“PSA and the family physician”

The full text of a recent article having the above title offers a good (if perhaps not perfect), reasonably current overview of issues related to PSA testing for prostate cancer and appeared recently in a supplement to the Canadian Journal of Urology.

As the author — Dr. Barkin, a urologist — notes right up front in the abstract to this article, “The need for men to undergo screening for prostate is controversial.” However, he gives a well-thought-out explanation for the appropriate and justifiable use of PSA testing, while simultaneously emphasizing the importance of risks related to the diagnosis of clinically insignificant prostate cancer and the over-treatment of such clinically insignificant disease.

With the latest results of the Scandinavian trial (as reported in the New England Journal of Medicine a few weeks ago), and the initial results of the PIVOT study (as presented at the annual meeting of the American Urological Association only 8 days ago), both demonstrating no statistically significant impact on survival as a consequence of surgery in men with low-risk prostate cancer who were ≥ 65 years of age, the importance of understanding that aggressive treatment of older men with low-risk prostate cancer potentially comes with greater impact on quality of life than benefit from aggressive intervention is a very, very important and new piece of knowledge (long suspected but now finally proven).

The article in question will be a useful tool for the well-informed prostate cancer support group leader and other prostate cancer educators — in addition to primary care physicians.

It is becoming increasingly important for patients at risk — and all their doctors — to ensure that careful assessment of the real risk for clinically significant prostate cancer (as opposed to one or two tiny foci of Gleason 6 disease) is a critical factor in deciding (a) whether one or more biopsies are necessary on the basis of PSA data and (b) whether further treatment is justifiable on the basis of the biopsy data. This is most particularly the case in men with a PSA level of 4 ng/ml or less who are either ≥ 65 years of age or have a reasonable life expectancy of < 15 years (or of course both).

One Response

  1. I am 74 years old and a prostate cancer survivor. I survived because I had water works problems. I went to see my GP and on snapped the infamous glove. Fear not, lads, this is more embarrassing than painful. A lot of “umming” and “arring” from the doctor followed. After the rubber finger was removed, he referred me to the local hospital.

    At the hospital, I met some very worried looking men, all drinking water by the gallons to pee on demand into a machine which looks like a bucket with whirly bits in it. This measures the power of your pee (or lack of power as the case may be). The resulting chart had a sudden descent downwards. I then had more embarrassing investigations of my rear end, including a student bum inspector who kept apologising as they took some scrapings for testing. Again, this was more red faced than pain. I was then allowed to go home.

    I received a curt letter which simply said, “You have prostate cancer”. There was no doctor to break it gently to me here. The upshot was to attend the hospital daily for 6 weeks of radiotherapy, with weekends off for good behaviour! So daily I attended the hospital. I had to lay down on a long platform and was trundled slowly into the jaws of a large machine. This is totally painless and you even get to meet a lovely bevy of caring nurses.

    One problem with the scrapings that nobody told me about was that a scab forms and when the scab becomes detached you get blood in your pee. Unfortunately this happened to me when I was using a public urinal. I don’t know who was more astonished as my blood/pee went slowly downhill past my fellow pee-ers. They all looked at me and I looked at the bloke next to me!

    Also, and just as importantly, there are also injections of a capsule into the stomach. This is slightly painful. The only drawback is you tend to put on a lot of weight — don’t let anyone tell you it’s because you eat too much! And the cost of new trousers is a bind. Every 12 weeks I would toddle off to the local clinic so another nice nurse could inject the capsule into my tummy. I also had regular blood tests to check everything was going OK but I always had very good results. This is also carried out by the same nice nurse at the clinic.

    That all happened 8 years ago and as I look at the smiles of my grandchildren I think, “Thank God for the doctor with the rubber glove!”

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