was a very thorough clinician, and would not have missed an obvious cancer. The patient did not die, but sued, and collected. My partner stopped seeing patients shortly afterwards, demoralized by the affair. Do I order PSAs on my patients? You bet I do.

By: Norman Morris

Norman Morris — Fri, 20 Mar 2009 00:42:40 +0000

PSA is a very complex test, and dare I say little understood by the lay public. The current media report on the two studies released by the New England Medical Journal is misleading and irresponsible. The suggestion is that the PSA test itself–a simple blood test–can cause harm to the patient. The supposed harm, by the way, is not clearly described. The reports urge men to carefully consider the risks before undergoing screening. And they add that the testing fails to significantly reduce the chance of dying from the disease.
What’s wrong here?
Let’s get right to it. PSA is a tool–admittedly not a perfect one–used to detect the presence of cancer in the bloodstream. You can have minimal amounts–not dangerous,not life threatening–in your prostate that will perhaps cause you no grief. On the other hand,
if the measurement of PSA exceeds what your doctor thinks is “normal”, it MAY signal the presence cancer in the prostate and the patient may want to do something about it. Or not. He may elect a course called Expectant Managment, a course of surveillance.
If you or the doc wants to make sure there is cancer, he does a biopsy. That’s not a horrible procedure, but it may be uncomfortable and still there is no harm done! The procedure hunts for disease using tiny needles, so it can be missed. Think of trying to hit an infected seed of a strawberry. So, the biopsy makes several strikes and can even be repeated.
Now, if it is determined that you have cancer, you have an option of TREATMENTS. It may be surgery or radiation of one sort or another. It is at this point that you can have what these reports call “harmful.” Almost any treatment will have an impact on urinary incontinence and/or sexual function. But…these are not necessarily permanent. In any case, incontinence CAN be dealt with. In 85% of the cases, sexual function can be restored. But you have to be alive
to worry about either “harmful” effect.
The purpose, then, of the PSA test is to make sure you are not carrying around an excessive PSA that can become cancerous. The purpose of it is to discover any cancerous cells in your prostaate before they migrate beyond the walls of the prostate. If they do,
you can lose your opportunity to retain sexual function.
African Americans develop cancer twice the rate of any other race and should be tested by PSA earlier. So when you read about these
studies that try to correlate PSA testing with the death rates, understand that there is no proper correlation. That is NOT what a PSA is supposed to do. The problem with the PSA as a tool is that
it can detect something is amiss in your prostate that needs to be tended to…it is not a death sentence. A next generation tool is one that will point directly to cancer of the prostate–not to say, prostatitis or benign enlargement–but directly to prostate cancer.
That way we can eliminate the need for uncomfortable biopsies.
So if you content not doing a PSA, think again. Finding out early if you are at risk is the only way to find yourself a cure.

By: Joseph Ernst, M.D.

Joseph Ernst, M.D. — Thu, 19 Mar 2009 20:06:24 +0000

“Needless treatment” implies useless treatment, but preventing death is not the sole goal in treatment of prostate cancer. Prostate cancer can cause years of misery without killing (bone pain, pathologic fractures, urinary retention, bleeding, kidney obstruction, etc), and prevention of this misery is a laudable goal even if the patient eventually dies.
Consider that the 10 year disease free survival rate for radical prostatectomy (for clinically localized prostate cancer) is 85%. Everyone dies eventually, but 85 of every 100 men treated will not die of prostate cancer, and will not suffer the effects of untreated prostate cancer.
Did you make the right decision? Maybe. I don’t think I will ever know because you won’t tell me if you develop prostate cancer, and you yourself won’t know until it is well advanced.

By: DB’s Medical Rants » Prostate cancer screening « Best HEALTH InfoCenter

DB’s Medical Rants » Prostate cancer screening « Best HEALTH InfoCenter — Thu, 19 Mar 2009 06:39:17 +0000

[...] Url : http://www.medrants.com/index.php/archives/4145 [...]

By: Richard Neill, MD

Richard Neill, MD — Wed, 18 Mar 2009 23:46:28 +0000

What’s a ‘routine physical exam’? I am surprised by your choice of this phrase but am hopeful you can explain.

By: DB’s Medical Rants » Prostate cancer screening « Prostate Concerns

DB’s Medical Rants » Prostate cancer screening « Prostate Concerns — Wed, 18 Mar 2009 23:05:54 +0000

[...] See original here: DB’s Medical Rants » Prostate cancer screening [...]

By: DB’s Medical Rants » Prostate cancer screening | The Cancer and You Network

DB’s Medical Rants » Prostate cancer screening | The Cancer and You Network — Wed, 18 Mar 2009 21:56:22 +0000

[...] Several months ago I had a routine physical exam, lab work, and a colonoscopy. More: DB’s Medical Rants » Prostate cancer screening [...]