Prostate cancer is never an emergency

PSA is on the rise after years of quiet, following Radical Prostatectomy.  Both MD and oncologist agree that a bit of watchful waiting will not change the treatment or the outcome.  Doubling is a trouble sign, but a spike would be a different matter.  I’m in a holding pattern currently...and here to get the maximum amount of information as well as views from others who have ’walked the walk’.

There's good basic advice that we all need to be reminded of every so often. Thanks for offering it to the forum.

The majority of the time, people are diagnosed with the slow growing Pca with low to moderate Gleason numbers and these people may not be in a "emergency" situation. However I was one of the unlucky 5% that had a deceptively low PSA (7.1) at diagnosis of Stage 4 Gleason 4+5=9 that had already spread beyond the prostate and was no longer operable or locally treatable. I had regional spread to bone and lymph nodes. I would call this an EMERGENCY! I started Lupron HT right away thru a clinical trial with another drug and so far it is arrested for now. I would think that in cases like mine, it would be an emergency to keep the Pca from getting to the spine or any further spread period.

Also, being involved in a clinical trial, I am required to get blood tests every 6 weeks, a checkup every 90 days and yearly CT and Bone scans to monitor progress. These seem completely logical and necessary tests to have done regardless of treatment.

ASAdvocate said:

Sorry about the mistake

Typing "too many" instead of "too few".  Glad you figured it out.

Foamhand makes a good point about the five percent or so who are diagnosed already in need of immediate treatment. Certainly, the "never an emergency" theme does not apply to him.

But, was that 7.1 psa a first psa ever, or were there others previoulsy that would have caused suspicion?

 

My PSA over the prior few years were lower. 3.8 in 2007 but doctor at the time didn't believe in the PSA accuracy. 2 years ago I had a 4.1 and a different doctor was concerned so he said lets check again in 6 mos. that's when it almost doubled to 7.1.

SPT said:

that makes sense

Ah, I see now.  I think you are right, ASAdvocate meant to say ‘too few’ instead of ‘too many’.

I should have figured that out myself.  Lupron brain  is my excuse.

Separating wheat from chaff is indeed the problem, and it extends to medical journals, doctor's opinions and beliefs, and forums and web sites.

Therre's a good, short article about the solution: critical thinking.  It turns out you don't have to be a genius. 

(Critical thinkers) think rationally in a goal-orientated fashion, and a disposition to use those skills when appropriate.  Critical thinkers are amiable skeptics.  They are flexible thinkers who require evidence to support their beliefs and recognize fallacious attempts to persuade them.  Critical thinking means overcoming all sorts of cognitive biases (e.g., hindsight bias, confirmation bias, etc.).

Why do smart people do foolish things?

Worth the read, especially for people facing tough decisions like everyone here.

Thank you for the assistance.

I was taught to be careful of the "quantifier" words as early as elementary school:  There is virtually never a case wherein the word never fits reasonably.

26,000 men die of PCa in the US during an average year. At some point, it was an emergency for them.  I have watched two die personally, and had another relative die of it in his early 50s (diagnosed in his mid-40s, treated at MD Anderson, Houston; that is, the best in the world).

I tend to err on the side of caution, and over my years at CSN, which began with severe, advance Lymphoma, I formulated two slogans of my own. Both are in response to the various truisms that one hears all the time when dealing with cancers.

One is I'd rather have side-effects than have cancer, and the other is "What is the 'quality of life' if your dead ?"

The men I watched pass would have rather had E.D. or incontenince or whatever than knowing they were drawing their last breath, and about to leave their loved ones forever.

max

lmered said:

I strongly disagree

While most of the men diagnosed with PC may not be in an emergency situation delay can be disasterious.  Four of my Uncles were diagnosed with PC, one had a RP and lived a long life, the others all died of PC.  In my case eight years ago during a routine physical the doctor noticed that my PSA had gone from normally under 2 to 4.  He was concerned that it had doubled in one year.  He sent me to a urologist who did a biopsy and determined that there were no cancerous cells just some atypical ones.  30 days later they did a PSA again and it had increased to 20.  Went to Dr Patel in Orlando and had another biopsy which showed a gleason of 7.  Even Patel said that I had some time there was no rush for surgery.  I went ahead and scheduled surgery withiin the next month.  When the biopsy came back after the surgery it was 9.  I was one of the few that had a particularly agressive type of PC.  Had I waited I would not be writing this today.  Also a good friend of mine waited a little too long and passed away a few years ago.  While the overwhelming majority may have tiime don't bet your life on it.  

We are all betting our life on “It”.  Applaud you winning your bet.  

Darn shame that it comes to that...but there you go...it is a crap shoot for any of us.

IMHO

Max Former Hodgkins Stage 3 said:

Your story is remarkable, Imered.

My own PSA had been doubling about annually for 3 years.  I asked my primary care doc, and he said to ignore it, and his further suggestin was to "just stop having PSA tests completely."  He is from the popular "PSA and biopsies are overused" school of though.

I made my own appointment with a urologist who recommended an immediate biopsy. It came back positive at a probable Stage I, but the pathology report after RP about 3 weeks later was a Stage II, with a lot more tumor involvement than the initial biopsy had shown.

My Gleason was never high, but if I had not acted, I don't know when I would have finally been diagnosed.  I had bad problems with urination and sex before surgery that were attributed to BPH.  And, as luck would have it, the symptoms of BPH and PCa are often identical.

You obviously have a genetic propensity toward the disease, so warn any sons or nephews that you may have to be vigilant,

max

 

Dr Patel and his staff advised my son to begin PSA testing at age 30 as a result of my family and personal history.  I'm not sure he is taking it as seriously as he should.

Here's an article from a man who was diagnosed at 35; there are men who are diagnosed at still earlier ages. At any rate, in high risk situations a man needs to start monitoring at an early age to determine trigger points...These men need to live a heart healthy life style..........Additionally a correlation has been show between prostate and breast cancer, so woman in the family are also more likely to be diagnosed, and also need to be closely monitored

https://www.huffingtonpost.com/gabe-canales/young-men-get-prostrate-c_b_732296.html