Prostate cancer diagnosed too late to cure…how can this be?

So look at the two things below- a comment and an article. The diagnosis of prostate when it is too late to cure occurs in 1 in 25 men. So if 250,000 men are diagnosed with prostate cancer a year in the U.S. then the number who have metastatic disease at diagnosis is 10,000. Do you realize what this means? Do you have any idea how it would feel to have had no symptoms, voiding fine, active, young and happy and a doctor says you have a cancer too far along to cure? Are you sh….ing me? Well in America it happens 10,000 times a year. How can this be?

A large percentage of men have not been to a doctor and for whatever reason have not had a PSA or a rectal exam. “I have no symptoms peeing so my prostate probably all right.”

But what about the guy who has been diligent about his yearly physical exam to include a rectal exam and a PSA. The comment from tjgorton falls in this category. In my opinion more time and money should be spent on the investigation and study of this situation and its early detection than on the treatment of it after it occurs. That makes sense doesn’t it?

What happens in the below situation is that poorly differentiated prostate cancer are so bad they can’t and don’t produce PSA. In other words the really bad kind of prostate cancer that are most aggressive sometimes don’t have the ability to produce PSA and hence progress along undetected. Add to this that some prostate cancer don’t form a nodule, they are infiltrative and so don’t produce a palpable nodule that the family M.D. would feel on a regular exam. It is a bad and unfortunate “perfect storm.”

The solution in the below situation is a hard one. A friend of mine whose father was a doctor  and died 7 months after the diagnosis of prostate cancer comes to mind. So my friend who is about 48 and has a PSA of 2.5 and no symptoms comes to me once a year for the prostate exam and PSA. I have said to him that he makes me uncomfortable. I think he should have a biopsy. I have told him that not all prostate cancers can be felt and some are not associated with a high PSA. He says no. I document what I told him and also told him that his strong family history of prostate cancer would justify a biopsy.

So a heightened sense of awareness, being cognizant of the family history, use of the Free PSA, PSA velocity or rate of change all need to be considered not just the abnormal PSA or rectal exam in considering a prostate biopsy.

10,000 men and their co-workers, family, wives, and on and on……nothing to sneeze at.

Comment from tjgorton

All very well, but don’t let the arguments about “false positives” lull
you into forgetting that the PSA test gives a “small number” of false
negatives.  I was lulled all right, with stable, safely low PSA numbers
for years, until I woke up with Stage 4 metastatic disease.  Still
around but no thanks to the PSA test or my lovable, but passive GP.  If
the above inexplicably whets your appetite I tell my story on a webpage,
http://tjgorton.wordpress.com/pc-as-in-prostate-cancer/

From Johns Hopkins

As Discovery went to press, a group of scientists issued a disturbing report. The United States Preventive Services Task Force (USPSTF) recommended against PSA screening for prostate cancer, based on its evaluation of evidence of both benefits and harms. To understand this recommendation, you need to know that the panel is made up of “independent scientists who are better able to objectively evaluate the literature without bias.” No urologists were invited to participate.

The panel said that “healthy” men don’t need PSA screening. In effect, this decision sets the clock back to before the 1990s, when “healthy” men were diagnosed with cancer that was palpable and often, too late to cure. Is this about progress, or saving money?

Prostate cancer is the most common cancer in American men and the second most common cause of cancer death. Because the cancer begins on the prostate’s outer edges, it produces no symptoms until it is far advanced and too late to cure. You can be a “healthy” man and have a steadily climbing PSA, silently trumpeting the danger alarm. Early diagnosis is everything. It is the cornerstone that has dramatically reduced death and suffering.

In 1991, before PSA testing was in place, 20 percent of men were diagnosed with prostate cancer that had already spread to their bone. Today that number is less than 4 percent. It’s hard to imagine now, but in 1991, one out of fi ve men had metastases. Today, it’s one out of 25.

The effect on deaths is equally dramatic. Between 1994 and 2004, prostate cancer deaths plummeted 40 percent – more than for any other cancer in men or women. But what would have happened if PSA testing and effective treatment had not come along? Using the age-adjusted death rate from 1990 of 39.2 prostate cancer deaths per 100,000 men and applying it to 2007, there would have been 59,000 deaths. Instead, because the death rate fell to 23.5, there were 35,000 deaths. Thus, 24,000 fewer men died from prostate cancer. Because advances in treatment have also played a role, scientists from the National Cancer Institute estimate that 40 to 70 percent of this reduction is the direct result of screening.

Unfortunately, the USPSTF never mentions these figures, and makes no attempt to reconcile them with its recommendations. The scientists did use large, uncontrolled observations to look at the complications of surgery – but not at the number of lives saved since PSA testing was introduced in the United States in the early 1990s. Also, the USPSTF recommendations are based on two trials with only seven and nine years of follow-up – even though it is widely accepted that men with a lifespan of fewer than 10 years should not be screened or treated.

Of course, there can be harm with any intervention. We can reduce the potential risks of PSA testing by: screening frequently the men who are likely to benefi t the most (younger men with higher or rising PSA levels); screening infrequently, or not at all, men who are older, in poor health, or who have lower PSA levels; using surveillance, not immediate treatment, more often for selected men. Finally, PSA testing should continue to be used for monitoring patients after treatment for prostate cancer, to identify progressive disease.