Comments on: Three important editorials

By: E. Michael D. ("Mike") Scott

E. Michael D. ("Mike") Scott — Fri, 19 Sep 2008 01:54:03 +0000

In the actual editorial, Thompson gives detailed examples of what he means by "individualized prostate cancer risk assessment." He is absolutely not suggesting we biopsy everyone with a PSA of 1.5 ng/ml (for example). What he is saying is that there is an obligation on the physician to discuss the options carefully with the patient and make a decision together (as compared to the continuing current situation in which biopsies are the norm for everyone with a PSA over 4.0 ng./ml, or 2.5 mg/ml, depending on the physician's interpretation of the available guidelines). If you can get a copy, I suggest you read the actual editorial. Unfortunately we cannot post this on the site because of copyright restrictions.

By: Steve Z

Steve Z — Thu, 18 Sep 2008 21:02:55 +0000

That third important editorial (Thompson) really has me confused. What does it all mean? If you go below 4.0 PSA as an upper limit of normal, that’s below average PSA for anyone over the age of 55 (Mayo Clinic study: age 50-59 – PSA 3.5; age 60-69 – PSA 4.5).

Should you biopsy 2/3 of all men over 50, or abandon PSA (the best marker in oncology) as biopsy criteria?

By: Rabbi Ed

Rabbi Ed — Thu, 18 Sep 2008 05:31:39 +0000

Assessing whether patients who have been recently diagnosed are low-risk for tumor growth is feasible, but never a sure bet, especially if they are not closely monitored through active surveillance.

Still even with active surveillance, it appears to me that urologists can only guess at the real pathology, unless the patient decides to opt for surgery so a post-op biopsy can occur with the prostate under the microscope.

Equally important, as in my case, only surgery, with its clearer up-front glimpse inside the pelvic region, can determine if there are other complications involving nearby organs such as the bladder or seminal vesicles.

In my case it was discovered only after robotic surgery that I needed to have my bladder neck reconstructed, or else I would have ended up a “urological cripple.”

This phrase came up in a conversation between my surgeon and contributing author and with my wife, as I elaborate in my new book, Conquer Prostate Cancer: How Medicine, Faith, Love and Sex Can Renew Your Life.

In another friend’s case, it was discovered after robotic surgery that his cancer has spread from his prostate to his seminal vesicles. Had his doctors not identified that after his surgery, they might not have explored the extent to which his lymph notes were similarly involved.

In turn it would not have been clearly mandated that he would benefit from additional treatment such as chemotherapy and hormone therapy which followed his surgery. That treatment was no fun but he suffered willingly, knowing that those additional approaches would increase his prospects for greater longevity.

It may well be that risk assessment coupled with active surveillance can help patients avoid “over-treatment.” But at this time prostate cancer surgery can reveal more than other modalities like radiotherapy or active surveillance. This isn’t theory. As I’ve demonstrated, it really has happened.