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Comment by taylodl | Hacker News Reader

I don't understand this thinking at all. Most prostate cancers are a non-issue if caught and treated early. As my father's doctor told him - prostate cancer, if caught early, is largely a disease you die with, not a disease you die from. The PSA is the best tool we have for early diagnosis and treatment. I have the test done as part of my annual checkup and have done so for the past 15 years. Let me put it this way - it's a heckuva lot less invasive than a colonoscopy!

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Get your colonoscopy. Period. Don't let people tell you fables about "the prep" or be afraid of something going up your butt.

"The prep" is a bit unpleasant for a couple of hours, but no big deal. The actual procedure is done under propofol. Consider that part the best nap you will ever get.

You will either get a clean bill of health, or the doctors will find something that is easily treated right then and there. The stigma (especially of men) about this procedure will lead to countless numbers of them to die from something that doesn't have to be.

Get the procedure when your doctor says. Just do it. Please.

I've had my colonoscopy - I speak from experience when I say the PSA test is a heckuva lot less invasive! With that said, the colonoscopy wasn't bad at all - not nearly as bad as people make it out to be. They found a polyp, extracted it and did a biopsy, and found it to be benign. Now I have to have a colonoscopy every 5 years instead of every 10. Yay!!! :)

i believe (from experience) that propofol is massive overkill for what can be done easily with versed, making an even easier total win, to your point!

Yeah, didn't like the aftereffects of Propofol the first time I had it so I did it without sedation the second time. Saves time as well.

I should have also mentioned that my colonoscopy was done under a sedative, I wasn't knocked out - so I got to see the whole thing! The doctor provided a narrative as we went along. At one point they were having issues making a turn and I could feel it and let them know so the nurse squoze my guts in some way to allow them to get around it. They even showed me the polyp when they found it (I was laying on my left side with the monitors right in front of me - so I could watch the whole thing.) Except for that one turn I didn't feel a thing.

I just had mine a couple days ago and opted for no sedation because I wanted to see what's going on. It was a bit unpleasant, at a couple spots the doc snakes the scope around some sharp bends and you can feel that inside of you. It totally paid off, though, I had a clear view of the monitor and could watch everything going on. I've done a fair amount of optical engineering so I was really curious about the whole thing and it's really fabulous.

Unfortunately, they found quite a few polyps and one was large enough that a) the doc marked the spot with some dye and b) they cauterized it. The puff of smoke inside my gut was definitely the highlight for me.

That's an interesting idea, asking for no sedation. Next time....

I cannot imagine why you’d possibly want to be awake for it… especially to the point of calling it fabulous? I’m sure they could have given you a video afterwards without the discomfort.

My original goal was to avoid the extra time and having to organize a ride but also the aftereffects - the last time I felt weird a day or two later (could have been a red herring).

I just found it totally fascinating to see my own insides live in in high res and listen to the doctor and nurses talk about what was going on.

Well, I guess everyone has their own interests. I'm glad you got so much out of it. Personally I have no desire to see and feel myself be rotorootered and am very happy to knocked out, but it would be nice not to have the sedation after effects. The last two times I got one I ended up taking like a 4h nap afterwards. I'd imagine you also wouldn't have the same restrictions around drinking water cutoff times without sedation.

Similar experience here.

In my case, I didn't want to be administered a powerful substance (and experience any lasting effects) unless absolutely necessary. My understanding is that adverse reactions are very rare, but if the only upside is avoidance of minor discomfort for 30-60 minutes, I don't see the point.

The prep for my second colonoscopy had me passed out on the bathroom floor. More than "unpleasant".

There are multiple protocols for the prep. Check with your doctor for an alternative and mention the passing-out bit.

The problem is twofold: the test is notoriously flakey, and the cancer is frequently not an issue. You're also absolutely right that many more men die with prostate cancer than from it — but that's most commonly _without_ treatment or even knowledge of it!

The trouble is exactly that it _can_ manifest early and it can become aggressive and that's when it's crucial to catch and treat.

For decades the cancer treatment industry has beat the drum of early diagnosis and treatment. I looked into statistics a few years ago, and the drum beat appears correct for skin cancer.

I couldnt find statistical benefits of early diagnosis for internal cancers. The statisticians remove people from the counts if they die during treatment. So the 'early diagnosis' numbers were meaningless because they stop considering all the people in the original group.

Early diagnosis can give a false impression by increasing the time between when you're diagnosed and when you die, simply by bringing forward the former without changing the latter.

However, for diseases like Hodgkins where we have what is in effect just a cure, albeit a fairly drastic one (I had Hodgkins in my mid-20s, I'm now in my 40s) clearly early diagnosis isn't just playing with the statistics. If I hadn't been diagnosed, they couldn't cure it, and then I'd almost certainly just be dead.

So the answer is it's complicated.

The cynic would say it's a scam to transfer wealth from the cancer-afflicted to the medical industrial complex. After seeing how both my parents' cancers played out, I can see the appeal of that idea. Years of discomfort, hundreds of hours spent in medical facilities (mostly waiting around) and expensive medicines and fees, and in the end you're still just as dead.

But that simply isn’t true for many types of cancer if you catch early.

>I don't understand this thinking at all.

Which thinking do you not understand?

And I recommend both! No matter how invasive the test, cancer is worse.

Malignant cancer is certainly worse, but many prostate cancers that are exposed by this test are totally benign.

And not discovering early might very well mean the cancer becomes a lot more serious. Never understood the fear of medical exams.

Over treatment is a real issue and can create more serious issues that the original problem.

There absolutely are things worse than cancer.

Depends on the cancer, doesn't it?

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