Kristen was still distraught after losing her hubby Rob, a year earlier. What had been planned as a trip for two to Barbados this year ended up a trip for one. The saga isn't new and will likely unfold in many more households as low T mania continues unabated. How bad is it? According to the article, 'Low T: Real Problem or Ad-driven Fad?' in the AARP Bulletin (July-August, p. 18):
"A 2013 study in JAMA Internal Medicine found testosterone prescriptions grew more than threefold between 2001 and 2011. Data from IMS Health shows T sales rose from $324 million in 2002 to nearly $2.3 billion in 2012. Sales could hit $5 billion by 2018."
As the article also notes, most of this increase isn't based on any genuine medical issue. It is based on ads shamelessly playing to male insecurities. The loss of muscle mass , sex drive or energy - once described as "getting older" - suddenly was transmogrified into a condition dubbed "low T" by the Madison Avenue Ad makers. Thus were unleashed a torrent of print and TV ads from the makers of testosterone replacement meds and gels. One ad actually advised: "Millions of men 45 or older may have low T so talk to your doctor!"
Really? Gimme a break!
In Kristen's husband's case, Rob (then 47) felt he needed an edge at work so began the low T prescription solution. He did feel his energy rebound, his muscle mass increased and his renewed sex drive pleased Kirsten. Only she worried about taking increased testosterone which as a medical person (urology RN) she already knew provided a fuel for prostate cancer.
According to Dr. Mark Scholz, in 'Invasion of the Prostate Snatchers', p. 42:
"testosterone fuels prostate cancer growth and prostate cancer is the only type of cancer susceptible to testosterone inactivating pharmaceuticals"
Alas, Rob dismissed all such concerns, according to Kristen, and even increased his testosterone use. If some is terrific, more got to be better, right? Not quite. Within a year Rob's PSA had doubled, and six months later tripled. Finally, under pressure from his wife he reluctantly submitted to a prostate biopsy and prostate cancer was found in five cores with Gleason scores 4 + 5, and two with 5 + 5. The urologist pronounced "advanced prostate cancer" and recommended radical prostatectomy in combination with female hormone treatments.
The next year or so was 'hell' as he descended into depression following the surgery which left him incontinent, his penis shrunken, zero sex drive and with large breasts - arising from the hormone treatments. Kristen confided that at least he hadn't ended up like another T-using patient who - after his operation around the same time - experienced a vesicularectal fistula- farting through his penis and saddled with other complications before having to get a colostomy.
Despite all the horrific side effects Rob had to endure, the prostate cancer spewed secondaries into bones and lungs - and he died 6 months ago. Kristen said if she had one wish it would be to "get men to back off from this silly, idiotic non-solution".
She may well have a point. Even if by some miracle prostate cancer isn't spawned, other negative medical impacts abound. According to Dr. John La Puma, quoted in the AARP article,
"When you take testosterone your body shuts down production. As a result the testicles shrink and you could be using supplementation indefinitely."
He noted this circumstance meant "expense, inconvenience and worst of all, possible catastrophic health consequences."
Think aggressive prostate cancer. But as the AARP article also pointed out:
"A study published last year in the Journal of the American Medical Association reported a 30 percent jump in the risk of stroke, heart attack and death among men undergoing testosterone therapy."
It would seem that any guy seriously thinking of aspiring to be muscle-bound and energetic using T, would be advised to watch the video below first and pay close attention! Note the particulars of treating low testosterone, including the fact: a) testosterone can vary during the day so the time you get the blood test is critical, and b) the low testosterone can be due to multiple other causes than natural, including stress, fatigue, diabetes or other hormonal imbalances.
http://www.webmd.com/prostate-cancer/video/testosterone-replacement-prostate-cancer
The AARP article also adds (ibid.):
"But what is a healthy T level for an older man? Doctors can't agree. Many laboratories use wildly varying reference numbers based on the average testosterone levels of young men, anywhere from 300 to 900 nanograms per deciliter."
The Bulletin adds that, incredibly, just about any purported "symptoms list" will ensure a low -T diagnosis.
The fact is, as Dr. La Puma observes, most men (maybe 80%) don't need this "therapy" at all, period. As he puts it:
"All men need to do is eat a healthier diet and be more active."
To reinforce that, "it's found that when obese men shed an average of 17 pounds, testosterone levels climb 15 percent."
This in addition to quality sleep and regular exercise can help any guy improve his energy and muscle mass as well as sex drive.
Trouble is, too many guys want the "quick fix". For those who want the T-quick fix to “muscle up” to look better or get more energy, I'd say just be prepared for what’s coming later. It might also help to imagine yourself long past the cancer treatment stage when your dick is U-shaped, your breasts are bigger than Mariah Carey’s (so much you want to hide from your wife) and you have to wear giant diapers just to go to the corner 7-11.
Showing posts with label prostate biopsy. Show all posts
Showing posts with label prostate biopsy. Show all posts
Thursday, July 10, 2014
Friday, June 28, 2013
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!
Saturday, May 11, 2013
Mail Call Brane: Readers Seeking Answers
Just curious as to the latest on Colorado’s MJ laws, and Implementing them.- Allan, Montreal, QuebecA. 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.
Tuesday, July 31, 2012
Confronting the Cancer Demon....Full Speed Ahead!
Wednesday, July 11, 2012
No Reprieve, No Alternatives! Biopsy Forthcoming!
The appointment at the urologist's this morning (10.15) lasted at least a half an hour and included a review of family history (no prostate cancer) as well as previous infirmities, afflictions - from bronchitis to high blood pressure. Also a physical exam, which was passed with flying colors (i.e. no unuusal or abnormal growths, or enlargement of gland in question and no other evidence of anything amiss). These were all good signs, but alas, not enough to convince the urologist to leave out a biopsy.
His primary concern was the unrelenting increase in the PSA (doubling from 2.8 to 5.6 in a year, then increasing again to 6.1 in 3 months, and again to 6.5 in 3 weeks - registered in a most recent blood test that also found a low free PSA percent of 5.1. In combination, he said, all the numbers pointed to biopsy. There was only left the matter of scheduling it.
A range of dates, times was available at the front desk, but since the longer the time the longer the build up of anxiety, I decided to arrange it for next Wednesday morning, at 10.30. This would be the day after my last physical therapy session (for a strained lower back muscle) and also leave ample time to finish necessary chores ....like mowing the already overgrown lawn.
Also at the desk I was advised by a nurse of all the things which had to be done prior to the procedure, including filling prescriptions. The key one is for the antibiotic, Levofloxacin (500 mg), one of which is to be taken 1 hour prior to the procedure and the other the next day.
The issue of antibiotics and their potency is an especially critical one for me, as my wife had to be hospitalized twice for c. diff. infection in late 2006, and early 2007, after taking only four days of Augmentin.(Augmented Amoxycilliin) for a sinus infection. This high potency antibiotic essentially erased nearly all her "good" gut bacteria, leaving her prey to clostridium difficile, which had her running to the toilet 22-25 times a day for over a week, until she had to be hospitalized for treatment....ending with vancomycin - the only thing that would stop it.
On questioning the urologist about the antibiotic prescribed and possible risks of acquiring c. diff. he assured me that its emergence was more an issue of duration of use. And since I am only on it for two days (as opposed to the normal three or four) there was little chance of redux situation, with me now as the 'star'. He didn't rule out, however, adding yogurt and acidophilus to my diet to ramp up the good guys in the gut. Just as an extra precaution and because I also likely have latent c. diff. spores in the gut.
Also emphasized by the RN was the importance of following instructions on administering an "Adult FLEET Enema" 2 hours prior. The accompanying biopsy fact sheet and summary states in loud caps: IF YOU DO NOT USE AN ENEMA YOUR APPOINTMENT WILL BE CANCELLED! Fair enough! It's probably not as bad as the "cleansing" one must undergo before a colonoscopy, drinking all that disgusting pineapple tasting stuff - then having to sit on the can for eight hrs.
Before the actual procedure I have to provide a urine sample to rule out any urinary infections. Immediately before the actual biopsy there will also be an ultrasound examination, in which an ultrasound probe is inserted into where the sun don't shine. Transducers on the end of the probe then will send sound waves into the prostate. When different textures and densities are encountered to those deemed normal, the waves are reflected back to the transducer. A computer then measures the time for the sound waves to travel out and back, dispatching the information to the urologist.
The importance of the ultrasound can't be overemphasized, as it can well reveal conditions (not cancer) that are present and may have incepted high PSA readings. These include: inflammation, cysts, vascularity, and prostate stones. (One must magine they're somewhat like gall stones except maybe a lot smaller!)
Finally, the biopsy is done by insertion of a spring-loaded device (through the ultrasound tube) which injects ten fine needles, five on each side of the prostate. The end of each needle snatches tissue each time, which is recovered as a sample for the histology. Ultimately, that histology will be scored on what's called a "Gleason score" with 5 being the highest....and also indicating the worst, cancer. Two samples bearing cancer cell histology are then added together to yield the total score. What you do not want to see is anything like a '10' which basically means your choice of options for treatment is pretty limited.
I am hoping for a 1, 2 or better, 0! Anything to avoid a next round requiring treatment that can leave you in a hospital and with surgical risks, not to mention having to deal with urinary catheters, associated infections!
As for the pain aspect, the urologist was most sympathetic since not all males experience pain, but many do (leading 1 in 3 to never have a biopsy again!) The difference is attributed to whether the injecting needle hits a nerve or not. Contary to some myths, the prostate is not unenervated! It's got nerves all right, it just depends whether the biopsy needle hits 'em or not! If not, the guy brags he felt no pain. If they do, the guy goes into a ball and lets out a primal scream vowing no more tests....ever.
Anyway, I will be allowed to have a light sedative (versed) during the procedure....and yes, my wife can be there too! Perhaps the ideal nerve-calmer of all!
His primary concern was the unrelenting increase in the PSA (doubling from 2.8 to 5.6 in a year, then increasing again to 6.1 in 3 months, and again to 6.5 in 3 weeks - registered in a most recent blood test that also found a low free PSA percent of 5.1. In combination, he said, all the numbers pointed to biopsy. There was only left the matter of scheduling it.
A range of dates, times was available at the front desk, but since the longer the time the longer the build up of anxiety, I decided to arrange it for next Wednesday morning, at 10.30. This would be the day after my last physical therapy session (for a strained lower back muscle) and also leave ample time to finish necessary chores ....like mowing the already overgrown lawn.
Also at the desk I was advised by a nurse of all the things which had to be done prior to the procedure, including filling prescriptions. The key one is for the antibiotic, Levofloxacin (500 mg), one of which is to be taken 1 hour prior to the procedure and the other the next day.
The issue of antibiotics and their potency is an especially critical one for me, as my wife had to be hospitalized twice for c. diff. infection in late 2006, and early 2007, after taking only four days of Augmentin.(Augmented Amoxycilliin) for a sinus infection. This high potency antibiotic essentially erased nearly all her "good" gut bacteria, leaving her prey to clostridium difficile, which had her running to the toilet 22-25 times a day for over a week, until she had to be hospitalized for treatment....ending with vancomycin - the only thing that would stop it.
On questioning the urologist about the antibiotic prescribed and possible risks of acquiring c. diff. he assured me that its emergence was more an issue of duration of use. And since I am only on it for two days (as opposed to the normal three or four) there was little chance of redux situation, with me now as the 'star'. He didn't rule out, however, adding yogurt and acidophilus to my diet to ramp up the good guys in the gut. Just as an extra precaution and because I also likely have latent c. diff. spores in the gut.
Also emphasized by the RN was the importance of following instructions on administering an "Adult FLEET Enema" 2 hours prior. The accompanying biopsy fact sheet and summary states in loud caps: IF YOU DO NOT USE AN ENEMA YOUR APPOINTMENT WILL BE CANCELLED! Fair enough! It's probably not as bad as the "cleansing" one must undergo before a colonoscopy, drinking all that disgusting pineapple tasting stuff - then having to sit on the can for eight hrs.
Before the actual procedure I have to provide a urine sample to rule out any urinary infections. Immediately before the actual biopsy there will also be an ultrasound examination, in which an ultrasound probe is inserted into where the sun don't shine. Transducers on the end of the probe then will send sound waves into the prostate. When different textures and densities are encountered to those deemed normal, the waves are reflected back to the transducer. A computer then measures the time for the sound waves to travel out and back, dispatching the information to the urologist.
The importance of the ultrasound can't be overemphasized, as it can well reveal conditions (not cancer) that are present and may have incepted high PSA readings. These include: inflammation, cysts, vascularity, and prostate stones. (One must magine they're somewhat like gall stones except maybe a lot smaller!)
Finally, the biopsy is done by insertion of a spring-loaded device (through the ultrasound tube) which injects ten fine needles, five on each side of the prostate. The end of each needle snatches tissue each time, which is recovered as a sample for the histology. Ultimately, that histology will be scored on what's called a "Gleason score" with 5 being the highest....and also indicating the worst, cancer. Two samples bearing cancer cell histology are then added together to yield the total score. What you do not want to see is anything like a '10' which basically means your choice of options for treatment is pretty limited.
I am hoping for a 1, 2 or better, 0! Anything to avoid a next round requiring treatment that can leave you in a hospital and with surgical risks, not to mention having to deal with urinary catheters, associated infections!
As for the pain aspect, the urologist was most sympathetic since not all males experience pain, but many do (leading 1 in 3 to never have a biopsy again!) The difference is attributed to whether the injecting needle hits a nerve or not. Contary to some myths, the prostate is not unenervated! It's got nerves all right, it just depends whether the biopsy needle hits 'em or not! If not, the guy brags he felt no pain. If they do, the guy goes into a ball and lets out a primal scream vowing no more tests....ever.
Anyway, I will be allowed to have a light sedative (versed) during the procedure....and yes, my wife can be there too! Perhaps the ideal nerve-calmer of all!
Tuesday, July 3, 2012
NOT the News I wanted to hear!
Four days before my 66th birthday, the news I received this morning was nowhere near what I wanted to hear. At 8.45 a.m. it was my doctor's voice, mellow but firm: "I'm afraid I have bad news for you: the free psa test you took last week came back with a 5.1% reading......" Of course, after two high total psa test results I'd been pinning my hopes on the free psa % (or % fpsa) to be my deliverance. (If the value came back 25% or more I could justifiaby and rationally forego a biopsy given that 92% of men in that category had BPH or benign prostate hypertrophy - not cancer. To me it was great odds to avoid the possible complications of a biopsy - see below).
It became possible about five years ago to measure the different forms in which PSA is found in the blood, either free (fPSA) or bound to serum proteinase inhibitors (complexed PSA; cPSA). It was observed that these molecular forms occur in different proportions in benign prostatic hypertrophy and prostate cancer. Patients with prostate cancer show a lower proportion of fPSA, while those with BPH have a higher percentage. Assays were developed to measure fPSA, and researchers set up prospective clinical trials. Even before results were in, many predicted that determination of percent fPSA (%fPSA) would add value to PSA screening.
Summing up results of the clinical studies with %f PSA, Milenko Tanasijevic, MD, associate director of Clinical Laboratories, Brigham and Women’s Hospital, Boston, averred, "We believe that there is sufficient evidence showing the clinical usefulness of percent free PSA in clinical practice, especially for patients in whom total PSA is between 4 and 10 and who have a negative DRE."
The relative risks of prostate cancer given by the % fpsa results are well known, and my meager 5.1% (total psa reading of 6.1 at last testing 2 weeks ago) fell into the category of men with more than a 60% probability of having cancer, as opposed to benign prostate hypertrophy.
Anyway as she rambled on, informing what the research showed on cancer probability for my % f psa my mind had by then blanked out. In any case I already knew it and the odds.
By the end of her message she flatly told me there could be no more excuses or other tests, and she was referring me to a urologist for a prostate biopsy. Of course, given the choice between that and two root canals I would likely take the latter any day. A prostate biopsy meanwhile is no sport with more than 12- 80mm long needles inserted one by one at a time into one of the most sensitive regions of the body to snatch (in turns) 1/2" sections from differing positions and then do it again. Some have colorfuly referred to it as "being sodomized by knitting needles".
One Brit who faced it wrote on his blog some years ago:
"All men everywhere should demand sedation during a Prostate Biopsy. Accept no less. Demand sedation -- unless you like knitting needles being inserted where the sun don’t shine -- and 15 samples (or more!) being extracted by a circle of eleven needles, from a place that does not usually have needles pricking it & poking it.
I think what makes me most furious is that in this day & age of instantaneous information available on the internet, the “sedation” option for a Prostrate biopsy is almost not there.
Almost not there? Far into one article the writer says, in a very vague way, “general anesthesia helps….but your insurance company might refuse to pay.’ Saying “general anesthesia helps’ sounds like saying that an aspirin might help a headache. No, no, no. General anesthesia obliterates all pain at time of contact (later you will feel some soreness). General anesthesia doesn’t just help, it annihilates all memory of the pain.
In Modern Times there should be an addition to the Doctor’s Motto: “If at all possible, inflict no pain,” should be added to “Above all do no harm.’
I really am furious at the state of affairs. Everyone needs to know that in the case of a Prostate biopsy (a very-very common procedure for older men), “There is no reason for pain in a modern, well equipped room.’"
I definitely will be taking this guy up on his advice and insisting on sedation, and whoever the urologist is may regard me as "wimp", "wuss" or whatever, but hell - if you're going to have sedation for a colonoscopy why not for something 100 times more invasive!
The pain, of course, is not the worst aspect - another is the possibility of complications which I covered in an earlier blog. SO imagine my freak out when I also pulled up a comprehensive report out of Johns Hopkins Hospital, published in The Journal of Urology in 2011, noting all the hospitalizations for infections (an increase of ~ 7%) reported within 1 month for Medicare patients undergoing biopsy since 2000. (This compares with a hospitalization rate of 0.5% during the same 1 month post -biopsy period in the 90s). You can read much more on their findings here:
http://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_study_reveals_significant_rise_in_prostate_biopsy_complications_and_high_post_procedure_hospitalization_rate
Excerpt:
"Hopkins researchers have found a significant rise in serious complications requiring hospitalization. The researchers found that this common outpatient procedure, used to diagnose prostate cancer, was associated with a 6.9 percent rate of hospitalization within 30 days of biopsy compared to a 2.9 percent hospitalization rate among a control group of men who did not have a prostate biopsy. The study, which will be published in the November 2011 issue of The Journal of Urology, was posted early online.
The researchers emphasize that this new data should serve as a reminder to physicians to carefully weigh the risks and benefits of biopsy for individual patients and take all precautions to prevent infections and other complications.
The Johns Hopkins team’s findings are the result of the largest analysis ever performed of Medicare records of American men age 65 and older who underwent prostate biopsies in the last two decades. They found that having a prostate biopsy makes patients more than twice as likely to need hospitalization in the immediate post-procedure period. Those hospitalized had a range of complications, such as bleeding and infection, as well as flare-ups of underlying medical conditions, such as heart failure or breathing disorders."
Where will this lead and where will it go? I can't say for now, but will keep blogging as long as I can and keep readers appraised. My first visit with the specialist is unlikely to be before next Wednesday and the biopsy will not likely be before the following week - Wednesday or Thursday. I keep hoping for the best including that no cancer will be found.
Meanwhile, I am weighing treatment options!
Get set for the possibility of another atheist on a cancer ward!
It became possible about five years ago to measure the different forms in which PSA is found in the blood, either free (fPSA) or bound to serum proteinase inhibitors (complexed PSA; cPSA). It was observed that these molecular forms occur in different proportions in benign prostatic hypertrophy and prostate cancer. Patients with prostate cancer show a lower proportion of fPSA, while those with BPH have a higher percentage. Assays were developed to measure fPSA, and researchers set up prospective clinical trials. Even before results were in, many predicted that determination of percent fPSA (%fPSA) would add value to PSA screening.
Summing up results of the clinical studies with %f PSA, Milenko Tanasijevic, MD, associate director of Clinical Laboratories, Brigham and Women’s Hospital, Boston, averred, "We believe that there is sufficient evidence showing the clinical usefulness of percent free PSA in clinical practice, especially for patients in whom total PSA is between 4 and 10 and who have a negative DRE."
The relative risks of prostate cancer given by the % fpsa results are well known, and my meager 5.1% (total psa reading of 6.1 at last testing 2 weeks ago) fell into the category of men with more than a 60% probability of having cancer, as opposed to benign prostate hypertrophy.
Anyway as she rambled on, informing what the research showed on cancer probability for my % f psa my mind had by then blanked out. In any case I already knew it and the odds.
By the end of her message she flatly told me there could be no more excuses or other tests, and she was referring me to a urologist for a prostate biopsy. Of course, given the choice between that and two root canals I would likely take the latter any day. A prostate biopsy meanwhile is no sport with more than 12- 80mm long needles inserted one by one at a time into one of the most sensitive regions of the body to snatch (in turns) 1/2" sections from differing positions and then do it again. Some have colorfuly referred to it as "being sodomized by knitting needles".
One Brit who faced it wrote on his blog some years ago:
"All men everywhere should demand sedation during a Prostate Biopsy. Accept no less. Demand sedation -- unless you like knitting needles being inserted where the sun don’t shine -- and 15 samples (or more!) being extracted by a circle of eleven needles, from a place that does not usually have needles pricking it & poking it.
I think what makes me most furious is that in this day & age of instantaneous information available on the internet, the “sedation” option for a Prostrate biopsy is almost not there.
Almost not there? Far into one article the writer says, in a very vague way, “general anesthesia helps….but your insurance company might refuse to pay.’ Saying “general anesthesia helps’ sounds like saying that an aspirin might help a headache. No, no, no. General anesthesia obliterates all pain at time of contact (later you will feel some soreness). General anesthesia doesn’t just help, it annihilates all memory of the pain.
In Modern Times there should be an addition to the Doctor’s Motto: “If at all possible, inflict no pain,” should be added to “Above all do no harm.’
I really am furious at the state of affairs. Everyone needs to know that in the case of a Prostate biopsy (a very-very common procedure for older men), “There is no reason for pain in a modern, well equipped room.’"
I definitely will be taking this guy up on his advice and insisting on sedation, and whoever the urologist is may regard me as "wimp", "wuss" or whatever, but hell - if you're going to have sedation for a colonoscopy why not for something 100 times more invasive!
The pain, of course, is not the worst aspect - another is the possibility of complications which I covered in an earlier blog. SO imagine my freak out when I also pulled up a comprehensive report out of Johns Hopkins Hospital, published in The Journal of Urology in 2011, noting all the hospitalizations for infections (an increase of ~ 7%) reported within 1 month for Medicare patients undergoing biopsy since 2000. (This compares with a hospitalization rate of 0.5% during the same 1 month post -biopsy period in the 90s). You can read much more on their findings here:
http://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_study_reveals_significant_rise_in_prostate_biopsy_complications_and_high_post_procedure_hospitalization_rate
Excerpt:
"Hopkins researchers have found a significant rise in serious complications requiring hospitalization. The researchers found that this common outpatient procedure, used to diagnose prostate cancer, was associated with a 6.9 percent rate of hospitalization within 30 days of biopsy compared to a 2.9 percent hospitalization rate among a control group of men who did not have a prostate biopsy. The study, which will be published in the November 2011 issue of The Journal of Urology, was posted early online.
The researchers emphasize that this new data should serve as a reminder to physicians to carefully weigh the risks and benefits of biopsy for individual patients and take all precautions to prevent infections and other complications.
The Johns Hopkins team’s findings are the result of the largest analysis ever performed of Medicare records of American men age 65 and older who underwent prostate biopsies in the last two decades. They found that having a prostate biopsy makes patients more than twice as likely to need hospitalization in the immediate post-procedure period. Those hospitalized had a range of complications, such as bleeding and infection, as well as flare-ups of underlying medical conditions, such as heart failure or breathing disorders."
Where will this lead and where will it go? I can't say for now, but will keep blogging as long as I can and keep readers appraised. My first visit with the specialist is unlikely to be before next Wednesday and the biopsy will not likely be before the following week - Wednesday or Thursday. I keep hoping for the best including that no cancer will be found.
Meanwhile, I am weighing treatment options!
Get set for the possibility of another atheist on a cancer ward!
Monday, April 16, 2012
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.
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.
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