Incurable Prostate Cancers on the Rise

[Luv2play]

This topic hasn’t been discussed for some time. This week there is a report stage 4 incurable cancers are appearing to be increasing in Canadian men since 2015, a year after the official guidelines for PSA testing were revised to exclude regular PSA testing, which caught cancers at an earlier treatable stage. (Deaths are also increasing in the US since 2015)
After many years of declines in morbidity rates, the levels plateaued off after 2014 and deaths from cancers in men over 50 skyrocketed by 50 percent and men over 70 by 60 percent. (I hope I got these figures exact but they are in the ballpark).

We had quite a discussion here back then and many argued against the testing because of the adverse effects that can occur from treatment. I was beyond having to consider the options becuz I had had my prostrate removed in 2006 after an elevated PSA reading. I’m glad I did and I have been cancer free for almost 20 years. And approaching 79. 

I read quite a few obituaries about men these days dying from prostate cancer in their 60s and early 70s

I do suffer from ed but as a bottom, it’s not too concerning. I can still achieve climax so there’s that. And I’m alive! So there’s that.

[+ SirBillybob]

15 hours ago, Luv2play said:

This topic hasn’t been discussed for some time. This week there is a report stage 4 incurable cancers are appearing to be increasing in Canadian men since 2015, a year after the official guidelines for PSA testing were revised to exclude regular PSA testing, which caught cancers at an earlier treatable stage. (Deaths are also increasing in the US since 2015)
After many years of declines in morbidity rates, the levels plateaued off after 2014 and deaths from cancers in men over 50 skyrocketed by 50 percent and men over 70 by 60 percent. (I hope I got these figures exact but they are in the ballpark).

We had quite a discussion here back then and many argued against the testing because of the adverse effects that can occur from treatment. I was beyond having to consider the options becuz I had had my prostrate removed in 2006 after an elevated PSA reading. I’m glad I did and I have been cancer free for almost 20 years. And approaching 79. 

I read quite a few obituaries about men these days dying from prostate cancer in their 60s and early 70s

I do suffer from ed but as a bottom, it’s not too concerning. I can still achieve climax so there’s that. And I’m alive! So there’s that.

I, too, read both of Kelly Grant’s related prostate screening articles this year, as well as Dr Wilkinson's editorial and valiantly plowed through the extremely detailed epidemiology Wilkinson’s team published in oncology. It’s exhausting because it’s decades of data stratified by multiple age groups, cancer stages, survival, and mortality along with temporal sequences of cancer intervention stages. By the way, all the data are confounded by about 50% of men above age 50 with “opportunistic” uptake of PSA screening in spite of no recommendation for it. A lot of cancer is detected through routine PSA screening that transcends recommendations against such screening. Therefore, pro-con screening guideline alterations over decades' span are not a great independent variable for predicting clinical outcomes when half of men are behaviourally contrarian along with physicians erring on caution's side against a simple reductionist argument that too few deaths are prevented by too vast a number needed to screen per averted mortality. The actual testing data are not integrated into cancer surveillance registries and the dissonance between formal testing guidelines and testing reality at various points in time is unknown. The ratio of stage 4 cancer diagnosed due to non-screening that results in insidious under-radar progression and due to screening that colours outside the guidelines is unclear. An abrupt shift in the sands regarding guidelines was never going to eliminate pro-screening trends that existed previously. 

Like most journalists, Grant aims to get views from those with clinical expertise that often contradict, or present both sides of a topic. While there seems to be merit in reviewing and revising screening guidelines, one of the main areas of pushback against expanding PSA screening, following its systematic reduction within health protection recommendations some time ago, is cases wherein an elevated PSA is followed by radical intervention, leapfrogging over post-PSA intermediate steps. 

Naturally, removal of one’s prostate based on a PSA level alone will reduce or eliminate prostate cancer risk irrespective of whether cancer would have occurred. What is unclear about your prostate screening and intervention history is whether there were other diagnostic measures taken prior to prostatectomy. I am not referring to family history or the comparator of a male sibling. Those are not diagnostic but may reinforce a past surgical decision.

Clinicians pushing back against certain revision recommendations are not attempting to undermine patient autonomy. Rather, a desire to circumvent unnecessary more extreme  interventions that lead to poor outcomes outside of the binary of any grade of cancer or no cancer.

If you had no diagnostic assessment between PSA and surgery yet you are fine with it, that acceptance does not alleviate the concerns posed about unnecessarily aggressive and invasive measures by clinician subsets wishing to constrain and temper screening revisions in spite of the morbidity and mortality tracking that currently steers recommendations for screening revision. 

Your personal anecdote is more meaningful and supportive of current screening revisions if your personal case details included inarguable evidence of true malignancy, not merely theoretically forecasted aggressive cancer.

Anybody can put forward an anecdote. My elevated PSA levels commenced over a decade ago. I have, nevertheless, had no biopsy done. Biopsy can miss cancer so once you scale up diagnostic screening at that degree you risk repeated screening at invasive levels, potentially submitting to a regularity of biopsies that begins to mirror the frequency of PSA levels over time when younger. My prostate/ bladder MRI roughly bi-annually for 10 years, out of pocket cost, stable PI-RADS score of 2 on 1-5 scale.

PSA screening did nothing for me but impel regular imaging that assuages concerns based on PSA interpretation. My cancer outcome is the same as preventive, but possibly premature, prostatectomy yet intact prostate and avoidance of pelvic nerve plexus trauma. I am happy to be alive with a non-cancerous prostate. There’s that. No point begrudging anyone a choice either way if the goal is no chance of site  anatomically specific cancer that may or may not contribute to all-cause mortality for the individual. Postponing death that might have occurred and maintaining prostate gland function whose loss might have been averted are two values-specific factors hanging in the balance.

My case supports revisions in PSA screening accompanied by far more expensive and difficult to access diagnostic procedures, short of tissue pathology, or inclusive of needle biopsy. It cannot easily fly within a public coffers funding model. My case also supports historically zero screening, for me, and for others never screened yet not having been affected by non-testing.

The fly in the ointment is that in this clinical domain you can’t eliminate the risk of the associated medically iatrogenic by scaling up disease detection. Hence, tension between clinical opinion factions, attempting to reconcile the pros and cons of screening with morbidity and mortality data pit against do-no-harm concepts anchored in the true existence of needless invasive diagnostic and surgical harm.

It’s difficult to portend the outcome of expanded PSA screening access on the future direction of morbidity and mortality because it would be egregious to withhold the costly components of a far more sophisticated diagnostic decision tree these days compared to a time when radical prostatectomy was more the default … getting that thing out instead of waiting for its eventual  short- or long-term status.

Edited December 9 by SirBillybob

[mizuki777]

The shift away from routine PSA testing did change how often aggressive cases are caught early. When screening drops, the first sign of cancer can show up later and that leads to more advanced diagnoses. That is what many of the recent reports are pointing to.

Most doctors now say the best approach is a personalized one, meaning you look at age, family history, and overall health rather than skipping screening altogether. Men who stay in touch with their doctors and check any new symptoms early still have the best outcomes.

Your story shows how much early detection can matter, and it is helpful for people who are unsure about what to do next.

[+ SirBillybob]

 

55 minutes ago, mizuki777 said:

The shift away from routine PSA testing did change how often aggressive cases are caught early. When screening drops, the first sign of cancer can show up later and that leads to more advanced diagnoses. That is what many of the recent reports are pointing to.

Most doctors now say the best approach is a personalized one, meaning you look at age, family history, and overall health rather than skipping screening altogether. Men who stay in touch with their doctors and check any new symptoms early still have the best outcomes.

Your story shows how much early detection can matter, and it is helpful for people who are unsure about what to do next.

What could be more valuable than early detection of anything serious if early intervention has an impact? What I read from the OP’s account was a leap from an elevated PSA to surgical prostatectomy. If anybody thinks that such a clinical approach taken today, opined with certitude by one’s physician without other factors considered, is living under a rock, not through their own fault mind you, with said incompetent completely not up to date practitioner. I don’t know if that was the actual trajectory and an elaboration may yet occur. PSA alone is not diagnostic wrt cancer.

The point about thorough individualized consultative screening is of course golden. My thousands of dollars spent out of pocket on surveillance isn’t regrettable to me due to my socioeconomic status. I’m able to ease the burden on public surveillance resources. However, intervention wait times, owing to resource access difficulty, also play a key role in cancer stage progression. I would be screwed there. It’s a shame that invasive surgery in some cases supplants effective more ideal measures categorically known as needed and applied in a timely fashion. The current need, boomer factors included, already translates to a leadened systemic burden. Earlier detection won’t solve who gets what when. I feel for anybody whose test results propel them into the caprice  of the treatment realm. 

Edited December 9 by SirBillybob

[Luv2play]

I didn’t go through my whole case history as I had related it years ago in this forum but of course many here now were not present then. To be brief, I was alerted to having a PSA test done from my oldest brother who had recently been diagnosed with prostate cancer after an elevated PSA led to a biopsy which confirmed cancer, 

I went and had the PSA which showed an elevated level from a test I had from 4 years earlier. A subsequent biopsy confirmed cancer in the mid range of 7 on the Gleason scale. My specialist recommended either surgery or radiation. My family doctor supported this and I opted for surgery.

 A year later my other brother was diagnosed with prostate cancer. He was more advanced and higher on the Gleason so he had surgery. It also came back 9 years later and he had to have radiation and other therapy.

My oldest brother opted for watchful as he was lower on the Gleason scale, in the 6 range as I recall. He has had to monitor it ever since . On the other hand I haven’t seen a doctor about this for 10 years now and am cancer free for almost 20 years. 

[+ SirBillybob]

12 hours ago, Luv2play said:

I didn’t go through my whole case history as I had related it years ago in this forum but of course many here now were not present then. To be brief, I was alerted to having a PSA test done from my oldest brother who had recently been diagnosed with prostate cancer after an elevated PSA led to a biopsy which confirmed cancer, 

I went and had the PSA which showed an elevated level from a test I had from 4 years earlier. A subsequent biopsy confirmed cancer in the mid range of 7 on the Gleason scale. My specialist recommended either surgery or radiation. My family doctor supported this and I opted for surgery.

 A year later my other brother was diagnosed with prostate cancer. He was more advanced and higher on the Gleason so he had surgery. It also came back 9 years later and he had to have radiation and other therapy.

My oldest brother opted for watchful as he was lower on the Gleason scale, in the 6 range as I recall. He has had to monitor it ever since . On the other hand I haven’t seen a doctor about this for 10 years now and am cancer free for almost 20 years. 

Thanks for clarifying the bridging steps between PSA screening and intervention decisions which I expect were challenging but worked out given the findings. 

Had your brother with relapse had prostatectomy yet eventual  metastasis? I think yes, since you indicated surgery.

Has your brother opting for surveillance had to endure the  invasiveness of multiple biopsies over time for progressive decision-making? 

Any of you had MRI steps for detection alone or for imagery-guided biopsy?

Edited Thursday at 01:07 PM by SirBillybob

[Luv2play]

7 hours ago, SirBillybob said:

Thanks for clarifying the bridging steps between PSA screening and intervention decisions which I expect were challenging but worked out given the findings. 

Had your brother with relapse had prostatectomy yet eventual  metastasis? I think yes, since you indicated surgery.

Has your brother opting for surveillance had to endure the  invasiveness of multiple biopsies over time for progressive decision-making? 

Any of you had MRI steps for detection alone or for imagery-guided biopsy?

The brother who opted for surgery as I did unfortunately had the result that the cancer had spread from the prostate when it was removed. It had pierced the wall of the gland but doctors were uncertain how far it had gone. He rejected further treatment at that time for fear of becoming incontinent. When the cancer returned 9 years later he then had radiation and other treatment. Today he seems ok but suffers incontinence. 
The older brother has had his cancer monitored for 20 years but it hasn’t progressed. Whether he has biopsy or MRI procedures I don’t know. He never raises it. 
I didn’t find the one biopsy I had that troublesome. Of course I’m used to having things poke around in my rear but the needle was a little uncomfortable. They took at least a dozen samples and it started to wear on me a bit. I recall they used a mild sedative but I was fully conscious. 

Edited Thursday at 08:22 PM by Luv2play