I'm curious though, my bf says his doctor asks if he wants a PSA at his checkup. His doctor then goes on to explain that pretty much all men eventually get prostate cancer and there's not much you can do about it and you're far more likely to die of something else first so, not really much reason to get the PSA
Anyone have any other info? Is there actually treatment and is it worth while?
If the numbers are low, you're probably good. If the numbers are high, it isn't necessarily bad, but it could be good excuse to keep a closer eye on things. You might do additional PSA tests and look at whether it's trending up or down. A biopsy might be suggested, which is more invasive, and can be more accurate, but it also depends on where the doctor is able to collect the tissue -- if they miss the spot, a biopsy could be inconclusive or contradictory.
Finally, if you have prostate cancer and the numbers are bad and your doctor tells you that it needs treatment, the common treatment seems to be high intensity focused ultrasound (HIFU), which is unpleasant and invasive, but it isn't surgery, and it isn't anywhere near as damaging as radiation, and apparently it works rather well.
Source: I'm 47 and have prostate cancer (metastasized, so incurable but there are still a number of treatment options to improve quality and quantity of life).
[1]: https://www.cancer.org/cancer/prostate-cancer/about/key-stat...
Take 1000 men over the age of 50 and give them PSA and DRA for about 15 years. Take 1000 other men over 50 don't give them PSA nor DRA over the same time.
> About 10 out of every 1,000 men with screening, and 12 out of every 1,000 men without screening died from prostate cancer within 16 years. This means that 2 out of every 1,000 people could be saved from death from prostate cancer by early detection using PSA testing. This was not reflected in overall mortality.
Over all about 322 men died in both groups, so it doesn't seem to make much difference to all cause mortality.
However, in the group who was screened we see 155 people had a false alarm (and that includes unnecessary tissue removal), and 51 men with non-progressive cancer had unnecessary treatment (that sometimes includes impotence or incontinence).
The most important question you can ask a doctor is what happens if we don't do this?
There are different types of prostate cancer. Some are very slow growing and people tend to die with it, not of it. There are aggressive types of prostate cancer that do kill people, but these tend not to be found in time to make much difference to populations at the moment.
Personally, I've had false alarms and dealt with that stress, and I still find that screenings are worthwhile. Having seen family members/friends die of cancer, I don't find the additional and potentially unnecessary discomfort of screenings to be too much of a cost.
At the same time, I'd never judge someone for feeling the opposite, particularly in cases like prostate cancer, wherein most people die "with it, not of it" as they say.
Fact is, most men over age 70 do have elevated PSA due to small amounts of low grade prostate cancer cells (Gleason score of 3+3). Usually it advances slowly, never growing beyond the bounds of the prostate gland before the patient dies from some other cause.
But an elevated PSA (over 1 and below 10) in someone younger than 70 should not be ignored. Often a second PSA test is done perhaps a month later to confirm the first score and to see if the number is rising quickly. If repeated tests do not show PSA elevation AND the score is low, often the urologist will recommend a "monitor it, and wait and see" strategy.
If the PSA number is high or is rising, the next step is to get a biopsy where 12 to 18 samples of tissue are taken from the prostate to see how much of the gland has cancerous cells (Gleason 3, 4, or 5).
I know something about this topic because a routine PSA test at age 55 showed that I had asymptomatic cancer in 80% of my prostate. Luckily it was removed surgically. But if my doctor was as casually unconcerned as your BF's doctor, my cancer would have metastasized and by now it would be incurable.
I wouldn't go that far. In your n=1 case it seems clear that not monitoring PSA would have been an error, but there exists a debate on the risk/benefit of this test. Namely, the unnecessary suffering that it can inflict to a healthy person with elevated PSA.
This is a good review [1]
"To screen or not to screen for prostate cancer? This remains an important question. Screening relies on a highly imperfect measure, the prostate-specific antigen (PSA) blood test, which is prone to false-positive results. And with mounting evidence that survival benefits from screening pale in comparison with the harms from overtreatment — particularly incontinence and impotence — the pendulum has steadily swung away from it. Still, screening research continues, in the hopes that some lifesaving benefits may be found."
[1] https://www.health.harvard.edu/blog/new-study-once-again-cas...
Starting about 10 years ago, just before it mattered to me, official policy decided to NOT screen using the PSA test. The belief was that underinformed primary care docs were overreacting to a high PSA number and ordering too many biopsies which often led to "unnecessary" infections. Of course, the right response was to do a better job of interpreting the test results, ideally to refer the results to a more expert urologist before doing a biopsy, not to cut back on the test.
Given its low cost ($50) and very high sensitivity, the PSA test provided a very valuable service that could be equalled by no other test. Physical exam is often wrong, missing a large fraction of positive cases of cancer. And biopsies introduce infection most often in older patients. Younger ones can tolerate biopsy better, but were disallowed from PSA screening entirely due to this overprotective policy.
The right solution was clearly to interpret the PSA test results more judiciously by introducing more expertise prior to biopsy, knowing that PSA is overly sensitive for diagnosing cancer. Fortunately the official policy has since been reversed, and PSA has returned to routine use -- now with inclusion of a second test or a urologist prior to biopsy.
The same blunder took place in mammographies at about the same time. Too many false positives led to too many biopsies and thus routine screening with mammography was deemed unacceptable and it was deprecated as well. Fortunately that overreaction has also ended.
Sensitive medical tests are essential. Overreaction to possible misinterpretation of positive results by inexpert GPs is the problem, not the test itself. I routinely thank the stars above that my GP was expert enough to know that.
That said, the doctor might be trying to benevolently prevent unnecessary tests, stress, and treatment. Some people hear "cancer" and rush into risky treatments. This is part of the reason the United States Preventative Services Task Force "demoted" asymptomatic PSA screening from "recommended" to "have a talk with your doctor." Their review of the studies didn't show that screening asymptomatic men resulted in a large reduction in mortality. Mostly because prostate cancer is so common and often develops slowly. Somewhat because treatment can bring its own dangers.
At first, in 2012, they recommended against it. Then doctors and patients' groups protested, so now it's "have a talk." We are now starting to see the result of that first decision in the increasing incidence of late-staged prostate cancer.
All this is to say: PSA screening's not a bad idea as long as you can keep perspective if it comes back positive. Out of the major cancer types, prostate cancer has one of the highest 5-year net survival rates [0]. It's over 95% in my state[1].
[0] Net survival tries to exclude the risk of death from other causes. So 100% net survival for a cancer diagnosis means there's no difference from a similar person who didn't have cancer.
[1] The official statistic from the CDC may be lower, but I disagree with some adjustments they make. I believe they force the data to fit their mental model.
1. 1 in 8 men are diagnosed with prostate cancer.
2. Second leading cause of cancer death among men.
3. There are treatment options. With treatment, 15 year survival rate is 95%.
All of that info can be found here: https://www.cancer.org/cancer/prostate-cancer/treating.html
Your bf should switch Dr's.
However some cases are more aggressive and will have a negative impact or even kill them.
The problem, as with most cancers, is to figure out which ones are worth treating rather than risk iatrogenic consequences.
I also heard from urologists that everyone eventually gets it but normally you can outrun it. If you have an aggresive variety or get it when you're young you should definitely do something about it.
The tricky part is that the current PSA test is not specific enough to avoid the stress and extra human cost of overtreatment so a better test would be great.
Everything else is pretty straightforward in terms of diagnosis and there are decent treatment techniques, I had a simple needle biopsy that confirmed the cancer but for many men this test (although easy-peasy in my case) is scary, expensive and often confirms there's no cancer at all.
I don't know the time between the 'treatment' and his death, could be anything from 12 - 24 months. I know at least one of the pellets had started 'wandering'.
He died of acute leukemia and I suspect that had to do with the radation. However, I am not pursuing research into this, it won't bring him back. He was 63 years old.
Some cancers are aggressive and some are slooooow. In younger patients, cancers tend to move fast and kill fast. But a slow prostate cancer in a 70 y.o. may be better left as it is, because the risks of the operation may actually be higher.
This, of course, is a difficult judgment call and belongs to the experts only.
It makes intuitive sense to me that a cancer diagnosed in a young patient, who is below the common screening age, is probably being diagnosed because it is presenting serious symptoms (i.e. is growing fast).
Cancers diagnosed in a 70 year old, on the other hand, would seem much more likely to be diagnosed while they are asymptomatic and relatively contained, or to be cancers that have been growing slowly for a long time (more likely as the 70 year old has been alive longer).
Obviously, I don't know if this is the case or not. If anyone has experience in this field, I'd love to hear about it.