Tuesday, 4 October 2016

This is a great read if you've listened to people who argue that the PSA test is unreliable....




Ben Stiller on the PSA test...

The PSA test is unreliable? Bollocks!
It saved My Life!

“So, yeah, it’s cancer.”
My urologist segued from talking about how inconvenient 
it was picking his daughter up at school that morning 
to dropping a cancer diagnosis on me without missing a beat. 
Two weeks earlier, I didn’t even have an urologist.
“Yeah,” he said, in a slightly nonplussed way, gazing at
 the results, “I was surprised myself.”
As my new, world-altering doctor spoke about cell cores
 and Gleason scores, probabilities of survival, incontinence 
and impotence, why surgery would be good and what kind 
would make the most sense, his voice literally faded out like 
every movie or TV show about a guy being told he had 
cancer… a classic Walter White moment, except I was me, 
and no one was filming anything at all.
I got diagnosed with prostate cancer Friday, June 13th, 2014. 
On September 17th of that year I got a test back telling me 
I was cancer free. The three months in between were a 
crazy roller coaster ride with which about 180,000 men 
a year in America can identify.
Right after I got the news, still trying to process the key words 
echoing dimly in my head (probability of 
survival–vival-vival-val…” “incontinence-nence-nence-ence…), 
I promptly got on my computer and Googled “Men who had 
prostate cancer.” I had no idea what to do and needed to see 
some proof this was not the end of the world.
John Kerry… Joe Torre… excellent, both still going strong. 
Mandy Patinkin… Robert DeNiro. They’re vital. OK great. 
Feeling relatively optimistic, I then of course had to do one 
more search, going dark and quickly tapping in “died of” 
in place of “had” in the search window.
As I learned more about my disease (one of the key learnings 
is not to Google “people who died of prostate cancer” 
immediately after being diagnosed with prostate cancer), 
I was able to wrap my head around the fact that I 
was incredibly fortunate. Fortunate because my cancer 
was detected early enough to treat. And also because my 
internist gave me a test he didn’t have to.
Taking the PSA test saved my life. Literally. That’s why I 
am writing this now. There has been a lot of controversy 
over the test in the last few years. Articles and op-eds on 
whether it is safe, studies that seem to be interpreted in many 
different ways, and debates about whether men should take 
it all. I am not offering a scientific point of view here, just a 
personal one, based on my experience. The bottom line for 
me: I was lucky enough to have a doctor who gave me what 
they call a “baseline” PSA test when I was about 46. I have no 
history of prostate cancer in my family and I am not in the 
high-risk group, being neitherto the best of my 
knowledgeof African or Scandinavian ancestry. 
I had no symptoms.
What I hadand I’m healthy today because of itwas a 
thoughtful internist who felt like I was around the age to start 
checking my PSA level, and discussed it with me.
If he had waited, as the American Cancer Society recommends, 
until I was 50, I would not have known I had a growing tumor 
until two years after I got treated. If he had followed the US 
Preventive Services Task Force guidelines, I would have never 
gotten tested at all, and not have known I had cancer until 
it was way too late to treat successfully.
Now, in my case, my doctor, Bernard Kruger, watched my 
PSA tests rise for over a year and a half, testing me every 
six months. As the numbers continued to rise, he sent me to the 
urologist, who gave me a slightly invasive physical check in his 
office using a gloved finger. This took all of 10 seconds. While I 
don’t recommend it for fun, amazingly some don’t recommend 
it at all. After this exam, and looking at my rising PSA numbers, 
he suggested an MRI to get a roadmap of my prostate.
It’s a non-invasive procedure like the one athletes get to check 
for torn ACLs. Loud, but painless. Only after studying the 
MRI results did my doctor recommend a not-fun-at-all biopsy. 
Unlike the MRI, the biopsy was as invasive as it gets: long 
needles in sensitive places and more small talk about kids 
and school pick ups while it was all going down.
Then the biopsy came back positive. Of course “positive” 
for medical tests is usually not so positive. I had a Gleason score 
of 7 (3+4), which is categorized “mid-range aggressive 
cancer.” Surgery was recommended. At this point I decided 
to go out and get a few different opinions. All the doctors I talked 
to concurred that the tumor needed to be taken out.
Ultimately, I found a wonderful surgeon named Edward 
Schaeffer who I felt comfortable with. He performed 
a robotic assisted laparoscopic radical prostatectomy. Due to 
a lot of skill and a little beneficence from some higher power, 
he got all the cancer. As of this writing I am two years cancer 
free and extremely grateful.
So. What is the deal with this PSA test and why the controversy?
It is a simple, painless blood test. It is not dangerous in itself in 
any way. If the PSA (Prostate Specific Antigen) value is 
elevated in the blood, or levels rise sharply over time, it could 
indicate the presence of prostate cancer. 
It is definitely not foolproof.
The criticism of the test is that depending on how they interpret 
the data, doctors can send patients for further tests like the 
MRI and the more invasive biopsy, when not needed. Physicians 
can find low-risk cancers that are not life threatening, especially 
to older patients. In some cases, men with this type of cancer get 
“over-treatment” like radiation or surgery, resulting in 
side effects such as impotence or incontinence. Obviously this 
is not good; however it’s all in the purview of the doctor treating 
the patient.
But without this PSA test itself, or any screening procedure at all, 
how are doctors going to detect asymptomatic cases like mine, 
before the cancer has spread and metastasized throughout one’s 
body rendering it incurable? Or what about the men who are 
most at risk, those of African ancestry, and men who have a 
history of prostate cancer in their family? Should we, as the 
USPSTF suggests, not screen them at all? 
There is growing evidence that these guidelines have led to 
increased cases of prostate cancers that get detected too late 
for the patient to survive the disease.
Five years after their initial recommendation to stop PSA testing, 
the USPSTF is presently, per their website, “updating their 
recommendations.” I think men over the age of 40 should have t
he opportunity to discuss the test with their doctor and learn 
about it, so they can have the chance to be screened. 
After that an informed patient can make responsible choices as to 
how to proceed.
I count my blessings that I had a doctor who presented me 
with these options. After I chose to take the test, he directed 
me to doctors who worked at centers of excellence in this field
(see note below regarding UK centres of excellence) 
to determine the next steps. This is a complicated issue, and an 
evolving one. But in this imperfect world, I believe the best 
way to determine a course of action for the most treatable, 
yet deadly cancer, is to detect it early.

FIND OUT MORE ABOUT PSA SCREENING...

American Urological Association’s 
Guidelines on Prostate Cancer Screening

American Cancer Society on 
Prostate Cancer Screening

The Melbourne Consensus Statement on 

Note: Centres of excellence in the UK? You have to research this, 
it's NOT something your local hospital can handle. 

If in doubt, contact me at dansencier@yahoo.co.uk  
I will reply same day.

If you are in the UK then the Prostate Cancer Charity is the 
place to go for everything you need to know and all the help 
you need. It's amazing!

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