PSA Testing Controversy – A Lesson Learned

The following article provides great insight into prostate cancer and the PSA testing controversy. The heart of the article is one man’s struggle with the disease.  Unfortunately his doctor ignored early warning signs of the prostate cancer and did not order a PSA test because he was so young, at 47.  Once a PSA test is performed, a year and a half later, his results came back at 16 and increased quickly to a PSA test score of 32. This story provides an important lesson about taking control as early as you can and monitoring your own test results. 

 Prostate cancer: The facts and the dangers

Palm Beach Post:  Feb. 15, 2010

When Keith was diagnosed with prostate cancer at the young age of 49, he was resolute: “I was bound and determined not to let it change my life.”

An engineer by training, he decided he would tackle the situation as any engineer would approach a technical problem: weigh the data, develop a plan.

But three years after his diagnosis, despite his best efforts, Keith says, he cannot lie: Prostate cancer has changed his life. It’s one thing to read that a therapy has side effects including incontinence and impotence.

It’s another thing to live it.

“I think for a man to be told, or to come to realize, that he may never couple with the woman he has loved for a lifetime?” he searches for words. “That’s kind of tough.”

Prostate cancer is generally the “lucky” cancer. It’s usually slow-growing. It usually doesn’t spread. It usually responds well to treatment.

But there are exceptions.

Each year, 200,000 men are diagnosed with prostate cancer and about 30,000 die of it.

There has been controversy over a study that concluded too many men may be getting tested for prostate specific antigen at too young an age, leading to unnecessary treatments.

Dr. Abraham Schwarzberg, an oncologist with the Lake Worth-based Cancer Center of South Florida, thinks there may be some truth to those findings.

“Some people will live with their prostate cancer forever, and it will not be clinically relevant,” said Schwarzberg, who is affiliated with Massachusetts General Hospital.

But for other men, the cancer can be life-threatening. Schwarzberg said he watches not just the PSA, but its doubling time and something called the Gleason score, which tells how extensive the cancer is.

“We are learning that PSA doubling time is one of the most important predictors of how aggressive a tumor is,” Schwarzberg said.

“If someone is a young person whose PSA is doubling every three months, that’s not the person you want to take six months to make a decision on.”

That was Keith.

He began to suspect something was wrong when he was 47 and he was having difficulty urinating.

The prostate is a walnut-sized gland that sits in a delicate spot between the bladder and the rectum, at the base of the penis. Its job is to help produce semen. When it becomes enlarged with cancer, it can block urine flow or produce blood. But infection can do the same thing.

Keith was so young that his family doctor told him it was probably nothing. A year and a half later, an exam showed an enlarged prostate. A PSA test came back at 16.

“They called me and said, ‘You need to get in to a urologist right away.'”

A month later, a second PSA came back more than twice as high, a sign he didn’t just have prostate cancer, he had fast-growing prostate cancer. Watchful waiting was out of the question.

Some studies suggest that by the time most men are in their 80s, half of them will have at least some cancer growing in their prostate.

Jesse Seligman, who is 85, watched his father die of prostate cancer. Seligman runs the prostate cancer support group at Wellington Regional Medical Center. While breast cancer has come out of the shadows, most men still wouldn’t think of discussing prostate health with each other. Seligman thinks it’s time to start.

Men will have a chance to do that on March 20, at the Third Annual W.B. Ingalls Memorial Prostate Health and Cancer Seminar, which will take place all day at The Scripps Research Institute in Jupiter. Nationally recognized scientists and physicians will speak on controversies surrounding testing, as well as advances in treatment. To reserve a place call (561) 776-6666 or go to www.myhir.org.

One of the toughest things about prostate cancer is that there is no one right treatment.

Many doctors would advise surgery for a man Keith’s age. But when Keith interviewed several surgeons, he was told he should expect to lose the ability to have an erection after surgery, and he could not be guaranteed that they’d manage to get all the cancer.

He chose radiation, along with androgen deprivation therapy, hormone treatments that block testosterone. The hormone treatments alone can cause impotence. The issue of side effects is not trivial, doctors said.

Dr. Neal Rothschild, an oncologist, discusses many factors before recommending a course of treatment.

“For every patient it’s a different equation. You look at tumor factors, patient factors, age, other medical conditions,” Rothschild said. But in the end, “the decision is ultimately always the patient’s,” he said.

Rothschild helped found the Palm Beach Cancer Institute in West Palm Beach. An affiliated foundation supports the Sari Asher Center for Integrative Cancer Care, where free counseling is available for cancer patients. Call (561) 578-5900 for an appointment.

Keith says he’s telling his own story to encourage men with concerns to see their doctor and ask questions. But he doesn’t want to share his full name and profession. He works on long-range projects, and he’s worried that his clients might drop him if they knew he had cancer. Keith speaks with a sense of wonder at his wife’s loyalty, her love and her support through his ordeal.

They have been together for almost three decades now, and he loves her more than ever. There has been some good from his journey with prostate cancer.

“I have come to learn the difference between intimacy and sex,” Keith says.

PROSTATE CANCER FACTS …

•The prostate gland lies between the bladder and the rectum, at the base of the penis. It’s normally about the size of a walnut. It helps men make semen.

•About 200,000 men a year are diagnosed with prostate cancer. About 30,000 men a year die from the cancer.

Prostate cancer is common, often slow-growing

•Usually, prostate cancer is slow-growing, so that it can take 10 to 30 years for a tumor to grow to the point of causing problems. For that reason, prostate cancer is often treated with ‘watchful waiting.’

•Other options, radiation and surgery, have frequent side-effects including incontinence and reduced ability to have an erection. Those need to be discussed with a doctor. Treatments may be accompanied by hormone therapy.

For more information: www.cancer.gov/

ATTEND A LECTURE

Attend the Third Annual W. B. Ingalls Memorial Prostate Health and Cancer Seminar on March 20. Sponsored by the W. Bradford Ingalls Foundation, the seminar will bring together nationally recognized scientists and physicians expert on topics ranging from the usefulness of the PSA test to advances in assessment of risk and treatment of prostate cancers. The seminar will be held at Scripps Florida in Jupiter from 7:45 a.m. to 3:40 p.m. To register call 561-776-666 or go to www.myhir.org/.

Jupiter Medical Center is offering several upcoming lectures on prostate cancer and related issues. Reservations are required. Call 561-745-5737 .

On Wednesday, prostate cancer screening will be discussed from 5 to 6 p.m. This is intended for men over 50 who have not been diagnosed with prostate cancer. Please RSVP. Call 561-743-5069.

On Thursday, prostate cancer screening and diagnosis will be the focus from 5:30 to 6:30 p.m. at Jupiter Medical Center meeting room one.

On Feb. 25, treatment options, including surgery, radiation therapy, brachytherapy and chemotherapy will be addressed from 5:30 to 7 p.m. in Jupiter Medical Center’s meeting room one.

For more information go to www.jupitermed.com/events

CONNECT WITH OTHERS

Free counseling is available through the Sari Asher Center for Integrative Cancer Care, a project of the Palm Beach Cancer Institute Foundation, 1411 North Flagler Drive, West Palm Beach. For more information call 561-578-5900 .

A support group meets at Wellington Regional Medical Center on the first Friday of each month from 7 to 9 p.m. in the conference center. For more information, call the facilitator, Jesse Seligman, at 561-963-3412 .

The 5-YEAR SURVIVAL RATE

for men with prostate cancer that has not spread is nearly 100%

The 10-YEAR SURVIVAL RATE is 86%

The 15-YEAR SURVIVAL RATE is 56%

THOSE WHOSE CANCER WAS CAUGHT TOO LATE

Telly Savalas

Actor

1924 – 1994

Billy Bixby

Actor

1934 – 1993

Linus Pauling, Ph.D.

Scientist, Two-time Nobel Prize Winner

1901 – 1994

Frank Zappa

Musician

1941 – 1993

Timothy Leary

LSD advocate

1920 – 1996

 

By Stacey Singer

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