General Petraeus has Prostate Cancer

[Luv2play]

It was announced yesterday that General Petraeus has been treated for prostate cancer, which was diagnosed last February. The 56 year old general apparently had early stage prostate cancer and received radiation therapy to treat the tumours. The treatment is being called "successful".

 

This is a topic of special interest to the members of this board as many, if not most, are middle aged to older gentlemen and it is this group which is at the highest risk of contracting prostate cancer. I should know as I was treated for it two years ago and my two older brothers are receiving treatment for the same problem now.

 

Several other members of this board also have been successfully treated for prostate cancer and we have had discussions about it on this board. General Petraeus's cancer is a timely reminder that guys our age should watch out for this problem, which is the second leading cause of cancer-related deaths for men in North America.

 

In my case, there is a history of prostate cancer in my family going back two generations so there is evidently some genetic link. I believe men who have similar risks should be screened on a regular basis, perhaps every year, by a simple blood test (PSA). Testing might start as early as your 40's for high risk individuals and 50's for others.

 

Recent studies have cast doubt on the efficacy of widespread screening for prostate cancer. There are risks associated with the treatments (radiation, surgery) so any treatment should only be undertaken after serious consideration of all the risks. One of the risk factors is a person's weight, and people who are seriously overweight might encounter problems in getting timely treatment.

 

Anyway, this is a problem that men need to face up to as they age and they should talk to their doctors about what is best for them.

[Guest zipperzone]

Thanks for the timely reminder.

 

I have had bladder cancer twice (low grade, successfully removed) and my mother died of stomach cancer so I am very vigilant for any signs that could possibly indicate a problem.

 

My doctor calls me cancer-phobic which I think could possibly result in him not taking my inquiries as seriously as he should. I have been trying to get him to order a colonoscopy for several years now and finally wore him down and had the procedure done yesterday. (The "prep" is hell but the actual procedure, no big deal).

 

They discovered one polyp which was removed and because of that I was told I would have to have one every 2 years from now on.

 

So - if you have any doubts about any symptom that might indicate cancer, please, please look into it immediately. Do not delay. The words I never want to hear are.... "If only you had come here six months ago"

[+ LIguy]

Prostate Biopsy

 

Would someone who has had one tell how the procedure was? Is there alot of bleeding and is it painful? I would really appreciate hearing about it from a patient's view.Thanks.

[Luv2play]

I had a biopsy after my PSA test revealed there was a problem. The test went fairly smoothly until the 8th or 9th sample when I think the needle went a little too close to the urethra and I gasped with the pain. The next pinprick (about 20 seconds later) was even worse and I told the doctor "this is no walk in the park"!

 

All he said was there are only two more to go and they went alright without much sensation. Afterwards there was not much tenderness and in fact I had no real symptoms.

 

For one of my brothers, he related a different experience. Although he experienced no significant discomfort with the procedure, he had some significant bleeding in the following three days, such that he went back to his doctor to see if everything was alright. He was told this could be expected and it cleared up after that. Unfortunately, his biopsy result was not good and he has now had a radical prostectomy and is scheduled to undergo radiation treatment as the cancer had spread outside the prostate gland.

[+ glutes]

Prevention

 

I was speaking to a friend who happens to be a Urologist, and asked him about prevention in this venue (saw palmetto, etc).

Quote, "Whatever is good for the heart is good for the prostate"

 

From the Mayo Clinic:

 

* Eat sensibly. Eat moderate-sized portions and keep your calories under control.

* Choose balanced meals. Prostate cancer rates vary greatly from one country to another, with the highest rates appearing in countries where people tend to eat a lot of fat. A diet high in saturated fats (such as animal fats found in red meat) may pose the greatest risk.

* Eat a variety of fruits and vegetables. A diet high in fruits and vegetables has been linked to a lower risk of various kinds of cancer. Foods high in folate — a B vitamin found in spinach, asparagus and some beans — may be helpful. Also, eating vegetables with diindolylmethane — a nutrient found in cruciferous foods such as broccoli, kale and cabbage — might protect against prostate cancer. Studies show mixed results about whether lycopene — an antioxidant found in tomatoes — lowers prostate cancer risk.

* Choose healthy foods. Opt for whole-grain foods, such as brown rice, quinoa and whole-wheat bread. Limit sweets and salt.

* Drink alcohol in moderation. Generally, this means no more than two drinks a day for men. Studies show that regular heavy drinking increases the risk of aggressive prostate cancer.

[Guest zipperzone]

Would someone who has had one tell how the procedure was? Is there alot of bleeding and is it painful? I would really appreciate hearing about it from a patient's view.Thanks.

 

I had it several years ago. Thankfully the result was negative. Small amount of bleeding afterwards but not enough to be an issue although the first ejaculate is probably going to be quite bloody and can be a surprise for your partner if he is not prepared for it.

 

I can't say that the actual procedure actually hurt. It felt more like a good kick in the ass every time the needle took a sample.

[uwsman2]

The PSA game

 

I've been getting PSA's for many years, and they have always been elevated, but the search for cancer has yielded nothing - two biopsies and an MRI over the past several years, and not a sign of cancer, but the PSA continues to be high, although it went down slightly last winter and seems to be at a lower plateau than before. The problem is that the PSA is a non-specific test, things other than cancer can "set it off," and so we continue the watchful waiting with my slightly enlarged but otherwise quite normal prostate.

[gp0560]

Need for PSAs?

 

I too have been getting PSAs and DREs for years. Recently, negative professional reaction against the need for PSAs has been published, so please check with your doctor on that. Wish I could quote a source, but try googling and you should find references.

[Guest]

There have been many studies published in the last few years in the U.S. and Europe examining prostate cancer screening ("screening" refers to looking for a condition in people with no symptoms). Every study so far, looking at many tens of thousands of men for up to 15 years, has shown screening does nothing helpful (and since prostate cancer workups and especially treatment have a fairly high degree of morbidity, it is harmful). It is very easy to "successfully treat" prostate cancer since this is an unusual form of cancer in that it will never affect in any way 95% of the men who get it. It makes it very easy for the doctor to look like a hero or life-saver (while maiming the patient). Of course, studies are still ongoing, and there may be benefit found after 15 years, but that is speculation so far. If, knowing this, some men still want to be screened for prostate cancer, that's up to them. I generally think it's a good idea to check for prostate cancer, though, only if there are symptoms, or if there's a significant family history (not just of prostate cancer, which ALL men get if they live long enough, but of prostate cancer which actually did something harmful). Since we know that screening is harmful with a 15-year timeline, it should NEVER be done in men over 70 (a group with an extraordinarily high rate of harmless prostate cancers).

[+ purplekow]

[since we know that screening is harmful with a 15-year timeline, it should NEVER be done in men over 70 (a group with an extraordinarily high rate of harmless prostate cancers).

 

Are you saying that asymptomatic men with a palpable prostate nodule should not have a PSA and biopsy if the are over 70?

 

Prostate screen should include a good digital rectal exam and if a PSA is done, the relative risk of cancer should be explained and the patient and doctor should then determine a plan for further evaluation. Even with a PSA over 10 and an abnormal exam the likelihood of cancer is less than 50%. If someone has underlying disease which would preclude treatment then certainly further investigation is unnecessary. What about the vital, athletic and otherwise healthy 70 year old who might actually have a life expectancy of 25 years?

 

Never and always are very dangerous words in medical care.

[KMEM]

PK-

Never say never. I agree with you.

 

One problem with prostate cancer is statistics. If you are on the "wrong" side of them, in other words, an exception, you could become very ill and die regardless.

 

It seems to me the most important things are to get screened which includes the DRE and PSA but become informed enough to deal with the various issues. That means reading the literature and conferring with enough doctors to feel comfortable with what they are suggesting. There is seldom any need to panic. You have time to figure things out before you MUST act or decide to NOT act. Being scared and ignorant and then reacting too quickly is almost as bad as it can get.

 

A rapidly rising PSA especially if you are under 50 does call for investigation. Sometimes I think it might seem as if a doctor is bound and determined to test until he finds something but it is far better to know than to wonder. A biopsy is commonly given with no drugs or Valium. It may not be completely pain free but the mental anticipation is worse than the actual test.

 

PSA's as high as 900 have been recorded but the doctors start getting nervous at or around 10, as PK indicates, but it is the interval over which the increase occurs that is more important aka rate of increase.

 

Wouldn't you hate to wake up one day and find that your treatable prostate cancer had metasticised throughout your body? The only way I know to prevent that is to have regular screening. Then, slow down, become informed and make a reasonable decision.

 

Best regards,

KMEM

[+ purplekow]

Do a quick check, I think hell may have frozen over. Not only does KMEM agree with me, I agree with him.

[KMEM]

Do a quick check, I think hell may have frozen over. Not only does KMEM agree with me, I agree with him.

 

Hell has indeed frozen over. I credit it entirely to "global warming".

 

We agree much more often than we disagree, PK, or so it seems.

 

Best regards,

KMEM

[+ glutes]

What clear & cogent thought Nurse Practioner KMEM, even I agree with you!

Hell has frozen over...

 

http://static.rateyourmusic.com/album_images/s618.jpg

[uwsman2]

re modifying the routine

 

So after my PSA went to a plateau (high, but steady) and we found no cancer after two biopsies (ouch!) and an MRI, my doc and I agreed that I would have PSAs at my regular annual physical but only see the urologist if there was a change of significance in the PSA.

[Guest]

[since we know that screening is harmful with a 15-year timeline, it should NEVER be done in men over 70 (a group with an extraordinarily high rate of harmless prostate cancers).

 

Are you saying that asymptomatic men with a palpable prostate nodule should not have a PSA and biopsy if the are over 70?

 

Asymptomatic men should not have their prostate palpated if they're over 70. Opinions and arguments are all very interesting, but facts are facts, not what wish they were. The studies have been large enough to show even a tiny amount of benefit, and they have all been negative. For some cancers, screening is helpful. For others, it is not. In most of the forms of cancer in which screening has been shown to be useless, it is because the cancers grow so quickly that it is too late once it appears (ovarian, lung, for example). In the case of prostate cancer, the reason appears to be that it is so benign in most cases that more harm results from the sequelae of screening. I'm not denying the possibility that benefit will be found after 15 years. After all, the cancer grows extremely slowly. But just last week a study came out in JAMA which showed that men 65 and over who had no interventions for their diagnosed low-grade prostate cancers fared better than those who had surgery or radiation.

Just because "you'd think that" something is true doesn't mean it IS true. "You'd think that" doing chest X-rays every few months on smokers would reduce lung cancer morbidity or mortality. All very interesting in theory, but the fact is that it doesn't. Same with doing frequent transvaginal ultrasounds for ovarian cancer, urinalyses of bladder cancer, and so on. Yes, "you'd think that" if you have a prostate cancer inside of you, that you'd be better off having it taken out. All very logical in theory, except that facts prove otherwise. Yet there are no shortage of true believers.

I can certainly understand those who don't want to wait for the ongoing studies, and feel there may be a benefit after 15 years. So I would never tell a man in his 50s or 60s that he shouldn't get screened. If he accepts the fact that there's no evidence of benefit and is willing to risk the harm of screening, I don't feel he's being unreasonable.

However, at the present time it is a fact, not an opinion, that no benefit has ever been shown for anyone with any form of prostate cancer screening, be it DRE or PSA. We simply do not know if there will be benefit after 15 years, and the reality must be stated as thus.

[gp0560]

Unicorn writes, "I would never tell a man in his 50s or 60s that he shouldn't get screened. If he accepts the fact that there's no evidence of benefit and is willing to risk the harm of screening, I don't feel he's being unreasonable."

 

Is there some medical usage of "screening" or "harm" that I don't understand? For example, in what sense is a DRE or PSA harmful? Neither one hurts or is invasive, so to this layman, there's not even pain, let alone harm in these screening tests.

 

Can you help me out here? Thanks.

[KMEM]

Unicorn writes, "I would never tell a man in his 50s or 60s that he shouldn't get screened. If he accepts the fact that there's no evidence of benefit and is willing to risk the harm of screening, I don't feel he's being unreasonable."

 

Is there some medical usage of "screening" or "harm" that I don't understand? For example, in what sense is a DRE or PSA harmful? Neither one hurts or is invasive, so to this layman, there's not even pain, let alone harm in these screening tests.

 

Can you help me out here? Thanks.

 

The first risk of screening is the possible mental harm. Some men will drive themselves crazy thinking they have a time bomb inside. There are cases where an elevated PSA has been so worrisome that they have had their prostate removed rather than continue to monitor what might be going on. Generally that is very much over reacting.

 

The second risk is that "warning signs" of increased PSA or a suspicious DRE leads to more and more testing which has its' own risks as mentioned earlier on this thread. Those are physical risks as well as the aforementioned mental risks.

 

No one likes to be told they have cancer or might have it or develop it. However, prostate cancer most of the time does not need to be addressed in an urgent manner and sometimes not at all. Becoming knowledgeable and consulting with your medical team is paramount.

 

Best regards,

KMEM

[gp0560]

Thanks, KMEM, that helps a lot.

 

But now I have another problem. My doctor says that after 70, a colonoscopy is no longer necessary either. But if I don't get a DRE finger or a colonoscopy scope up my ass, whatever will I do?

 

Oh, wait, I have some ideas.

[KMEM]

You are welcome. Let me think a minute about your dilemma, oh, I think I know what you have in mind.

 

Best regards,

KMEM

[+ purplekow]

Are you saying that asymptomatic men with a palpable prostate nodule should not have a PSA and biopsy if the are over 70?

 

Asymptomatic men should not have their prostate palpated if they're over 70.

 

 

The question is, once it is found are you advising the it should be ignored? There are two different populations, one is the population of all men over 70 and the other is all men over 70 with a palpable prostate nodule. So someone comes in for an evaluation of anemia, a rectal exam is done. Presumably he is in the first population to start. Would you specifically ignore the prostate so as to keep him in the first population.? If you should inadverently feel something, thereby moving him to the second population, would you ignore that? By the "never" in your original statement, I would suppose you would actively try to avoid the prostate and if the mass were so big that you ran into it, being asymptomatic, you would ignore it. If you didn't ignore, but rather told the patient, would you advise him to ignore it? If he decided he wanted another opinion and he went to a specialist and was advised a PSA and biopsy, would you advise him to ignore the specialist? Would you refuse to give his now requested referral? If you have answered yes throughout, then I would say you have great faith in those studies and by extension so do your patience, and you really meant never. It you wavered even a bit, then never didn't mean never, it meant evaluated on an individual basis. Either way, for right now, I am in the evaluated on an individual basis camp but should the data become incontravertable, I am willing to learn and change.

[+ purplekow]

In reading your original post, you have already answered these questions, well most of them anyway.

[Guest]

Thanks, KMEM, that helps a lot.

 

But now I have another problem. My doctor says that after 70, a colonoscopy is no longer necessary either. But if I don't get a DRE finger or a colonoscopy scope up my ass, whatever will I do?

 

Oh, wait, I have some ideas.

 

Hmmm. Your doctor isn't quite toeing the official line with respect to colonoscopy screening. Colonoscopy detects pre-cancerous lesions years before they become cancerous, and can catch early cancers before they spread. It's overall a slow process, but, unlike prostate cancers, colon cancers usually DO cause trouble for the person who has it. The official recommendation from the USPSTF (the most evidence-based, not special-interest driven of the recommendations) states:

 

* The USPSTF recommends screening for colorectal cancer (CRC) using fecal occult blood testing, sigmoidoscopy, or colonoscopy, in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary.

Grade: A Recommendation.

* The USPSTF recommends against routine screening for colorectal cancer in adults age 76 to 85 years. There may be considerations that support colorectal cancer screening in an individual patient.

Grade: C Recommendation.

* The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years.

Grade: D Recommendation.

* The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer.

Grade: I Statement.

[Guest zipperzone]

I generally think it's a good idea to check for prostate cancer, though, only if there are symptoms, or if there's a significant family history (not just of prostate cancer, which ALL men get if they live long enough, but of prostate cancer which actually did something harmful). Since we know that screening is harmful with a 15-year timeline, it should NEVER be done in men over 70 (a group with an extraordinarily high rate of harmless prostate cancers).

 

My doctor has always told me that most men die WITH prostate cancer but not OF it.

[Guest zipperzone]

I had a colonoscopy this week - one polyp found and removed with the recomendation for further such exams every two years.

 

I am curious as to why routine screening is not recommended between ages 76 & 85 and any screening is not recommended after 85. Does the cancer really grow so slowly that you'll die of age before it kills you? Very confusing.......