For the men who develop prostate cancer, early testing can impr...

It's funny that this article appeared on the very day that some national medical organizations are actually urging that the PSA test not even be given to men over the age of 75. The reason, according to them, is that for men of that age, the 'cure' may be worse than the disease.

These 'experts' explain that, because the surgery to remove the tumor can cause problems like loss of control over the bladder and loss of, uh,male 'function', that the patients shouldn't be troubled with the knowledge of a tumor - especially when there is no 'proof' that detection can lead to cancer remission.

Excuse me? No proof, when we've been seeing great strides in survival of those who were fortunate enough to have early detection of their cancers? And shouldn't the patient have some say in the matter?

I think this is yet another version of the medical discrimination against older patients that our family dealt with in my grandmother's life. After our Mom died, our grandmother had an episode of heart failure. While she was hospitalized, the doctor told her son (my uncle) that Grandma had leukemia, but that the consulting doctors all advised against any aggressive treatment.

The doctors advised against treatment. They suggested that any 'aggressive' treatment might worsen Grandma's heart - and besides, they said, at her age (93) she would pass away before the cancer worsened because cancer is 'slower' in the aged.

Were they ever wrong! Grandma lived another 4 years, and the leukemia spread into her bones. She lived her last year in agony when she wasn't on heavy pain medication - and she never really knew why she was in so much pain.

It wasn't as if her Medicare policy and my uncle couldn't pay for the treatment, but it was as if the medical and insurance industry are writing off people over a certain age. Why treat them aggressively - they're just going to die, anyway. You know what? We all are.

If a patient says 'Doctor, don't tell me the details; just decide what's best', that's one thing. But for some insurance clerk or factory-line medical professional to not even offer info so a patient can make an informed choice - something is really, really wrong with that picture.

Thank you, thank you, THANK YOU! As the previous poster said," I think this (and the idea to not do mammograms on older women) is an attempt by Medicare to reducs costs. How completely vile.

PSA's do not cause extensive treatments. Biopsies after a high PSA do not cause extensive treatments. Having cancer causes extensive treatments, and the PATIENTS may choose a more extensive treatment than the doctor would recommend. I know I did. My doctor recommended a lumpectomy but I chose a mastectomy. The surgeon clearly thought of it as "disfiguring." I thought of the cancer as disfiguring and the mastectomy as *my personal choice.*

We DON'T KNOW everything there is to know. Maybe they start out small but become aggressive later? What if a man doesn't want to have prostate cancer that is starting to spread at 85 because the doctor said it was no big deal at 75? What if he would rather than die in his sleep than of bone cancer?

My father died of bone cancer. My brother-in-law lived, because they had the PSA and because the biopsy showed that his form was aggressive. Everyone in my family knows that prostate cancer can kill.

We have to stop this tyranny of the statistics. People are not statistics.

A very good summation by a Edward Siguel, M.D., Ph.D.(a clinical pathologist):

PSA is a substance produced by the prostate. People with an enlarged prostate produce a lot of PSA. By the time a man is over 65, the odds are very high that he has an enlarged prostate and a high PSA. Many also have partial urinary obstruction. Many (probably the majority) are also overweight.

After a high PSA, the next step in diagnosis is a biopsy. A biopsy is painful and can lead to urinary obstruction, particularly in older men with an enlarged prostate.

Frequently, the biopsies find nothing. And they must be repeated. Some patients lose organs because of a biopsy that mistakenly breaks a vessel. Although doctors bet that the risk is small, nobody is willing to put a price on their “bet” on the patient.

Suppose the biopsy shows cancer. Depending on the type of cancer, studies suggest a certain life expectancy. But these average results are meaningless when applied to a specific case because treatment does not produce huge differences compared to no treatment. Moreover, there are many risks associated with treatment of prostate cancer. The risks have to increase with age because the body’s ability to recover decrease with age.

Treatment may increase life expectancy. Or it may not for people over 75 who likely have cardiovascular disease and other complications. Treatment may substantially decrease quality of life, and could shorten life.

If the PSA is extremely high, then the odds are high that there is prostate cancer. But if it is low, there could also be prostate cancer. There is also stress associated with the test. Once the test is high, there is psychological pressure on the physician and patient to have a biopsy. Or many biopsies. And if the biopsies are abnormal, there is pressure to have it treated. Although a few men may benefit from aggressive treatment, many more will suffer undesirable consequences.

Some men may benefit from having a PSA test. Men who have a history of PSA values to compare over time, or family history of severe prostate cancer. Or man who will have the PSA repeated every 4 to 12 months, depending on the results and physical condition. Men who have a biopsy when there is a substantial increase in PSA values (PSA velocity) given their prostate size. Men who are slim, exercise, don’t smoke, avoid unnecessary risks, eat very well, have excellent immune system, excellent healing, no bleeding abnormality, and have no known disease. These are the men that will likely live long and can withstand the adverse consequences of treatment (bleeding, fibrosis, decreased inmune system and susceptibility to infections, etc.).

Very few men meet these criteria. And the odds are high that even fewer have high PSAs. The vast majority of men are overweight, have abnormal cardiovascular disease, immune system and other abnormalities that makes them likely to suffer undesirable consequences from treatment (increased susceptibility to infection, etc.). These men will feel pressured to do something if the PSA is high, to have biopsies and proceed to treatment.

For them, the consequences of having a PSA test are far more likely to be undesirable than worthwhile. Moreover, once the chain starts, it is very difficult to stop (for legal, ethical and psychological reasons). From the high PSA we move to biopsies and then treatment.

Contrary to popular belief, it is practically impossible to make a rational decision. The necessary data does not exist. If the data existed, humans like the ability to make the multivariate probability calculations and cost/benefit analysis. Instead, decisions are almost random, and shifted towards aggressive therapy when the PSA is high.

Incidentally, there are several alternatives to conventional treatment. They are not followed because they are not profitable and there is no funding to evaluate them.

It was a terrible article, and no, it's not impossible to make a rational decision. People do it all the time. I GUARANTEE you that given the choice, my father would have chosen life after death. And, the alternative treatments ARE followed, GDP. You seem to want 100% guaranteed answers on a group of diseases with some similar traits called "cancer." There are many different kinds of cancer, and researchers are working hard to understand them. But they don't have all the answers yet. Anyone who constantly demands perfect answers from an implete body of knowledge will end up frustrated and angry for no good reason.

I certainly do sympathize with your frustration of purpose Gail.

Can hereditary cancer be eliminated?

http://myspace.com/totalhealthwithoutsorrow

"Frustration of purpose" is a legal term, gdp. Are you a lawyer now as well as an angry nurse?