Medical Public Service Announcement

[JohnMOhio]

Thought I would pass along a recent experience I have had and maybe it will help a few of my fellow posters.

There has been controversy lately about men getting results when they have a PSA test for Prostate Cancer and it being worth the effort cost wise verses results. I can now tell you that it is imperative that you have the test done. I have to get a blood test every six months due to the medicines I take for a heart condition. Once a year, I have the PSA test done. In Nov. 2009 I had the test results and they were in normal range for me. Six months later, the doctor made an error in requesting it again, showed slight elevation. No concern that approaching the age of 70, the results are expected to show a rise in the test results for all men as we get older.
The following 6 months blood test, we got back on schedule for the yearly PSA test again for November 2010. Again the results showed a slight increase but well below the 4.0 rating they use as a guide. This past Novermeber, the test was again done and the results came back with a 3.7 reading, again below the 4.0 rating guide.

To make this story shorter, I decided to consult a Urologists, gave him the test results and family history, he suggested we do a biopsy. The results are back with good news, bad news as they say. Bad news, I have Prostate Cancer. The good news, with combining the 3.7 PSA and the Gleason test, I have an 88% chance that the cancer is confined to the Prostate. I will be going for the Cat Scan this coming week and will be going for radiation treatment most likely the following week.

I highly suggest that you make sure your getting a PSA test after the age of 40 and that you watch the numbers yourself. My primary physician felt that 3.7 reading was within range and not to worry about it. I didn't worry about it, I did something about it on my own. If you want to make sure, get a second opinion of a Urologists and find out where you stand. Don't rely and the guide readings of 4.0 as the bench mark the medical people have set. Early detection is your best bet. It is not all that uncomfortable having someone look "up your address" for a biopsy but it is a darn better the doctor finding no one at home in your prostate. It is your life, live it and make decisions based on your gut feeling. You just might be right.

Hope this will help some of you that have not been to a doctor in a while for a PSA testing.

Best regards to all.
John

Please disregard all punctuation and spelling errors.

[dave]

IN my experience its is not the number that matters as much as the number having a study raise (this is what most docs will tell you). I had a 7.3 reading at about 59 yrs. The doc ordered another 3 mo. later and it was 7.0, which he said was about the same (test is not accurate down to the 10ths). So I had a biopsy and no cancer was found. A biopsy can only reach one side of the gland, not the 'back' side as its done thru the colon wall. A year later I had a PSA of 10.2 and another biopsy, of 9 samples 3 were cancer. Had prostate removed, cancer confined to the gland.
Its been 17 years now and PSA is always below 0.0-something. The younger you get it the more aggressive, faster growing it usually is, older-slower growing. Father was found to have it at 80 yrs., doc said he would die with it but not from it. His heart just gave up at 93!
I thought the biopsy was VERY uncomfortable, it hurt, in fact! But every one is different!
PSA tests should start early, age 50 at least, so a base line can be achieved.

[JohnMOhio]

I agree with you regarding watching the numbers rise. I suppose everyone is different and have always been told that anything above 4.0 should be a concern. Again the changes I noticed caused me to do something about it. Also, my Dad had it and was told the same thing. Unfornately, his heart gave out at age 84.

Glad to hear that you are a survivor.

[PhillipM]

I've been thinking about adding saw palmetto (http://www.preventive-health-guide.com/Nutrition-Men.html) for prostate health and Luten + Biliberry (http://www.preventive-health-guide.com/lutein.html) for eyesight to my list of supplements.

So far that list includes:
Centrum multivitamin
1200 mg Calcium. They can't put enough calcium in one multivitamin pill
1200 mg extra strength fish oil (http://www.bodybuilding.com/fun/4-main-fish-oil-benefits.htm)


I take a lot of pills each morning to avoid taking prescription pills later, lol!

[UUURah]

Good info, good topic. Affects all of us old codgers one way or another. I could write a book on Prostate, I know it backwards and forwards, inside and out. All of what my old friend JohnM says is true. Also, no two people's situation is the same, our Prostate situations are as varied as the size of our .... Prostates.

My situation evolved like this. While still working 7 years ago, I decided to have a physical and had not had one for 4 years. The GP did all the tests, all came out good. But doing the finger wave, he said my Prostate was "slightly enlarged", probably normal for "your age". My PSA was about 3.3. He said to come back in 3 months and they would do another PSA for free. He lied because the lab still charged for the test.

Anyway, it came up slightly, to about 3.5. He said I should see a Urologist and scheduled me an appointment. Remember, a GP might do 5 - 10 finger waves a day. A Urologist does 100.

At the Urologist, he did one finger wave and said I had "something" there. Scheduled biopsy. Bingo. Caught it in the early stage, supposedly. In scheduling the operation, it took a few weeks, then the doctors went on vacation skiiing for a week. It was probably two months after my first exam before the operation took place. In the meantime, underwent a "bone scan". I was able to watch it on the little screen as it scanned my body. Showed the white spot down there. Showed white spots on top of my shoulders where arthritis was, from years of playing fast pitch softball. Also showed white tips of my toes where the old nurse didn't have me take off my steel toe boots. I wondered if she really knew what she was doing.

Here's the kicker. At the hospital after the operation, PSA was then about 3.7, doctor came out and told wife that I was lucky, it actually was starting to "break out" of the Prostate. Said that if I had waited 6 more months .....curtains. Well NO SHEITE. All the stalling around. Turns out I still had a slight number so had to undergo some radiation. Talking to a guy there one day, a younger guy in his early 50's, he said he was going to work in Iraq and at a physical his PSA was 11.0. So this ties in with what JohnM said. It does vary greatly with age.

It's been seven years and PSA has been fine, 0.0. Once a year, I make sure it's tested. But I cut nearly all beef out of my diet. For about 3 years before my diagnosis, I had been eating Hamburgers and Fries EVERY day. Now, it's only Chicken or Turkey Burgers.

Go ahead, call me a Wuss.

[JohnMOhio]

UUURah, I know what you mean about diet. Been watching the red meat thing for 24 years and eating more veggies etc. as suggested by heart doctor. Now he has restricted me on some of those due to an erratic heart beat earlier in the year and a shock treatment to get the beat back to normal. Just prior to that, kidney stones, changed diet again.

Now, with this prostate problem, that diet conflicts regarding certain veggies that was suggested for heart treatment. You can only eat so much chicken so many ways and it still tastes like chicken. Then throw in some fish inbetween and you still have to watch which species of fish, not only because of what they contain from them eating the wrong stuff but the fish itself.

The more I look at the diets, I think I will be eating pine cones and tree bark pretty soon and have to stock up on wild berries or something in that area. My mid-life crises has now occured at 70 and I didn't think it would be this. With 70 years left to reach my goal, dieing at the hands of a jealous husband, I can't seem to wait for the next chapter to unfold. Life sure is interesting so far.

John

[sid]

I have read all about the current fad of "wait and see." From my own experience I would regard this as bad advice. Ten years ago, at age 71, I was diagnosed with prostate cancer by a competent urologist. He said that I was too old for surgery since 70 was the usual cut off for this. I was given 2 options, either radiation or brachytherapy. I asked the doctor which one he would choose if he was in my shoes. He said brachytherapy and I followed through with this. The treatment involves planting radioactive seeds in the prostate. I was able to leave the hospital the same day as I had the procedure and recovered quickly. Brachytherapy has a high cure rate and a low incidence of side effects such as impotence. It has now been 10 years and I am completely cured. Had I taken the wait and see approach I would have died.

Those who advocate wait and see do so because most prostate cancers develop slowly, but this is not true in every case. It has to do with something called "the doubling rate." This involves how long it takes the PSA number to double. I know of one case where the PSA doubled very quickly and the man was dead in 18 months.

[Deano41]

All of us here that visit CSP play with things that go boom. The reason we are all still alive is because we respect the inherant danger of what we are handeling. Keeping an eye on the prostate in later years is just good sense.

My PSA jumped three points in three months last year. I went to the urologist and he found the cancer. A good friend told me "pay the extra money and have them give you an anesthetic when they do the biopsy". I thought he was kidding, but I jokingly mentioned it to the urologist. He said he always numbed the area. It turned out, my friend wasn't kidding. My doctor told me some of the old timers don't numb the area because they think it skews the results, but the new guys proved that wasn't true.

There ar four choices of treatment. "Watchful waiting" (to me that's like having a hang-fire).
Surgery (total removal of the prostate)
Beam Radiation
Brachytherapy (radioactive seed implant)

I had Brachytherapy. And like Sid said, so far it has been sucessful. However, the choice is up to the indivdual, and I wouldn't try and tell someone what to do. The message is, DON'T ignore it or put it off.

[Clark Howard]

Before you blindly follow the advice of a workman who makes his living doing surgery, you might want to check out " The Invasion of the Prostate Snatchers" by Ralph Blum. My friend had removal surgery in November 2010 for an 8% biopsy return. He is still wearing a diaper with no wood in sight. Pay your money, take your choice. Regards, Clark

[John R.]

I read ALL of your posts with great interest ! Most of us who hang our hats here are probably over 50 and although I don't know the ratio of military service vets to NON service vets I think that it's quite HIGH. Many of us have also"seen the elephant" too in either WW2(very few anymore due to the age factor (and G*D BLESS ALL OF THEM TOO !!) Korean WAR vets and those who served in BOTH WW2 and Korea also dwindling.
Vietnam vets abound(thanks be to G*d ) and now receive their just recognition FINALLY ! Then, many of our younger members are either Desert Storm or Iraqi vets or BOTH,We aren't short of folks who have done ALL THREE sandboxes either.

My point being many of us are getting kind of "Long in the tooth" as it were.

Oversized prostates are VERY COMMON according to my Urologist friends.Zeke Perler is approaching 80 and Ryan Paterson is in his early 40's and BOTH are well respected adjunct professors of Urology.LISTENING to what they have to say is IMPORTANT but YOU have input too.Some guys aren't too keen on getting the "Rigid Digit" inspection.Put the unpleasantness aside and LISTEN UP MY FRIENDS.

I had a close friend who was well known to collectors of cased Colt percussions and Colt "Lightning" slide action rifles.His name was Chester P.Bonoff MD.He was also the father of Carla Bonoff the noted singer as well as Lisa his older daughter a Professor at Northridge University in CA.Chet had been a noted Radiologist as was his Father before him.Chet was in his 80's and a Veteran of the last days of fighting on Okinawa as a US Navy Doctor too.

We normally had a chat for a bit 5 to 6 nights a week.One night at the usual time my phone rings and I look at the call display but don't recognize the number OR the area code.I pick up the handset and say good evening and it was Chester and he did NOT sound all that great ! I asked where he was and was told Santa Monica Med.I got a flash of worry and asked WHY ? Seems that Chester got up in the middle of the night to take a whiz and NOTHING HAPPENED but he could feet that his bladder was FULL.Went back to bed but the fullness only got worse.So,he got up and got dressed and drove to the local hospital.Due to age and professional courtesy he sailed right into the ER and a young intern catheterized him and he had an "explosive voiding"(Chet's description) of the bladder.Next Chet was asked to roll over for the aforementioned "Rigid Digit" and predictably was told that his prostate was swollen to about double normal size.Received and immediate cat scan AND MRI and found that not only was his prostate affected ,but the tumours had metasticized to 3 places on his spine.

Obviously this was NOT a good diagnosis and he passed shortly before 9/11 and we spoke most nights right up until the end.I still miss him and his advice and always will.Here is what he told me and I have taken it to heart and hope and indeed PRAY that all of you will too.

Chet RELIGIOUSLY had PSA tests biannually.BUT he didn't like the digital inspections and being a Senior Medical Doctor nobody pushed the point.I too graduated as a MD but have never practiced NOR licenced(did ALL my clinicals as a student too but NEVER INTERNED post graduation)Chet was well aware of this.His ORDERS to me were "John,NO MATTER HOW UNPLEASANT THE "RIGID DIGIT" IS ASK FOR IT WHEN YOU SEE ZEKE PERLER" I have NEVER had to because Dr Perler(and Ryan Paterson who was a student of Zeke's before graduation) are very aggressive and a digital check is mandatory as far as they BOTH are concerned.Chet figured that he was good for MANY MANY MORE Riviera Shows had he only taken that rectal exam along with the PSA tests.

So,PLEASE listen to my passing on his advice so all of us can keep meeting here for MANY MANY more years.All jokes about making sure that the urologist ONLY had one hand on your shoulder aside etc PLEASE get that rectal check.It COULD save our lives !

A finer man than Chester Bonoff would be hard to find and a gun collector and shooter to the CORE too. So,let's ALL take his final advice and get BOTH tests i.e., PSA and the rectal digit.

"G*d Bless All here" as the Irish say !

Cheers,

John R.

PS Sorry that this got so long BUT it is sage advice from a VERY GOOD DOCTOR(Chester Bonoff and NOT me)

[Dave in NGA]

Thanks to everyone here for your thoughts and experience. It has helped to read about your experience. I'm currently awaiting an afternoon appointment with a Urologist. Seems I've been having prostate problems and pain in my groin. As you can well imagine the anxiety factor is rather high. Not looking forward to this but it's got to be better than the alternative. I've been doing antibiotics off and on for nearly six months and nothing much to show for it. Hopefully this exam will get to the 'bottom' of things and get a resolution.

[Art]

As far as I'm concerned the recommendation for less prostate screening is a cost saving deal related to Obama care. These are the same people that said women shouldn't get breast cancer screening before 50. Get screened, you won't regret it. Caught early this is a very fixable problem

It is said there are two kinds of men when it comes to prostated cancer; the ones who have it and the ones who will get it if they live long enough. A study of prostate cancer on deceased guys over 80 who were autopsied showed half of them had the disease though in many it was microscopic.

If it's detected early it's almost 100% curable if treated. All of the forms of a cure involve destroying the prostate by cutting it out, nuking it, freezing it, microwaving it (popular but not FDA approved so you have to leave the country for that one.) The FDA approved ones here all have the same result and the same side effects more or less. Probably the best non surgical option is Proton Beam Therapy which isn't available everywhere and is hideously expensive so your insurance almost surely won't cover it since the cure rate is no better than other options. A urologist told me that Proton Beam Therapy was originally created to treat pediatric brain cancer which is quite rare. Rather than have these very expensive machines sit idle they also use them to treat rich guys with prostate cancer.

As was mentioned above there is the option of one form or another of doing nothing. "Watchful waiting" is usually done for old guys with low PSAs, low Gleason Score tumors that are small. There is another doing nothing option, sort of, called "active surveillance" which involves PSA every 3 months and an annual biopsy.

In my case my PSA went up from a bit over 2 to a bit over 4 in a three year span in my early 50s. Well off to the urologist for a biopsy that was negative. My PSA stayed in the hight 3s to low 4s for 7-8 years then 2 1/2 years ago popped up to 5.7. A complicating factore was I had developed prostatitis which is notoriously hard to treat as well as being vastly uncomfortable. My urologist did a free PSA test which I recomment highly if your PSA bounces up. If the percentage of free PSA in your sample is equal to or over 25% your chances of having prostate cancer is very low no matter what your total PSA. This bit of knowledge may save some of you guys a biopsy. Be sure to ask for a total and free PSA should you get a bounce in your number. Also, having sexual intercourse, actually ejaculating at all, withing 48 hours of a PSA will raise your number a few tenths, so will the "finger wave" before the blood draw so keep that in mind when you get that PSA. Well after being treated for the prostatitis for several months with no decline in PSA and a free PSA of just under 20% (indicating a 1 in 3 possibility of cancer) I had a biopsy that disclosed a cancer the size of a number 6 birdshot pellet. One adviso on the prostate biopsy - this is important. Regardless of what you may be told, the prostate biopsy is a dangerous test. Infections from a prostate biopsy can be lethal. less than 36 hours after the biopsy that found the tumor I popped a hot fever and wound up in the local ER with a life threatening e-coli infection. I got out after five days on the nuclear weapons of IV antibiotics. IF YOU POP A FEVER AFTER A PROSTATE BIOPSY GO TO THE EMERGENCY ROOM IMMEDIATELY. 1% of men who get prostate biopsies wind up in the hospital. Dosen't sound like much until you realize that about 1,000,000 prostate biopsies are done a year which means that 10,000 men every year develop an infection from the test. The only bright side to the hospital stay was the industrial strength antibiotics did kill off my prostatitis :icon_lol:.

After I got out of the hospital I went back to my urologist who told me that any option to treat my cancer would work. I asked if I had a bit of time to think it over and he said there was no real rush. I decided on surgery but went to the doctor who treated me in the local ER for the infection who has an excellent reputation. He said with my relatively low PSA and my gleason score indicating a slow growing tumor "active surveillance" was an option. I went back to my urologist and informed him of this option and he said that if I was 72 instead of 62 he would be good with that but for a man in as good shape and health as me he preferred another option. He said we could try it for a while but he wanted me on Avodart. I asked why Avodart and he said that Avodart is used to treat enlarged prostate by supressing the production of Dyhydrotestosterone which accelerates tumor growth. It also artificially suppresses PSA so after a year the PSA number has to be multiplied by 2 to get the real result, ie PSA of 2.5 on Avodart equals a PSA of 5 off Avodart. I had a follow up biopsy after 10 months and it was negative (no it dosen't meant the cancer is gone it just means none of the 10 needles hit it. It's been over 2 years now on the "active surveillance" routine and I talked to my urologist about surgery in the future and he said frankly he now considers me one of the perfect candidates for doing just what I'm doing.

One word about the Avodart, which in my case is being used as low rent hormone therapy. It has sexual side effects in some people that increase with age. They include reduced libido, erectile disfunction, reduced or zero ejaculation and breast swelling and tenderness. I have every one except the breast tenderness. There is no free lunch in this.

My doctor says I'd had the disease for at least two years prior to diagnosis and possibly as long as 10 years, now that's a happy thought.

I am not recommending any form of waiting, it just happened to be ok for me up to this point. I do realize that any bump in PSA or any more growth shown by a biopsy will result in my having surgery anyhow. My brother just was diagnosed with prostate cancer at about the same stage and PSA as mine and opted to have his prostate removed and is very happy with the decision. I'll tell you right now that active surveillance is a pain in the a$$ literally as well as figuratively, so are the other options, it's just a matter of degree.

[Art]

Caught an error in my above. Prostate biopsies can be dangerous, not PSA tests.

[M1Riflenut]

You guys are scaring me. I just turned 48 so I think I'll stay at that age. :)

[JB White]

I go for blood screenings quarterly as part of my treatment for Menieres. Monitoring BP, diet, and trig numbers has gotten me off all the meds but for one. I supplement that with a multi-vitamin, omega3, and recently I added Vitamin A to my regiment when I realised my night vision starting to deteriorate. (Bad night vision makes it really tough to get home sometimes)
Now that I've established I'm under a physicians care on a regular basis, the PSA test has been done as part of the screenings but I don't recall how often that's done. Having read this thread you can bet I'm going to have a chat about it with my GP. Had there been any elevations over the years I'm certain he would have mentioned it. Heck, I get a scolding after my blood tests show I've been visiting the cute gal over at the candy store again.

I want to thank everyone here for contributing to this thread. Especially John who wasn't embarassed to share in the first place. Some things aren't thought about if they aren't a problem and a little prompt is good for a reality check once in a while. I was aware of most of it but only from a distance. The gravity of it all hadn't entered into my mind until now. I'm not paranoid at all. I just keep forgetting that I'm older than I think...no wonder that guy told me to stay away from....oh never mind.

[Weasel]

You guys are scaring me. I just turned 48 so I think I'll stay at that age. :)

I started having problems at 47 and one of the managers for Enterprise near here started at 33. I have been lucky that medication has keep it in check but I know that it is just a matter of time before it will have to come out. It can hit you anytime and any place. No male is exempt from it. One bad thing about it men just don’t talk about it, it’s like hiding it under the rug. When I first had problems I had no idea what was going on because no one talked about it. There is nothing embarrassing about it so ask and talk about it. If nothing else get that PSA test and talk to your doctor.

[JohnMOhio]

I am glad that my starting this has gotten some of you to think about yourself in a different manner. We are not in our 20's anymore and have the world by the tail. Have to admit it, we are getting older, like it or not. Many of us have chosen different methods of treatment for various reasons and commend those that have gone the extra mile to voice their experience. And like said by one of the posters, side effects are pretty much the same. Some are immediate, some will show up a year or two down the road. However we can live with some of the side effects and still have memories of being young. That is until we get to old to remember. By then it doesn't matter. Meanwhile, life is to darn short as it is, and when I think about the last 50 years, I just doesn't seem right that I got here this quick.

There are still things I want to do, get to Perry and do the 1,000 yard match. Now to decide which gun to do it with is my next concern after all this other crap that is delaying me from going is taken care of. Thought I would make it this year but didn't, planning on next year to make the trip.

More personal things, I want to be around when my two Grand Daughters get married and or graduate from College. I don't get to see them that often and I cherish every minute I do spend with them. Just in case I don't make it, I have fun with them at my own expense and make them laugh from the time I arrive to the second I leave. Having them call me their Silly Grandpa makes me think they will remember me long after I am gone and maybe they will tell stories about me as I have told them the funny stories about my Grandfather. I think those are the best things I can leave for them. But that is only an opinion of a Silly Grandpa.

[Deano41]

One thing I didn't mention. A friend at work is a Vietnam vet, and served at Cu Chi. Apparantly this was an area that was sprayed with Agent Orange. He had gone to a civilian doctor (the old timer that didn't use anesthetic for biopsies), and when the doctor finally found the cancer (after the third biopsy session), he told the doctor he was going to the VA. This was his first encounter with the VA. He took his DD214 with him. One of the veteran advocates (I think it was the MOPH) helped him with all the paperwork and sheparded him through the hoops. The VA took care of everything at no charge. It's a longer story than needs to be here, but the bottom line is, for those that qualify for VA benefits, it's worth it to go to the VA and get it checked out.

[UUURah]

Caught an error in my above. Prostate biopsies can be dangerous, not PSA tests.

You DO know that it is possible to EDIT your post.

Yes, the Prostate Biopsy can be dangerous because the probe has to go through the colon, makes a small puncture in the wall. We know that's not the most clean area down there. It's why my Urologist always includes a few days of antibiotics when he does it. I would be sitting in the reception area and see guys walk out with bottles of something. I found out what it was when it was my turn.

For me the biopsy was mildly irritating, a slight sting. But one of my best friends, an old Marine buddy who had his Prostate problems the year before me, told me he hated it, that it was very painful for him. Guess he is just a WUSS. So that part of the whole procedure, like the rest of it, varies from person to person. One other thing. He chose to travel to the big medical center in Houston to have his done. But he still had the same problems some of us does, some urinary problems and some ED problems.

Oh, one other thing too, for all who will undergo surgery. You are told to get out and WALK. He did, I would see him walking down the street soon after his surgery. So I believe he "rehabbed" fast. I, however, could not drag myself out of the house for 3-4 weeks. So it required the entire 6-8 weeks before I was well enough to return to work. And even though I was in excellent physical condition back then, It was nearly a year before I could call myself fully over the operation. Anyway you slice it, opening up your gut for any reason is a major operation. The reason why it's not an operation for an "older" person.

Personally I am glad that it hit me when I was relatively young and in good physical condition.

[Art]

You DO know that it is possible to EDIT your post.

Actually I did edit my post and the note on the post under reason for edit shows why, it was a significant enough brain f@rt that I decided I would make a note of it in a short post to avoid appearing a total dolt.

People tend to tolerate the biopsies differently, I have a very tight sphinctor so it's a bit hard to get the probe in there. After that I just find the proceedure moderately unpleasant.

[Deano41]

I knew what you meant Art, that's why I didn't comment.

Not to scare off the younger guys, here is what I told the oncologist about the biopsy.

"Developed in 1938 by the Gestapo as a means of getting information, the prostate biopsy was also discovered to be useful in diagnosing the presence of cancer."

I thought the oncologist was going to fall off his chair laughing. Hey, humor is how I deal with stress.