Ben Stiller on the PSA test...
The PSA test is unreliable? Bollocks!
“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.
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.
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.
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.
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.
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 neither — to the best
of my
knowledge — of African or
Scandinavian ancestry.
I had no symptoms.
What I had — and I’m healthy today because of it — was a
thoughtful internist who felt like I was
around the age to start
checking my PSA level, and discussed it with me.
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.
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.
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.
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.
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.
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.
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.
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...
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!
“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.
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.
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.
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.
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 neither — to the best of my
knowledge — of African or Scandinavian ancestry.
I had no symptoms.
thoughtful internist who felt like I was around the age to start
checking my PSA level, and discussed it with me.
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.
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.
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.
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.
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.
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 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.
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.
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...
The Melbourne Consensus Statement on
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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