Was the Cancer Cryotherapy Successful? Good Question (The PCA-3 Test)

On arriving at UC Health in Aurora on Oct. 11 for my 4 month post op assessment, following the prostate salvage cryotherapy treatment in June, see. e.g.

 

http://brane-space.blogspot.com/2017/06/fighting-prostate-cancer-at-90-c-my.html

I was optimistic that the  PSA test would reveal a reading lower than  2.0 mg/ dl which was the level one month after the therapy. We had to arrive by 1: 30 so I could first go to the on site Oncology hematology lab for the PSA and % free PSA test.. I had to wait about 30 minutes and this meant the results would be roughly an hour delayed in getting to the urology professional assistant (Kristen) with whom I had to meet by 2:30.  

The test was done expeditiously by a medical tech and she said it would immediately be sent for analysis.  Meanwhile I went up to the 2nd floor Urology center to wait to be called for my appointment with Kristen. 

On being called right on time, I first had to have weight and BP taken by the RN assistant, then turned in a sheet with ratings for different urological -sexual functions, e.g. frequency of urination, retention of urine, erectile quality etc.  This data was then entered by her into a computer for the Urological PA to access.

Ten minutes later, Kristen appeared with her computer screen open and we went through the responses. She remained concerned about the urinary and erectile difficulties but assured me this was often a side effect of the cryotherapy - especially for older patients undergoing a salvage treatment (i.e. a second treatment, usually after a primary radiation treatment).  In my case, the primary treatment - the HDR brachytherapy done in September, 2012 at UCSF.

Again, she reiterated the erectile issues were not merely sexual but the importance of getting blood into the tissues, to remain healthy.  Hence, she prescribed a  low dose (5 mg) PDE inhibitor .  Recall the chemical pathways here: the cavernous nerves close to the prostate gland secrete nitric oxide which stimulates release of an enzyme (cyclic GMP) inside the smooth muscle cells. This promotes relaxation of smooth muscles and erection. An enzyme known as PDE5 prevents this,  else there may be a prolonged erection. Hence, a PDE5 inhibitor works to suppress secretion of the PDE5 enzyme.

About fifteen minutes later after the free PSA and PSA test results arrived on her laptop, she informed me of the results: 2.09 PSA and 4.8 % free PSA.  As she explained to wifey and me these results were not sanguine, especially the latter. In the case of free PSA you want the % as high as possible to indicate most of the prostate specific antigen is bound up with normal prostate cells.  The combination of the two results, she noted - using an on site software program developed by Dr. David Crawford - yielded a 55 percent probability the PSA was due to malignant cells.

This then led to her doing a urine test called the PCA-3, which is well explained by this UK site,

http://www.cancerresearchuk.org/about-cancer/prostate-cancer/research-clinical-trials/research-diagnosing-prostate-cancer/pca3-test

Noting:

"The test is in two parts. You have a rectal examination and then a urine test. A rectal examination is where the doctor puts a gloved finger into the back passage (rectum). It is possible to feel the prostate gland by doing this. You need to have a rectal examination because this massages the prostate gland and helps the PCA3 to go into the urine. You have to give the urine sample straight after the rectal examination. You normally get the results within a few days"

So with this in mind, she had me prepare and bend over her examination table, warning me in advance this would entail not only the usual DRE but also a prostate massage to force the biomarker into the urine tract.  Hence, there would be a degree of discomfort.  In this she wasn't kidding, and  while the entire procedure lasted just  over three minutes it felt like three hours.  While not painful like a trans-rectal biopsy it was definitely no 'walk in the park' - even a short one.

As she massaged the gland she told me what she felt, including "lumpiness" which was a "result of the cryotherapy".  She said that the process of the massage should also relieve pressure on the nerves as well as pushing fluids into the urinary tract.

Immediately following the procedure she handed me the specially labelled cup to produce a urine sample, using the bathroom across from the exam room. I confess it took seven or eight minutes to produce a stream of urine even adequate to get 1/3 the cup filled.  She later explained this was normal and was a result of the massage.

With the sample delivered, we left - prescription in hand - and booked the next three month visit on the way out. As I mentioned to wifey, I just hoped the numbers - including from the PCA-3 test- would be much better next time. Else, what was the point of going through yet another prostate cancer treatment?

Any positives? Anything? Well, after turning in on the night of the procedure I experienced the first nocturnal emission in nearly fifty years.  While irritated about having to change underwear, sheets, I did consider that the prostate massage -though extremely uncomfortable- did produce at least one  seeming positive "return".  In fact, on four successive nights I also experienced nocturnal erections that had been absent since the cryotherapy on June 20.  As wifey joked, "the trick is to translate them into day time erections".  Well, one step at a time!


See also:

https://emedicine.medscape.com/article/1948091-overview
 

And a detailed published paper on the PCA-3:

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382011000600006

Examining The Basis For New Prostate Cancer Screening Recommendations

Image from a 3D staged biopsy - the only type that can eliminate false positives.


Many men are confused after the latest shift in advice from the U.S. Preventive Services Task Force's  2012 recommendations against prostate cancer screening.  At that time the advice was less screening, specifically via the PSA test, for men even past the age of 55, noting that the "possibility of the PSA lowering deaths from prostate cancer was very small." .  The reasons were not hard to grasp, mainly that one can get false positives which put the tested person on a track for even more invasive tests including unnecessary biopsies.  These can carry their own risks, including sepsis, impotence.

For example, the standard prostate biopsy consists of an extraction of from 10 to 20 cores of tissue.. Thus, a needle device is inserted into the rectum and each time extracts tissue from the gland after puncturing the rectal wall. The primary risk is for sepsis, which is why antibiotics like ciproflaxin must be administered in advance.

The procedure is usually done in the urologist's office without even a sedative and takes from 20 minutes to 45 minutes, depending on the number of sample cores taken. The chief side effects include: swelling and pain in prostate, possible problem urinating, and blood in urine, stools and semen. In the former two body fluids it can remain 1-2 days and in the last up to 3 months.

Even given all this, the biopsy is basically "random" and can miss up to 30 percent of cancerous lesions.  By contrast, the 3D staging biopsy entails up to 100 needle sampling insertions through the perineum to extract prostate tissue. The locations are again confirmed via trans rectal ultrasound for later mapping of all the samples to a 3D grid. The meticulous and exhaustive sampling ensures nothing is missed, hence represents the "gold standard" for prostate biopsies with up to 99 percent confidence of identifying all carcinomas.

The downside is, while vastly more accurate, it entails a far greater medical burden. Thus one must undergo a full surgery prep for general anesthesia, including being asked if you're an organ donor, and to leave an advanced medical directive .  The main risk is for hemorrhage, given the dozens of extractions.

A confirmation of lesion, however, then also is more accurately graded (by Gleason score) and can allow more choices in terms of treatment which one may not have with the standard biopsy. (For example if the standard biopsy reveals a higher Gleason score than the lesion actually merits, as I learned in my own case - after getting the 3D staging biopsy)

Now, in the new advice from the U.S. Preventive Services Task Force for men aged 55- 69, the conclusion is that the benefits of getting the test are marginally enhanced over the risks. This has been ascribed to "additional medical evidence from some clinical studies increasing the certainty about the PSA test reducing the risk of dying from prostate cancer.".   Even so, the panel's qualifying remarks noted the balance between pluses and minuses "was very close", and advised men aged 55-69 to consult their doctors in deciding whether to get the PSA.

Let's note that the statistics show that for every 1,000 men who get screened, an estimated 240 will test positive on the PSA. Some share of these - maybe 10 percent - will show false positives meaning those men will be faced with unnecessary biopsies. Those who decide to get treatment run the risk of developing impotence and incontinence as a result of surgery or radiation.

Owing to these facts,  the Task Force recommendation for those 70 and older stands by its 2012 position that "the benefits of screening do not outweigh the risks". .  The reasoning, again, is that because most prostate cancers are slowly growing, by the time one is diagnosed - say at 70 or 71 - he is still more likely to die from any other cause than cancer. (Up to 50 percent have a form of prostate cancer that doesn't spread or grow rapidly.)

In addition, an older guy getting screened sets him up for even more nasty complications, as well as costly treatments that may not be needed, and in fact are unwarranted. This is assuming such a test is positive with "high PSA" say 5.0 or 6.0.  One is then liable to be trapped in the "rabbit hole" of cancer quandaries summarized by the aspects below:

1) Cancer experts themselves can't agree on which primary treatment is best.

2) The same experts (oncologists) can't agree on which ("salvage") treatment for recurrent disease is best, or when to start it.

3) Most agree that if a guy has recurrent disease and a biopsy shows it has spread to the bones ("bone mets"), his days are basically numbered - though certain treatments (e.g. hormone) will allow some limited life extension.

Now also, once driven into the treatment domain one will have to decide how far to go, i.e. how many and what type of treatments are you willing to get in order to grab maybe ten years of life? Are you even willing to go the medical castration route?

Recall I earlier cited the Prolaris genetic test for the aggressiveness of a prostate cancer tumor,e.g.


I cited my own score of 6.6, corresponding with a 12.5 % specific risk of mortality at ten years. That translated to a 1 in 8  probability of croaking from it if I decided to do nothing.  As my oncologist (Dr. Crawford) pointed out, most guys at age 70 would make that bet.  I'm not doing it because he insists I have a better chance getting rid of the tumor completely using focal cryotherapy. But the point is for many "watchful waiting" might be an equally ok strategy.

Watchful waiting, especially if a guy is younger (say than 55)  - becomes a dicier proposition especially if the Gleason score is 6. By now most everyone has also seen or read of actor Ben Stiller's bout with prostate cancer, e.g.
http://www.cnn.com/2016/10/04/health/ben-stiller-prostate-cancer/

But what they may have ignored is how the treatments and testing can often be worse than anything else - especially if one has a slow growing cancer. The risks of further treatments include sexual impotence and incontinence  The latter means wearing diapers - as in Depends - permanently. This is also why Otis Brawley of the American Cancer Society, has warned that most men need to be very careful before stepping through that testing and treatment door. Nine times out of ten the cancer will be so slowly growing that you can do 'watchful waiting' - especially for Gleason scores of 6 or less.

But ....also nine times out of ten a guy's significant other will insist the cancer come out as in out, out, out. The idea of living with a tumor that can grow - no matter how slowly - is a non-starter.  This is why it's a good idea for men and their spouses to have "the talk" ahead of time, say before the next PSA test. Decide in advance what PSA test value or threshold sets in motion further tests, including the "free PSA" test, MRIs and prostate biopsies (including MRI fusion biopsy.)

'The Great Prostate Hoax' - A Must Read Book For Every American Male

When the doctor who discovered PSA writes a book about how the PSA test is basically a sham, and a device used to amass tens of billions of bucks for the urology sector of the medical industrial complex, you have to pay attention. Dr. Richard J. Ablin, author of 'The Great Prostate Hoax' described his discovery of the prostate specific antigen in 1970 as comparable to "the thrill of looking through a microscope and peering into the unknown reaches of space".

That thrill soon tempered by the misuse of a test (PSA) never designed to be cancer detection specific and hence "opening the floodgates for a tsunami of routine nationwide testing" (p. 7).  Dr. Ablin is adamant that the FDA made a "fateful error" to approve the PSA test as a means to detect prostate cancer. But as Ablin notes, PSA is even in healthy tissue and it can spike from all manner of external stimuli including: riding a bicycle, riding a horse, or after a rectal exam or colonoscopy. So what the hell use is it? Virtually none, as Dr. Ablin makes clear.

All it does, according to Ablin, is result in nearly a million risky biopsies a year - to the tune of billions of bucks for urologists- as well as tens thousands of unnecessary radical prostatectomies leaving most of those men mere shadows of their former selves. Often incontinent as well as impotent - even using Viagra every day and getting costly penile implants.

Ablin cites Dr. Alan Shapiro (p. 192) - once a promoter of the PSA- whose wake up call on the unnecessary harms caused by PSA testing arrived "when a 50 year old man came to his urology practice wearing a condom catheter - a flexible, condom -like sheath that fits over the penis and is attached to a tube that drains the urine into a storage bag."

As Dr. Shapiro put it (ibid.):

"This relatively young guy had a radical prostatectomy and now he couldn't get an erection or control his urine. He was crippled. "

This was five years before Ablin and Shapiro decided to make their documentary, 'Second Opinion', showing men who'd undergone the procedure recounting their experiences and later suffering. All the men lament the predictable trajectory that imprinted and ultimately altered the quality of their lives: the initial PSA test or tests, the advice to then get a biopsy because of a "spike" and finally the urging of the urologists to get treatment- usually radical prostatectomy because each one of those puts the biggest bucks into their pockets.

Hence, urology has become - thanks to PSA testing - one of the most lucrative branches of the medical industrial complex.

Ablin notes men are often pushed "to have it out" and so the initial reaction to a PSA spike or high level is an emotional response, often from their wives asking - "Can you really live with that cancer inside you?" Failing to realize that after their hubby follows her imperative he will no longer be able to have any kind of sex with her. Thus we behold the power of naked emotion to sway sound scientific judgment. Of course, there are exceptions - but these are not the "rule" - something its eager advocates forget or neglect.

Ablin essentially insists a man ceases to be a man in many vital respects, after this surgery. He writes for example (p. 36):

"A man can live without his prostate but once it is removed he suffers varying degrees of physical and psychological changes."

He goes on to quote one patient who actually wrote a book, 'I Want My Prostate Back':

"He wasn't the same man after the robotic surgery and pulled no punches talking about it. In an article in Men's Health, he wrote: 'Without any ejaculate I felt like a broken toy, like a water pistol that squirts jelly. Or nothing"

Harsh words but he cuts through the BS surrounding the test, just as Dr. Ablin does in his book, including all the flack he's taken from the nabobs who are trying to protect their profitable lives.

Perhaps the best chapter is Six: Unintended Consequences, wherein we learn of the battle between the American Urology Association (AUA) and the U.S. Preventive Services Task Force, which had noted as early as 1993:

"The Task Force has determined that PSA screening fails to meet the criteria for effective screening. The test lacks accuracy in detecting early stage disease. There is little evidence that early detection of prostate cancer improves patient outcomes and there is mounting evidence of the adverse effects of testing and treatment."

It took nearly 20 years of ongoing PR battles with the urologists - remember they pocket a pretty penny from biopsies as well as surgeries - before the Task Force recommendations became generally accepted and have now  - in the past year- yielded for the first time fewer biopsies as well as cancers detected. While a segment of the pro-PSA bunch is still left to hair on fire screeching, blasting that "all those men not getting screened are playing with their lives" the evidence simply isn't there.

As Ablin notes,  prostate cancer is an inevitable disease of aging. By age 65 nearly half of all man have some manner of "neoplasm" in their prostates. By age 85 it is nearly 95%. What? We're going to cut out all those cancers despite the fact they're all likely to die of anything but prostate cancer?

Let's also bear in mind that Richard Ablin's take on the PSA test is not new. Years before we beheld medical author Shannon Brownlee's take, in her book 'Untreated: Why Too Much Medicine is Making Us Sicker and Poorer' (2007, p. 202):

"The evidence suggests that PSA testing is not saving any lives, and even it is the large numbers of men who are treated unnecessarily are paying a terrible price. They're the equivalent of civilian casualties in our war on cancer.".

That take very nearly resembles Ablin's of havoc wrought across the years by this screening test which actually isn't cancer specific.

Yes, in the interest of full disclosure,  I did have radiation therapy treatment myself - under pressure from my wife, my urologist, my primary doc and others. BUT......as a fellow Intertel member emailed me (soon after I wrote about the experience in the Intertel Regional Newsletter 'Port of Call') I might also have lived with only minor problems (the cancer stage was T1c) and croaked eventually  of something else. This is because 97% of prostate cancers are slow growing. (Incredibly, 99% of males autopsied who are 80 years or older  are found to have prostate cancer .....and most never knew about it!)

Even if you're an avowed and dedicated believer in PSA screening, you should try to get this book and at least see another point of view. Those who are in the age range for such tests, or have medical providers who recommend getting it, absolutely should read this book first.

See also:
https://www.inspire.com/groups/us-too-prostate-cancer/discussion/psa-test-is-misused-unreliable-says-the-antigens-discoverer/?page=4

PSA Increases: Is It Time to Be Worried?

Well, a recent complete blood panel ordered by my primary care doc turned up generally terrific results - including 178 for cholesterol, 143 for trigylcerides, 43 for HDL cholesterol and 29 mg/DL for VLDL cholesterol. The one bummer in the mix was for the PSA (prostate specific antigen) which had gone up to 2.5 ng/ mL from 2.0 last December. Thus, in a period of just over the year from the brachytherapy HDR treatment, my PSA had gone up as opposed to continuing a steady decline down. I emailed my radiation oncologist immediately, and his take was that it appeared to be a "benign PSA flare" - but I needed to send him my PSA test results now every three months.

Evidently, this PSA "bounce" - called such in most of the literature, occurs in 25-33% of men following any kind of treatment, whether radiation or radical surgery (prostactectomy). Generally then, it will go down by 18 months (for radiation therapy) to 1.0 ng/mL and stay there or decrease. A "treatment failure" on the other hand, is defined as three or more successive increases in the PSA after radiation, especially if these exceed the limit of 2.0 ng/mL total increment.

Treatment failure is serious, since it means the cancer may well still be there as well as resurgent, and ready to create havoc once more. The options - after you've received the primary treatment, say high dose rate radiation as I have, aren't too wonderful or promising. Basically, in most cases, some type of cryogenic treatment (freezing the prostate), or anti-androgen hormone therapy (i.e. female hormones administered) and now, after some improvements in "morbidity" - a kind of 'salvaging prostatectomy" - where a last ditch surgery is attempted.

As I told wifey yesterday, none of these will be chosen as any option should I be deemed to have "treatment failure". I sure as hell am not getting any surgery now, having elected the radiation therapy, and especially with the considerable risks still in play and the fact that surgery on the radiated gland requires much, much higher level of competence as well as technical skill - including operating any da Vinci robot. Anti-androgens are out, after reading about their effects on one hapless guy (Victoria Hallerman's hubby in her book, How We Survived Prostate Cancer. She religiously documented how he constantly broke down in tears, was dogged by muddled, emotional thinking and basically poor judgment. This is all on top of the other effects, including enlarged breasts, etc. So thanks, but no thanks!

Fortunately, the odds remain in my favor, and I don't plan to toss the towel in so soon. As one site at McIver Clinic notes, with their own study - "The 10 year PSA relapse-free survival was 94% for the patients with low risk prostate cancer who were treated with Iodine monotherapy. " I like those chances, and they are surely as good for the UCSF Helen Diller Cancer Center- where I received my (Ir-192) brachy hdr treatment a year ago.

Now, the question becomes: How low does the PSA fall after radiation treatment? According to the same site:

There is no absolute threshold for the PSA nadir (lowest value), but our center uses 1.0 ng/ml as a goal for successful treatment. There is tremendous variation in the time it takes to reach a nadir after radiation. Some patients reach a nadir after a few months while others can take a few years. There is no absolute PSA nadir value that is accepted for success or failure or treatment. Many patients reach a PSA of <0.1 ng/ml and most are below 0.5 ng/ml.

This suggests I need not hit any panic button yet, and likely not for at least a few years, maybe up to 5 - if Dr. John C. Mulhall's take is accepted. Now, what is a PSA "flare"? The same site defines it:

A “bump” or “Bounce” that occurs 18 to 24 months after radiation. The levels can go up to 20 ng/ml. The evaluation reveals no recurrence. These “bumps” in the PSA occur in nearly 30% of patients. The cause of the flare or bump is not known. In most bumps, the PSA rise is temporary and then falls in a quick fashion – up and down over a 6 – 9 month period. A PSA bounce can be confused with a PSA failure.

Again, nothing to be overtly alarmed about, so far as I can tell, though yes, one would want to monitor changes over time. This is why the oncologist asked me to get tested now at 3 month intervals. Given this, how does PSA level as indicated in testing, relate to recurrence of the cancer? The site again:

Prostate cancer patients who have a lower prostate specific antigen (PSA) nadir (the lowest PSA value) after radiation therapy are less likely to have the cancer return than patients with a higher PSA nadir. The longer the PSA continues to fall and the lower its ultimate lowest value (nadir) the better the patient's chances of disease-free survival. In our patients, those that had ultimately had PSA at or below 0.5 ng/ml did not have a recurrence. Those that achieved a 1.0 ng/ml at 1 year did not have a recurrence.

The same FAQ notes that the nadir itself may not be reached for three years. Hence, there is time on my side before action becomes critical- or delay, inaction has grave consequences. How much - who can say? But I'd allott at least another 3-4 years before getting panicky. By then, perhaps - if recurrence has been concluded by my oncologist- I might seek further treatment. But at this stage, I have no plans to do so. After all, the bible says "three score years and ten" is allotted to a man, not that I am a bible believer, but with rising Alzheimers and what's going on in the world, also the approach of savage climate change, hey - who knows? Clocking out "early" may be the best thing!

Mail Call Brane - Readers Seeking Answers

Could you please complete the solution to the ship problem differential equation in your blog of May 12? I know you started the solution for many of us but I can't seem to finish it! -
Andy K., Omaha NE

Let's pick it up where the partial solution left off.  I.e. you had to integrate:

dv/ (g - av) = dt


To obtain:

ln (g - av) = -at + C



The hint was then provided that you had to obtain the value of  a  to get the integrating factor.

As given in the partial soln.:

(k/m) = a

=   (10, 000 f/s lbs.)/ (4 x 10 ⁶ sl) =  2.5 x 10 ^-3

Now, taking natural logs of both sides of the integrated equation and simplifying::

  v =  g / a    -   B (exp - a t)

But the condition from rest is v= 0 at t = 0,  Þ   B = g / a

So:  v = g / a   - [1 - (exp - a t)]


=  g / a  - [1 - (exp - 0.0025)t]


Then, if  g / a  = 20 f/s, v = 20 [1 - (exp - 0.0025)t]


And from this the terminal velocity can be found.  Remember as v approaches the terminal velocity the second term must approach 0. so effectively the terminal velocity is: v = 20[ 1 - 0] = 20 f/s

Which equals 13.63 mph when converted from  feet/ sec  to miles per hour.


Q. I must have missed something! In your June 4 blog post you explained how the Germans you met at Zugspitze aren't buying Tom Hanks' version of events in what you describe as an up and coming "HBO 13-part series". Could you elaborate a bit because I'm sure I must have missed some back story! - Jake, Oklahoma City, OK

A. This stems from the news last year that Hanks told Truthdig.com in an interview that he intends to "do the American public a service" - because he thinks they "have been snookered into believing that Lee Harvey Oswald was framed."  So, he plans to do a 13-part HBO series to remedy that situation - or so he believes. And he intends to use the mammoth book 'Reclaiming History" by Vince Bugliosi as his "historical" basis. Of course, the book is nothing of the sort, and has numerous problems of fact, history and logic which I already expatiated on at some length, e.g.

http://www.brane-space.blogspot.com/2012/04/vince-bugliosis-magnificent-obsession.html

and:

http://www.brane-space.blogspot.com/2012/04/vince-bugliosis-magnificent-obsession_29.html

and:

http://www.brane-space.blogspot.com/2012/04/vince-bugliosis-magnificent-obsession_30.html

and:

http://www.brane-space.blogspot.com/2012/05/reclaiming-historyor-redacting-it.html

and:

http://www.brane-space.blogspot.com/2012/05/reclaiming-history-or-redacting-it-2.html


Clearly, Hanks' hubris has gone to his head, along with his 3 Oscars and some success in making HBO docu-histories, such as The Pacific. I mean, cripes, the guy actually believes he's chief historian of the country despite the fact he probably can't even pass a basic test on the assassination! See e.g. http://www.brane-space.blogspot.com/2012/05/basic-test-on-kennedy-assassination-can.html

Readers interested in other takes on Vince Bugliosi’s debauchery of history can check out these links:


http://911research.wtc7.net/essays/green/BesmirchingHistory.html


http://realhistoryarchives.blogspot.com/2007/05/reclaiming-history-from-vince-bugliosi.html


Q. I had been on a high T regimen to build more muscle mass, but then last year started to develop pains in my lower back. It got so bad I had to see a doc, and strangely enough, he wanted a PSA test done. Well, I had it done and the result came back at 7.3. He now wants me to get a biopsy but after reading your account of it, and then the treatment options for prostate cancer I'm not sure I want any part of it! I know you will probably say to get it done, including treatments, but do I have any other options here? - Tony M., Sacramento, CA

A. Well, you could try watchful waiting. You don't give your age but that may only be a solution if you're over 65 or so. If you're a young man then I'd say you've got zero options left and you need to get the biopsy. It's the only way to ascertain if you have prostate cancer, where it's located and how aggressive it is.  Readers can see my account of the biopsy I had here: http://www.brane-space.blogspot.com/2012/07/notes-on-prostate-biopsy-dont-fear-and.html

The problem with waiting if the cancer (usually an adenocarcinoma) is aggressive, it that you may run out of options. At least at the early stage, say several cores and no Gleason scores over 3 +3 or 3+4 you have a range of treatment choices. But once the threshold is crossed to Gleason scores 4+3 or 4+4 or higher, you're basically down to the most extreme response which is generally a radical prostatectomy, and often adminstration of androgen suppression hormones afterwards.

My suggestion? Find a urologist or have your physician refer you to one, and get that biopsy! Oh, and leave those gels of T alone!


Q. I want to get your take on some recent responses to Edward Snowden's travels, especially this line that we've heard from Jay Carney, John Kerry and others in the administration:

"Mr Snowden's claim that he is focused on supporting transparency, freedom of the press and protection of individual rights and democracy is belied by the protectors he has potentially chosen: China, Russia, Cuba, Venezuela and Ecuador,"

Margaret S., Cincinnati, OH

A. What you referenced is the usual sort of false analogical rot trotted out by paid lackeys and other servants of the State and other State-System-Big Media actors. Can you take it to the bank? Hardly!  First, Snowden's ultimate and most important objective was preserving his own freedom, as opposed to wasting away in an Army Brig somewhere, being left naked for 24 hrs. a day for weeks (as Bradley Manning was), subjected to intermittent sleep deprivation and fed bread and water (ok, I exaggerate a bit on the last but only a bit). Hence, the choice of where he went must be seen in that light, i.e. with primary goal of avoiding the U.S. 'Gulag 'at all costs - after likely being given justice at the hands of a kangaroo court "grand jury" assembled out of Alexandria, VA (the domain of CIA, NSA, FBI)...

Also, to ensure no intervention he had to select nations that at least had some kind of power or leverage to stand up to a raging Uncle Sam. China and Russia met the criteria, for differing reasons.

The portrayal of both China and Russia as specious destinations for Snowden is absurd: China is now our leading trade partner for Pete's sakes - also our leading lender for all those Social Security, DoD and other monies! Russia assisted us with the apprehension of the Tsarnaev brothers, real terrorists!  Also, keep in mind Hong Kong wanted him out asap. He was a  PR liability and it was only on account of large pro-Snowden protests from thousands of people (and maybe some slight arm twisting from the mainland)  they laid off him, and let him leave HK for Moscow. Let's also bear in mind that China is now the largest capitalist nation in the world, and basically our banker! So, if we are calling down opprobrium on that country,  WTF are we doing taking out loans for military weapons from them etc.? Talk about hypocrisy (but of course, that's our nation's biggest export) - see also: http://www.smirkingchimp.com/thread/greyraven/50300/america-the-land-of-stupendous-raging-hypocrites

As for Russia, Putin also isn't exactly enamored of having Snowden holed up there at Moscow’s Sheremetyevo Airport. Note also: the airport is not on Russian soil, so technically Putin isn't obliged to extradite him, or indeed, pay any attention to a huffing and puffing bunch of Amerikkan hypocrites who seem to forget or ignore their own lawlessness the past 12 years, including starting illegal wars violating Article IV of the Nuremberg laws, see also:  http://www.smirkingchimp.com/thread/robert-scheer/50246/the-good-germans-in-government, not to mention violating the Geneva conventions with rendition and torture (water boarding).

As for Ecuador, I have news for the Amerikkan bigots and hyper-false patriots: Most of Latin America and the Caribbean sees us as a Yanqui gangster state after the  CIA assisted some reactionary Venezuelans (including Luis Posada Carriles, a former CIA agent)to  blow up a Cubana Airlines passenger plane over Barbados on Oct. 6, 1976.

One thing to take away from all of this: the US of A is not as pure as the driven snow as it claims or portrays itself. It also has supported terrorists, as in Honduras and Guatemala in the 80s, and also helped bring bin Laden to fruition by leveraging him against the Russkies when they invaded Afghanistan n 1979. But see, then it was convenient and expedient, to advance U.S. geopolitical objectives. Never mind the geopolitical strategies, a terrorist can be a state actor and hide behind all kinds of excuses, rationales.

Imho, the worst calamity to happen to the world was the collapse of the bi-polar equilibrium that prevented one country from gaining too much hegemony and power in the world. That happened with the collapse of the Soviet Union. Given that one big "superpower" now tries to rule everyone, it's no surprise a lot of smaller players- and even big ones-  would like to jab a finger or two in its hypocrtical "eyes."

Most interesting to me has been who exactly has come out on each side. It's now become much easier to tell the pro-state purveyors of deceit and character assassination from real patriots invested in protecting liberties. Ed Schulz, for example, is now dismissed by me as a bloviating propagandist having called Snowden a "punk" and demanded his return and prosecution. Chris Hayes, meanwhile, has been pro-Snowden - if not as outspoken as some others. But his intelligent take gets kudos from me. Rachel Maddow? I've no idea where she sits because she's presented some segments on her show but hasn't disclosed her position. Nice and coy, and safe!

The media corporo-pundits  like Aaron Ross Sorkin and David Gregory? Blow dried hacks, both of whom ought to be sent to Komodo Island on one way tickets - mainly to provide protein for the giant reptiles there. Oh, and you can toss Dianne Feinstein into that stew too, along with John 'Wuss' Kerry and Dick-head Cheney!

Mail Call Brane: Readers Seeking Answers

Just curious as to the latest on Colorado’s MJ laws, and Implementing them.- Allan, Montreal, Quebec

A. The latest news is that on Wednesday the Colorado legislature made history, becoming the first in the nation to pass laws regulating recreational marijuana use. This now makes 4 major bills passed this year on marijuana legalization, and now the legislature awaits Gov. Hickenlooper to sign them. If he does sign them, and as a Dem Governor presiding over a D-legislature he ought to, then we will see the following (Denver Post, Thurs. May 9, p. 1A):


1-Marijuana will be sold in specially licensed stores that can also sell pot-related items such as pipes. However, only Colorado residents can own and invest in the stores, and only current medical marijuana dispensary owners can apply to open recreational pot shops for the first nine months. The first stores will open on Jan, 1, 2014.

2- Colorado residents will be able to buy up to an ounce of marijuana, the maximum legal amount for non-medical needs. Out of staters will be able to purchase only a quarter ounce at a time. The pot must also be sold in child-resistant packages, with labels that specify potency.

3- Voters will have the option of imposing heavy taxes on pot sales. A ballot measure set for November will ask voters to approve a 15 % excise tax and an additional 10 percent sales tax on marijuana. The excise tax will fund school construction while the sales tax will fund MJ regulation. Hickenlooper has already advised voters to pass the bills, and one wonders given his past MJ opposition, whether he will postpone signing the passed bills until November. And also, if the tax ballots don’t pass, then vetoing the four already passed MJ bills. I wouldn’t put this past a guy that once drank fracked water and claimed it was fine.

4- Incorporated marijuana collectives will be banned, so will MJ coffee shops, MJ-smoking in bars and gov’t run MJ stores. Though Colo. will have the most liberal MJ laws in the country – it will have the most restrictive laws in the country for MJ-themed magazines. These, like pornography, will have to be kept under the counter. (Publications such as 'High Times' have vowed to sue.)


5-Colorado drivers for the first time will be subject to a “stoned driving limit” (which is still being worked out). Juries will be allowed to presume that anyone testing above the limit was too high to drive.


Q. Were you aware that Sally Jewel, President Barack Obama's newest appointed Secretary of the Interior, is a pro-fracking hireling? Having read your blogs on fracking I wonder what you make of this appointment?
- Cheryl T., Wauwatosa, Wisc.


A. Okay, what Jewell actually said is: “ We must develop our domestic energy resources armed with the best available science, and this unbiased, objective information will help private, nonprofit and government decision makers at all levels make informed decisions about the responsible development of these resources. “ And yes, a number of right wing papers (i.e. The Washington Examiner) have taken this to be a strong endorsement of fracking. But as the Examiner puts it:


"Jewell was referring to hydraulic fracturing, or 'fracking, ' the process by which a pressurized mixture of (mostly) water and chemicals is injected into shale rock formations deep underground. The process provides access to natural gas deposits that would otherwise be impossible to reach. The technology has been in use for 60 years in Texas and Oklahoma, but its phenomenally successful use more recently in Pennsylvania to develop the Marcellus Shale and in North Dakota to develop the Bakken formation has sparked an energy revolution in this country.  Environmentalists oppose fracking, claiming it threatens groundwater even though the evidence for this claim is all but nonexistent.”


Of course, assuming this is so, then it would be an unmitigated disaster. Anyone who has read my prior blogs on fracking would see why, e.g. http://brane-space.blogspot.com/2013/02/that-disgusting-oil-reeking-fluid.html
and  http://brane-space.blogspot.com/2013/03/doctors-muzzled-to-prevent-warning.html


The facts are substantial so that appeal to scientific basis must mean not going forward with fracking and applying the precautionary principle: the frackers must prove their methods aren’t harmful to ground water supplies, not the converse- that potential victims must prove the harm. Already there have been more than 1,000 documented cases of water contamination while methane leaks associated with hydraulic fracturing have caused houses and wells to explode.  Moreover, fracking doesn’t just contaminate water but air as well. Residents in Dish, TX have repeatedly complained of illness since frackers arrived. Air quality tests have revealed high levels of benzene in the air.


The notion of natural gas as “clean energy” is also a myth. While it emits half as much carbon as coal and 70% as much as oil, it still imposes a carbon burden. In addition, it emits large quantities of methane gas which is 30 times more potent than CO2.  These figures, though smaller than the coal and oil carbon burdens ought not be ignored given that we have now hit 400 ppm of CO2 in the atmosphere, a threshold not reached for nearly 3 million years (Denver Post, today, p. 1B). What the new threshold means is that we have far less margin for error. Do we really want to conduct an aberrant experiment to turn our planet into another Venus, with a runaway Greenhouse effect - making it uninhabitable for future generations?

The production of this fuel also isn’t “clean” as it damages water, air and infrastructure. It is, in reality, no different from fouling our own nest to get a temporary solution to an energy problem –which is really spawned by too high a global population and too concentrated energy use.


Here are 5 other facts on fracking that ought to cause alarm and get the attention of our politicos who are too often hostage to special (read 'monied') interests:

1- Fracking a single well requires more than a million gallons of water. Here in COS, a number of wells have consumed over 3 million gallons, and many have come up empty. This insanity is occurring in an arid region in which we’ve had severe drought the past three years. The wastewater produced by fracking also contains high levels of radioactivity that wastewater treatment plants aren’t equipped to deal with.


2- Dangerous fracking chemicals are kept secret. In many states, the drilling companies won’t disclose the chemicals used in the fracking fluid, claiming the mixture is a “trade secret”. But independent analysts have identified 41 known chemicals most highly toxic carcinogens.


3- There exists a “Halliburton Loophole” with respect to most laws and oversight applied to fracking. This means the effluent generate by the frackers as well as their shale driller cohorts is exempt the Clean Air Act and the Safe Drinking Water Act So, E coli, is controlled in your water but it’s A-ok if carcinogenic benzene piles up.  Pardon me, but this selective regulation shows the paws of big, I mean BIG, lobby money!


4- The number of fracking wells is now growing at an exponential rate, in 28 states.

5- Turning on your tap (see image in previous links) liberates water accompanied by methane which can catch fire.

Fracking is unacceptable as an energy extraction process, since it imposes severe long term health costs to extract a temporary energy fix.


Q. In your April 13 blog on Bird Flu you mentioned the reported mortality rate of highly pathogenic H5N1 avian influenza and that “studies of the levels of cytokines in humans infected by the H5N1 flu virus show elevated levels of tumor necrosis factor-alpha a protein associated with tissue destruction at sites of infection and increased production of other cytokines” What does this mean for getting sick? How sick can you get? - Delores, Bellingham, WA


A. Pretty damned sick! So sick in fact, that even if you don't die you will likely want to. The tumor necrosis factor-alpha a protein is implicated in severe inflammation and also potential degeneration of organs affected, including kidneys and lungs. Similar effects were reported during the Spanish Flu pandemic but of course the micro-biological, genetic marker tie- ins weren’t then available. However, doctors who performed the autopsies of some patients reported lungs turned to jelly as well as other organs. Basically, with the cytokine storm and tumor necrosis factor-alpha a protein, your whole body is sent into a death spiral of organ shutdown, shock,coma from immune system over-stimulation.

The closest I came to this was in December, 1968 when I got the Hong Kong Flu. I vomited for days, could barely breathe as I coughed up bloody mucus with each spasm, and felt like I had burst at least one lung. It was a god-awful experience I never want to repeat, and that flu barely killed 1 m around the world. The H5N1 will likely be 100 to 500 times more lethal and brutal.  I took more than 2 months to recuperate.


Q. I got a kick out of your brother Mike’s comments in your April 21 blog on the biblical exegesis test. He claimed that “the Jesuits themselves are the “storm troopers” of the RCC, and their purpose is propagation of the RC faith by any means possible? (i.e., SATAN!)”

What is he some kind of a crackpot? I couldn’t believe this guy couldn’t take the bible test or even answer one little question. And he claims to read the good book! It seems to me he’s got a lot of talk but little to show for it. I notice that since April 30 you have totally ignored him. Is this intentional? Alice K, Joliet, IL


It is. I think I mentioned in my blog on Colorado MJ issues and Mike's onerous errors (‘Reefer Madness Redux’, April 30) that since it's useless to try to argue or debate him (since he’s totally ignorant of the basic parameters that apply to the content of any worthwhile argument) . there'd be no further exchanges. At least not until he could pass a basic test in logic, for which I provided a link at the end of the blog.


Up to now, he’s not taken the test - which indicates to me he has no logic to demonstrate, nor is he the least interested in using logic in his arguments. This being the case, he's all about making noise and nothing more.

Therefore,  it’s a waste of time to engage him on any issue. He can believe whatever he wants to believe, but I don't have to give any heed to what I regard as noise.  If then he chooses to come to this blog (which he probably does to dredge for new material since he can’t think of any on his own) that’s his choice. As far as I am concerned his blog exists only as background noise in the blogosphere. It merits no more attention than noise, and certainly not being considered as any signal.  And if it is noise, then none of his harangues or "issues"  merit being dignified by any response.

Q. My husband of 44 just had his lab test come back and his PSA has tripled in 2 yrs. from 1.8 to 5.5.  I have pleaded with him to get a biopsy but he's terrified of sepsis as he read that this occurs in any cases with these biopsies. He also fears, after reading your own blog of July 19 last year (Notes on a prostate biopsy) having a young female physician assistant doing the procedure and not the actual urologist. He also fears the type of pain you described. Is there any way to get him to change? I fear he might have an aggressive cancer that might kill him!- Genevieve R.,  Los Angeles, CA

A. Your husband is actually quite right to be concerned, as the incidence of deaths, infections (including from sepsis, or massive blood poisoning via infection) have risen sharply, see e.g. http://www.naturalnews.com/033660_prostate_biopsy.html

As the article notes:

"....the research team found that having a prostate biopsy resulted in men being more than twice as likely to need hospitalization in the immediate post-procedure period. And once hospitalized, the men were at an increased risk of serious complications including bleeding and infection, flare-ups of underlying medical conditions (such as heart failure or breathing disorders) and death.


The researchers emphasized in their paper that their new data should remind doctors to carefully consider the risks and benefits of biopsy for individual patients before performing biopsies to look for cancer in the prostate"

See also: http://www.npr.org/2011/05/23/136501992/doctors-fret-over-rise-in-prostate-biopsy-infections


So what to do?  The best advice is to discuss the problem with one's personal physician, and this includes a cost -benefits assessment. In my case, the biopsy was done after PSA doubling, and then after the free PSA test, which also yielded a high probability of cancer. (The free PSA may actually be the most sensible next step. It measures the concentration of free prostate specific antigen, i.e. in the blood, relative to the bound form. The result comes back as a percentage. If it is 25% or higher then the chances are more than 90% the problem is enlargement of the prostate, not cancer. If the result is 5% or less, then the odds switch in the other direction: 77% that it's cancer and not benign hypertrophy.)


My biopsy, done after the free PSA,  then found an aggressive adenocarcinoma in two cores (Gleason socre 4+3) , and cancer present in five (lowest score Gleason 3+3). I was told by the urologist that watchful waiting could not be an option, so elected to have high dose radiotherapy. 

The infection risk from prostate biopsies can be contained with scrupulous cleanliness, and that means a thorough enema before hand. Also, the biopsy patient  takes a ciproflaxin  pill just before. Another alternative is to have the biopsy performed via the trans-perineal route (through the perineum) which carries vastly less risk of infection because the rectum wall isn't being penetrated by the tissue extracting needles. The problem is that this trans-perineal procedure is usually more costly, since in general the patient has to be put under (general anesthesia) and more staff are needed to be present.

Re: the physician assistant, I don't think the sex ought to matter - but whether the person is competent. A good way to find out is to become a temporary member of 'Angie's List' and then look up urologists and see what the reviews say.  The fact is that more and more physician assistants are now doing these procedures, and if they have the proper training - which most do - then the expertise should not be an issue.

PSA Test Results Are Back: To Celebrate or Not?

Barely ten minutes ago a nurse phoned from my primary care doc and gave the results of the PSA test taken last Friday, and roughly 3 months after the conclusion of my prostate cancer radiation treatment. She reported the PSA as 2.0 - which is "within normal range". While wifey was ecstatic, and this was definitely a positive,  considering it had gone up to 6.1 in June (before the biopsy and radiation treatment in September, see e.g. http://brane-space.blogspot.com/2012/09/thge-longest-dayand-then-some.html) I noted we still had to wait to see what Dr. Hsu of UCSF made of it. Would he be satisfied with this first post-treatment result? We'd have to fax the lab report to him then see.

In the meantime, I am not hitting the panic button though I had hoped the PSA would have been closer to 1.5. But in a way it makes sense. As I noted before one can't compare a first PSA taken 3 mos. after radiotherapy (even high dose) with that taken after radical prostatectomy because in the latter case the whole gland is effectively removed, while in radiation it is left in. Thus, one still has production of prostate specific antigen by the remaining intact cells of the prostate, and one knows this is fueled by testosterone. (I haven't had a test for testosterone level, but if I had I am sure it would show close to normal levels.)

The other thing one must bear in mind is that the effects of radiation are progressive. Most statistics show that by five years after radiation high dose treatment the effects are almost identical to those after radical surgery. In other words, my time line will disclose increasing effects- many of them negative - such as damage to the erectile tissue, blood vessels etc. as the effect of the radiation dose continues on the cells. Over this increasing time line, one ought to see a decrease in PSA, though as I also noted before there may be aberrations which occur - temporary blips upward- and then declines. A "treatment failure" is only reported when there is no further decline. When I hit the lowest PSA over a timeline, say two years, that will be defined as the "PSA nadir". If it pops back up, we call it a "PSA bounce". Ideally we don't see too many bounces!

The "cure rates" reported in most studies tend to depend on two factors: 1) the quality of the treatment, and 2) the average risk type of the patient. Note most studies are "retrospective" or ex-post facto, only concluded after the fact. This is consonant with both the nature of the disease and also the treatment, especially radiation. The problem is that accuracy is limited by variations in "risk types" for different institutions. (Oncologists do their best to match risk types from institution to institution but for a number of reasons the matching process is less than perfect, introducing uncertainty.)

In one of the most notable studies, completed by Dr. Patrick Walsh (who invented the modern form of radical prostate surgery) at Johns Hopkins, the 15-year cure rates as reported in the journal 'Urology' in 2007, were 85%, 63% and 40%. These were for low-risk, intermediate risk and high risk disease, respectively. (Let's also bear in mind that even the best surgeons in one study group left cancer behind in 10% of cases - as determined by the "positive surgical margin rate". This is the frequency, usually given as a percentage, of leaving cancer cells behind over a number of 'n' surgeries performed.

Meanwhile, in the most prominent reported study for (low dose) seed implant brachytherapy, in the International Journal of Radiation Oncology (2007), the cure rates were 86%, 80% and 68% for low, intermediate and high risk cancer.  (By all considerations my high dose rate brachy results ought to compare even more favorably!) In other words, the two methods compare very well at least from these two studies. (A futher interesting point is that a Johns Hopkins study has shown that relapses after surgery occur on average five years earlier than seed implants.)

In the end, it's a waiting game. Over more time, perhaps at least two years, the chief oncologist will be able to definitely say that the battle has been "won" or perhaps only drawn, or lost. Right now I am just elated to have a much lower PSA than I had 6 months ago, and will take that as a 'W'.

Why Isn't This Cancer Research More Widely Circulated?

Cancer is a scourge in this country, as I have noted in previous blogs. Though certain organizations want Americans to believe it's all on them - maybe 90% in terms of diet and other habits, the fact is virtually every form of cancer (breast, prostate, pancreas, liver, bladder etc.) is increasing because of the toxins in our environment. See also,

http://brane-space.blogspot.com/2012/02/cancer-industial-complex-biggest.html

Two particular cancers are especially prevalent: breast and prostate, with the latter killing nearly 12,000 men a year. Not stated, however, is the untold suffering experienced in the form of nearly 1 million unnecessary treatments, including biopsies, undergone each year by men whose physicians are hostage to the numbers....as in the PSA test. (For Prostate specific antigen).

These biopsies, especially, are not for the faint-hearted and the complications can be severe, with the ultimate being serious complications that require prolonged catheterization, being bed-ridden and extended hospitalization which can put the patient at risk for life-threatening hospital-borne infections such as c. diff. (clostridium difficile). Tens of thousands find even after the biopsies they're forced to wear diapers permanently because of the damage done via insertion of 12-15 pronged needles at once into the prostate (usually done through the rectum- but sometimes through the urethra or perineum) to extract sample tissue for analysis.

In the most mild after -effects, pain may last for weeks and males are warned by urologists against ejaculating - which may increase internal bleeding from the recently assaulted gland. As it is most are terrified because of the bloody semen that results when they do. This bloodiness can go on for weeks and makes even the most sympathetic spouse think twice about having sex, even if she wanted to. Condoms can help, but even the briefest sex ends up with the condom filled with blood. This is not exactly a turn-on, least of all for the guy!

Most of this is not passed on to the hapless male confronted with the prospect of a biopsy after his PSA numbers somehow go up. He's left to ponder his options and- what is worse - deciding whether to get this horrific procedure done (which is supposedly to his benefit), or betting the increased PSA (mainly now "PSA velocity" or the rate of increase in a specific time - say 1 year) is somehow anomalous and not cancer.

Medical author Shannon Brownlee, in her book 'Untreated: Why Too Much Medicine is Making Us Sicker and Poorer' (2007, p. 202) observes:

"The evidence suggests that PSA testing is not saving any lives, and even it is the large numbers of men who are treated unnecessarily are paying a terrible price. They're the equivalent of civilian casualties in our war on cancer.".

From reading many of the personal blogs of those who've endured this treatment, leading up to possible prostatectomy, this is not overstatement. Further, when Brownlee notes the PSA is "not saving any lives" she is referring to the actual numbers who benefit from the tests, or biopsies, relative to those that have them and receive zero benefit. The "saving rate" is actually maybe one guy for every 1,200 biopsies performed. The cost to benefit ratio is ....well, you figure it out!

Now, a recent contribution to the research promises to lend a more rational overtone and make it possible to at least reduce the numbers subjected to unneeded treatments and suffering up to and including resulting from major surgery and/or radiotherapy (the standard treatment in the latter case is called 'Brachytherapy' - in which dozens of tiny radioactive 'seeds' are inserted into the prostate gland and kept there over a specific time, to deliver a specific dose. I don't really think I need to elaborate on the side effects).

The research comes from Dr. Andrew Vickers of Memorial Sloan-Kettering Cancer Center in New York City, and was published originally in The Journal of the National Cancer Institute, February 24, 2011. Dr. Vickers and his co-author Hans Lilja, concluded that PSA velocity as a guideline would be unlikely to improve patient outcomes, adding, "we therefore recommend that organizations issuing policy statements related to PSA and prostate cancer detection remove references to PSA velocity."

Thus, this research is welcome information for those who may face a decision on whether to undergo prostate biopsy or not. Vickers and Lilja's point in their paper is that PSA velocity is not a good predictor of prostate cancer and, in the absence of other indications, such as a positive digital rectal exam or a high PSA level, there is no evidence to support prostate biopsy in men with a high PSA velocity. This is particularly so if the starting number isn't high already.
In his interview with the online journal Medscape, Vickers notes:

"What we've shown is that changes in PSA are not very important at all. The take-home message here is that if the patient doesn't have a high PSA to begin with and has a normal clinical exam, there is no reason to do a biopsy, even if the PSA is increasing."

In his interview, Dr. Vickers also pointed out that one of the problems with PSA velocity measurements is that velocity can be calculated a number of ways. According to him:

"There is no standardized method, and new ways of calculating it are continually being invented,"

Dr. Vickers added that a sudden rise in PSA is also not usually indicative of cancer, and "may be the result of an infection or other benign disease. It doesn't necessarily warrant a biopsy."

Now, why am I so invested? Because it's actually personal for me, having just received the results of a PSA test showing my number has nearly doubled in the past year. Have I hit the "chicken switch" and run to the urologist as originally recommended? NO. I asked for the test to be re-done and will take it again in about three months. Since the starting PSA level wasn't high as per Dr. Vickers' point, I am not going to panic irrespective of how the American Urological Association sees it (In the same article, other groups, such as the European Urological Association and the US Preventive Services Task Force, do not recommend population-based screening because of insufficient data on its benefits and harms.)

What we do know - based on recent cost assessments - is that nearly 30% of the $2 trillion odd costs in medical treatments are unnecessary. Nearly $4b a year is believed to accrue from unnecessary prostate PSA tests, biopsies and other treatments - later found to of benign causes or non-life threatening. (Two weeks ago, indeed, an article in the WSJ discussed how the AUA and its members have added incentives to ask for more tests, as "monetary incentives". Duh!)

As for me, I will bide my time. If the next test shows a further spike as opposed to levelling off or decrease, then I'll likely see the urologist. But even in that case will not likely schedule any biopsy unless the level is at 8.0 ng/ml or more. We will see.

New PSA Test Recommendations the Right Call

Though the Medical-Industrial Complex will doubtless howl like banshees, the recently released draft recommendation by the U.S. Preventive Services Task Force - to the effect that healthy men should not be regularly screened using the PSA test - is the right call. This recommendation is based on the results of five well-controlled clinical trials.

The PSA or "prostate specific antigen" test is routinely given to males 50 years of age or older , and measures a protein that's released by prostate cells. This protein serves as a proxy indicator to detect cancer of the prostate. The problem is that as the popularity of the PSA test has grown, the number of false positives has likewise, leading to a vast amount of unnecessary suffering and discomfort. Indeed, in many cases an elevated PSA may mean nothing more than normal hypertrophy of the prostate gland, experienced by nearly all men after age 60.

The detection of a false positive, meanwhile, sends the person on a hapless round of biopsies and treatments which often end detrimentally. For example, from 1986 through 2005, 1 million men received surgery (radical prostatectomy), radiation therapy or both according to the Preventive Task Force. Of these, 5,000 died soon after surgery and up to 70,000 suffered serious complications. Half had persistent blood in their semen and up to 300,000 or nearly one third of those treated suffered impotence, incontinence or both.

As a result of the frequency of such complications, even Dr. Richard J. Ablin, who developed the PSA, said recently (The Denver Post, 'Panel says Needless Treatments Follow', Oct. 7, p. 1A and 15A):

"The widespread use of this test is a public health disaster".

Another factor complicating the picture is that in nearly 60% of instances the cancer itself - mostly after age 70 - is so slowly growing that the person will almost always die of something else, such as myocardial infarction, or stroke.

Even before the draft release of the Task Force, there was enormous skepticism brewing regarding the cost to benefits ratio for the PSA. Author Shannon Brownlee in her expose book on the Medical Industrial Complex: 'Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer', noted (p. 202):

"The evidence suggests that the PSA is not saving lives, and even if it is, the large numbers of men who are treated unncessarily are paying a terrible price. They're the equivalent of civilian casualties in our war on cancer."

In respect of patient advocacy groups (some of whom took the Task Force to task, and often push for more widespread screening) she notes regarding this push(ibid.):

"This is the power of magical thinking. We all want to believe that early diagnosis of cancer will protect us. That if we dutifully head to the doctor for our yearly screening tests we can avoid disease and thwart even death. And yet, many of the screening tests we imagine will protect us- mammography, colonoscopy, and mroe recently CT scans to screen for lung cancer- sufer from many of the same drawbacks as the PSA test. The only screening test that has been shown to unequivocally decrease mortality is the venerable pap smear.."

This is sobering, but a conclusion with which I fully concur, especially in an era of massive deficits in which health costs are the biggest drivers. If these costs are not contained they will gobble up nearly all the GDP (or the Index for Sustainable Growth) by 2040. We simply can't afford to go that extensive route.

Thus, in this sense, the Task Force recommendation makes eminent sense, and again, it only applies to healthy men. This alone could save us over $400 million a year in unnecessary biospies, surgeries and other costs just for this one cancer.

In an earlier blog I also referenced a TIME special issue on cancer and how the CAT scans were adding to the costs for chemo and other treatments by "accidentally" detecting cancers when the scans were done for another reason. These newly found "accidento-plasms" added up to nearly 16% of all new cancer and were adding something like a billion dollars a year in medical treatement costs.

The end result is that enhanced screening is no boon if it picks up more cancers that will ultimately bankrupt this country if all are treated. In other words, it is simply impossible to at once contain medical costs and treat every cancer found under the Sun, or accidentally in the human body!

In a future blog I will look at a saner way for cancer prevention which begins with controlling the immense and profitable Chemical Industry now polluting the environment with over 80,000 chemicals a year, most of them carcinogens. Until we confront this toxic monster in our midst - another offshoort of Wall Street and its industrial predators - no amount of cancer screeenings or treatments will make a dime's worth of difference.