The Prostate Cancer Test That Saved My Life | Hacker News Reader

The Prostate Cancer Test That Saved My Life

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81 points_l4jh34 comments

I am not a doctor, but a Gleason score of 7 is not considered a high-grade/aggressive tumour according to cancer.org.

It's certainly possible that the intervention saved your life, but I'm highly skeptical. I think it just caused you unnecessary stress and trauma.

"Every old man dies with prostate cancer. Nobody dies from it." is the saying I've heard. Obviously it's hyperbole, but the core is valid.

That's exactly what I've always heard. On a long enough timescale, cancer is a virtual certainty.

IANAD but from what I understand the PSA test has a high false positive rate.

It can be flaky if used alone as a measure, but that's where the urine as well as Free PSA test comes in, which is used as a supplement. I just went through a PSA/Urine/Free PSA/12-needle core biopsy run. Not fun, but the doctors thought it necessary to rule out cancer.

After the third year of steadily increasing PSA scores, my doctor was concerned even though it was below the official "get worried" mark because of my relatively young age and the trajectory.

I went to a urologist, got a request for the MRI which the insurance company denied, and so had to follow up with the very unpleasant biopsy mentioned in the OP (including missed work, pain, peeing blood). All for the result to come back completely negative.

That was last year, and as luck would have it, this year's PSA score dropped significantly.

I don't know whether I'd say that I'm not glad to have a definitive negative answer, particularly since my father had prostate cancer. However, this false alarm did cost an appreciable amount of money, time, and suffering.

You're the classic argument against heavy PSA screening at a young age. Statistically it's probably a net negative what we're doing right now. My PC was actually caught with a digital (as in "finger") test, then followed up by a PSA.

To clarify, a Gleason score is not from a PSA test, but from a biopsy of the prostate. So, several steps removed from the initial PSA test.

Yes, huge false positive rate. My urologist said this: "Statistically there's a good chance you don't have cancer. The problem with statistics is: they may not apply to you."

In my experience it's really hard to keep your mind on the public health statistics of the nation when it's you sitting in the doctor's office.

So as a non doctor, do you think the surgeon choosing to operate was malpractice?

We know that overdiagnosis causes harm and isn't understood. Here's a cancer charity talking about the problem of overdiagnosis.

http://www.cancerresearchuk.org/about-us/cancer-news/press-r...

> Previous research has shown that around one in four women diagnosed with breast cancer through screening are overdiagnosed*.

Sure, it's absolutely something to be aware of as a patient.

But there is a big disparity in information between browsing cancer.org and being a surgeon that has looked at an MRI and biopsy.

A psychologist told me that she analyzed men who have prostate cancer.

Long story short, she found out that men who simply go to the doctor every 4-5 months to make sure that everything's fine are happier than those who did an intervention. The reason lies in the fact that you lose self-confidence when you're impotent and incontinent.

Sounds plausible to me and the results had high statistical significance, therefore I agree to your skepticism.

3+3 is the lowest you can get and 3+4 (what I had) is considered very treatable. Age is important, though, I was in my early 40s when I got the 3+4 result and that was not really something the urologists wanted to just watch. I think the auther was mid 40s maybe, so still not such a great idea to wait until you get urinary tract problems and/or have the cancer metastasize.

He was 46 when he had his baseline, clean test, so probably 5-10 years older.

'Myth #1 - Prostate cancer is common, but few men actually die from it. In fact, prostate cancer is the second leading cause of cancer death among men in the United States and claims almost 30,000 lives in the United States each year.'

https://www.verywell.com/the-top-ten-prostate-cancer-myths-2...

> Prostate cancer screening did not significantly decrease prostate cancer-specific mortality in a combined meta-analysis of five RCTs. Only one study (ERSPC) reported a 21% significant reduction of prostate cancer-specific mortality in a pre-specified subgroup of men aged 55 to 69 years. Pooled data currently demonstrates no significant reduction in prostate cancer-specific and overall mortality. Harms associated with PSA-based screening and subsequent diagnostic evaluations are frequent, and moderate in severity. Overdiagnosis and overtreatment are common and are associated with treatment-related harms. Men should be informed of this and the demonstrated adverse effects when they are deciding whether or not to undertake screening for prostate cancer. Any reduction in prostate cancer-specific mortality may take up to 10 years to accrue; therefore, men who have a life expectancy less than 10 to 15 years should be informed that screening for prostate cancer is unlikely to be beneficial. No studies examined the independent role of screening by DRE.

— http://www.cochrane.org/CD004720/PROSTATE_screening-for-pros...

This is a hot-button topic, which generates much heat. Most men (>80%) will have prostate cancer by the time they reach age 80 (ie, would be detected if their entire prostate was examined histologically (which is, you may surmise, not generally done). About 13% of men will be diagnosed with prostate cancer during their lifetime. About 2.9% of men will die because of prostate cancer.

Does anybody see the problem? Most men who will have prostate cancer develop will not die because of prostate cancer, but from something else -- and many of these men (most, actually) will have no idea they have or had prostate cancer ---> unless somebody goes looking for it.

A randomized controlled trial of prostate cancer detection using PSA was done in the US (sponsored by the NIH). It did not find any difference in the survival curves in men who were randomly assigned to PSA screening compared to those who were not so assigned. The trial has been criticised.

Obviously any man who had prostate cancer found through PSA testing and was treated and does not die from prostate cancer will be very happy, and convinced that the screening saved their life. But the actual RCT data is more complex, and PSA screening may simply be generating more "business" for urologists and radiation therapists, without providing real medical benefit.

Note that there are similar questions about another hot-button cancer screening topic, mammograms. But that is another chapter!

Wow, I read this a few hours ago, and I didn't even notice that it was written by Ben Stiller.

Here's a video where he talks about it: https://www.howardstern.com/show/2016/10/4/ben-stiller-goes-...

I had a similar journey although my prostate cancer was detected at age 42 by my family doctor during a routine finger-in-the-butt test at my annual physical. He thought it was “diffusely enlarged”, then PSA test (high), then biopsy (ouch!) revealed a 4+3 Gleason.

Like the author I had a radical prostatectomy but not robotically assisted.

Like everyone in our situation I was scared of the two I’s — incontinence and impotence. Luckily no sign of either one, 8 years out the plumbing is working fine. The annual follow PSA screening is a bit scary, so far it’s always come back 0 but if there’s any PSA it’s going to be bad news.

All in all I’d recommend PC as a starter cancer — pretty treatable if detected early on and if you have a skilled surgeon you can come out of it fully functional. Age is a big factor, if you’re in your seventies it’s probably best to just watch it, for us young outliers it’s good to get it out.

> All in all I’d recommend PC as a starter cancer

That is basically how it feels when I recommend Angular to people wanting to try a JS framework.

Happy to hear you are doing okay.

What can we take away from this if we don't fit into the demographics of typical PSA test subjects (40-70 years old or family history of prostate cancer)?

Does it make sense to request one out of the blue, or is this one of those things that will make your doctor give you funny looks and assume you're a hypochondriac?

I went, for example, because I felt a second or two hesitancy when needing to urinate. See my below comments, which, sadly, have been modded down for whatever reason...

I would say if you have any sort of feeling something isn't right, then talk to your doctor. A DRE alone would probably be enough if you are super worried.

Get the PSA test if your over 45. Just get it. I just went through it as well as a biopsy because the PSA looked fishy. I did the PSA as well as the Free PSA test. I then had a 12-needle core biopsy, which, while unpleasant, let me know I was OK. I need to, as do all men my age (almost 50), get tested yearly. It's not a joke. It's tough to get men into the doctor for anything unless they feel they're dying. Guys, get tested, especially if you have a wife and children. You owe it to them, if not yourself.

A PSA test takes 5 minutes. It's a simple blood draw and you learn the results in two days. Like ovarian cancer for women, prostate cancer is the "whispering death". It's often too late if it's metastasized after it's detected, then your chances are even less. Get the test, doubly so if you are a family man.

I have no idea why my comment is being modded down. Guys who disdain hearing good advice and the truth are beyond me...

because public health consensus[1] currently disagrees with your "good advice".

[1] https://www.uspreventiveservicestaskforce.org/Page/Document/...

I didn't downvote you, and I can't speak for others, but for me, people giving general, emphatic advice based solely on limited personal experience is really annoying and often counterproductive. Perhaps you have further evidence to back up your claims, but you didn't cite it.

> Please resist commenting about being downvoted. It never does any good, and it makes boring reading.

https://news.ycombinator.com/newsguidelines.html

My understanding is that the current thought on the utility of a PSA test is mixed at best, because prostate cancer takes a long time to actually threaten your health, so above a certain age, even if you have prostate cancer you're likely to die of something else before the prostate cancer kills you. It's definitely not as simple as "seriously, just get it."

If you have family history, get the test over 45. If you have urination hesitancy, which led me to get tested, get the test. Prostate symptoms can lead to all manner of things besides the dreaded cancer diagnosis. BPH, urination trouble, impotence, chronic pain. None of these are life threatening, but try living with them. They cut into a man's quality of life.

There are many different cancers we lump under the phrase "prostate cancer". Most of them are benign, and will not affect anyone's life before they die of another cause.

The effects of treating prostate cancer are awful 100% of the time, though. From incontinence to impotence, and a lengthy recovery at a time when your body struggles to keep up with the normal demands of life.

I completely agree with you.

Public health "consensus" is driven often by cost considerations and in this case it might as well be damned. Unlike things like "vaccine refusal", here there is no enormous cost to the society, if more people decide to get tested. If one wants to get a PSA test, he should without worrying about recommendations.

Does the PSA ever provide false negatives?

False negatives are always possible, however in a quick search I couldn't find any papers on the rates.

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