To PSA or NOT to PSA--A Man's Dilemma

...another controversial medical recommendation

Recently, the USPSTF (U.S. Preventive Services Task Force) published a recommendation against routine PSA screening for men of all ages. They cited numerous clinical studies (some inconclusive or contradictory) showing no statistical survival benefit for men getting regular prostate cancer screening with a PSA compared to those men who did not have a PSA screening.

Further, the report pointed out the risk of men having unneeded and risky treatments that could result in impotence, incontinence, infections, heart attacks, and other unpleasant side effects.

There is no way to determine from a PSA test whether a tumor is aggressive (life threatening) or slow growing (not life threatening). A biopsy can help determine the growth rate of a tumor but there is some risk of infection (albeit small) from that invasive procedure.

So, they contend, no screening is better for the 5 out of 6 men who are likely to never get prostate cancer. And of the 1 in 6 who will get prostate cancer some will have a slow growing type and will not need immediate treatment.

But what about those poor guys (like me) who have or will have an aggressive (life threatening) tumor in their prostate? Although statistically not significant, determining risk and getting treatment early would be really helpful‑‑maybe even life saving.

Maybe the problem is not with the PSA test, which can detect cancer, but with the decision making by doctors and patients after the test. Could this, perhaps, be an area for further study?

I have had and will continue to have PSA tests on a regular basis. I know a number of men who are being treated for an aggressive form of prostate cancer. To a man they are happy to have been diagnosed and treated and still be alive. Me, too. We do not believe that our lives are not significant. The discussion is not over. There must be a better solution!

axman

The Therapeutic Benefits of Good Times and Good Friends

...this probably doesn’t show up much in the clinical trials and statistical research data

In my last blog entry‑‑September 26‑‑I mentioned the group of people we met in a clinical trial last year. Last week we hosted the group at our newly renovated farm house. It rained, of course, because this is Oregon.

The meeting was a little sad because we missed John (see last blog entry) but once the group assembled (out of the rain on our new covered patio) the mood was definitely upbeat. A little wine, some barbecued chicken and a lot of conversation. Some of it was small talk, more than a little was prostate cancer related (stages, meds, hot flashes, the latest PSA, etc.), some future plans, and lots and lots of heartfelt laughter. Imagine that; sick old people laughing and carrying on like a bunch of kids!

This group of 20—now 19—has a unique ability to lift my spirits. Whatever I might call it, the real purpose of the group is people support. And it works for me.

Our backgrounds are diverse and prostate cancer is the only obvious thing we have in common (except for old age). But we also share an irreverent sense of humor, an honest concern for each other, and a determination to continue fulfilling those entries on our bucket lists. So far‑‑so good.

I’m looking forward to our next get together in December and in March and in July and... I'm sure everybody else is, too.

axman