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Early detection

The Nev
Posts: 50
Joined: Sep 2009

How important is early detection? Here’s a little history and food for thought for those that believe that we are over treated.

In 2007 my G.P. did a PSA it was 2.5 he didn’t even mention it. I was on meds for arthritis and was getting blood test every 3 mos. Later it was 2.7 he told me to follow up with urologists. I did I had some symptoms frequent urination, getting up 4-5 times a night. My next PSA 2.7 nothing to worry about says Dr. Next 6 months later 3.2 still nothing to worry about we’ll give you some anti-biotic and see what happens. Next PSA 3.5 I asked don’t you think we need a biopsy? No says Dr chances of cancer in man your age (53) very slim less then 10% lets come back in 6 months PSA down to 3.2 see getting better nothing to worry about. 6 more months PSA 4.5 it’s now Aug 2009 what about a biopsy? Dr says we’ll do it but still only about a 25% chance of cancer. Biopsy comes back positive all cores on the left side were positive; all cores on the right were negative. Gleason score 3+3=6. Still no worries it a low Gleason and slow growing you have plenty of time. Appt made with MD Anderson again no hurry so the appointment Sept 2009 MRI shows cancer well and shows may be outside of capsule. DaVinci Surgery scheduled for Sept 29th 2009. Post surgery Gleason 3+4=7 negative margins, negative lymph nodes, negative seminal vessels. Had to take the nerves on the left side. So Dr says there was a bulge on the left side of the prostate but it did not break out so looks like we caught it at the right time it was close to escaping. One year later my PSA is raising, looks like it wasn’t close after all it was out.

Not blaming anyone it is what it is, but the doctors play a numbers game I’ve seen the form they use. They go by percentages and treat accordingly. I guess that's ok unless you're in that percent class that gets passed. What would have happened had we done a biopsy a year earlier? Or even 6 months earlier?

Early detection is very important, and I can tell you from experience early treatment is important. Now I realize that no one can say if I had surgery in 2008 it would not have returned anyway, but under the circumstances, I would have liked to have had the chance.

Sorry for the length of this but I think it’s important for others making decisions on treatment.

jminnj's picture
Posts: 129
Joined: Nov 2009

I am sorry to hear about what happened in your case. I am in total agreement with you. I find myself fortunate in my situation that my docs were somewhat agressive in the treatment. I am 48, was 47 when first diagnosed. My PSA was still relatively low, but in the 3 years I was getting test the trend was that the number was going up. 1.7, 2.2, then 2.9. That caused my primary care doc to refer me to a urologist. Only one core came back positive but both my urologist and the urologist/oncologist I saw for a second opinion recommended treatment. In January of this year I had DaVinci surgery performed and upon full biopsy although all the outside margins were negative, over 35% of the gland was impacted. Now if I had waited until I was 50 to start getting tested or get a baseline test, who knows where I would be. Early detection is so vital as it gives you more options for treatment.

Take Care,

The Nev
Posts: 50
Joined: Sep 2009

Some things the doctors don't tell you.

A little more to ponder in your decision tree. If your PSA is rising and you elect to wait for a biopsy and if it's cancer (I know a lot of ifs) the cancer does not grow in the middle of the prostate all of the time or even most of the time. It grows to a side or top or bottom and can be very close to the margins of your prostate. This is important because even if it’s contained and even if it's a low Gleason they may have to take the nerves on that side, this could have a huge effect on E.D. So waiting could be the difference in nerve sparing or not. Also just because the doctor doesn't feel anything on the D.R.E. that does not mean there is not a tumor nor that the tumor is not near breaking out or even outside of the prostate. There is only a rather small area that they can feel about 1/3 of the prostate so that means they can't feel 2/3 of the prostate. I had 5 different doctors do a D.R.E. on me and not one felt anything abnormal even though the left side of my prostate was full of cancer. Because of the size and area of the tumor they had to take the nerves on the left side. Once you have your biopsy remember the Gleason score frequently goes up after surgery path has a better view. This means if you’re a Gleason 6 when you have a biopsy there’s a good chance you’re really a Gleason 7, and a 3+4=7 is much different then a 4+3=7

So just trying to give you all a little more ammo to make your decisions and maybe a few questions to ask your doctors. 95% of you won’t be in my position so you can always play the odds, they’re in your favor; Good luck!

Posts: 100
Joined: Aug 2009


Thank you for the insight. Sometimes I get focused on the numbers (studies and odds) and forget about falling in the other 5%.

PCa is the seconding leading cancer killer of men in the US and will kill an estimated 32,000 men in 2010; therefore, I feel it is very important men do early screening and try to stay out of the 5%.

Thanks again for the post and Good luck and best wishes.

Kongo's picture
Posts: 1166
Joined: Mar 2010


I think your perspective here is right on the mark. Although hindsight is always 20-20, most men given the same circumstances as you would have reacted the same way. Even though my own experiences were less onerous than yours, I quickly learned to take most of what my GP said about prostate cancer with a large grain of salt. To be fair, that is not his specialty and it seems to me it would be quite daunting for any GP to keep up with all the latest technology in this field, but I expect that many men who have only a GP as their primary physican when their PSA starts to rise fall into a similar limbo. I think the insurance companies play a role here too as they will base their coverage plans on acutarial tables and discourage what the statistics may show as unnecessary tests.

The latest PSA "to test or not to test" controversy comes to mind here. While widespread PSA testing may have led to overtreatment in some cases and increased laboratory costs, those of us who were diagnosed with PCa as a result of rising PSA are mostly thankful for the guidelines that were in place before 2010.

Another major advantage of early detection is that you have more choices in treatment, particularly when PCa is detected in a man in his 50s or early 60s and is otherwise in good health. While the five year survival rates of treatment versus waiting may be the same, in many cases the cancer is not the same. I would much rather look for treatment options with a low PSA and Gleason score than waiting to see if it gets worse. Although waiting may be a good choice for some, and particularly for older men, I just don't think it's the best choice for the increasing number of men who find themselves with PCa while relatively young and without other health issues that might limit their treatment choices.

Posts: 1013
Joined: Mar 2010

I agree. Early detection of all cancers is VERY IMPORTANT!

Posts: 230
Joined: Jun 2009

I agree, early detection of ALL cancers is VERY IMPORTANT!
There is no other way to say it....early detection is the key to survival.
My wife and I can vouch for the fact that early detection of all cancers is important!
We are both cancer survivors.

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