Prostate cancer risk: an investigative journalist’s tale

When Paul VanDervelder was told his PSA had spiked, he did what many men do. He panicked! But then he did what he was trained to do as an investigative journalist. He investigated.

Read Paul VanDervelder’s case study of his own experience in his article in yeterday’s Los Angeles Times.

7 Responses

  1. Yes, many men panic, and then they decide to play the wait and see game. Well that is fine if you are under age 65 or so. However, as you approach age 75, that magical age beyond which most doctors will NOT operate and perform a RP. And if you decide to have radiation instead before age 75? Well you had better hope that you remain cancer free because if not, you cannot receive a RP because the massive cluster of veins in that area are so hardened by the radiation that it impossible to operate. If you have cancer detected by biopsy, then don’t screw around with other treatments, you are only playing roulette.

  2. Dear Richard:

    I am sorry but you are making factually inaccurate statements. There most certainly are physicians who will operate on carefully selected men of 75 years and older if they are in good physiological health and have intermediate- and high-risk disease with a life expectancy tending toward 10 years or more. However, most men don’t meet those criteria, and most urologists don’t have the technical skill to operate on men of that age and consistently have good outcomes. The skill of the surgical team is an imperative to good outcome at any age, but particularly among older men.

    Furthermore, there is considerable evidence today to demonstrate that surgical treatment of men of 65+ years of age with low-risk cancer is not associated with any survival benefit, but is associated with significant risk of death from other causes as well as side effects, so why would anyone want surgery when they are > 65 years of age if they have low-risk disease?

    I do agree with you that salvage radical prostatectomy in men of 75+ years of age after first-line radiation therapy is completely inappropriate. In all but the rarest cases it would leave the patient completely incontinent and is unlikely to offer any survival benefit either. I am actually not aware of any surgeon who would consider a salvage RP on a man > 75 years of age.

  3. I believe that Richard’s statement about playing Russian roulette is somewhat correct for all middle-aged men. Except that the gun has 30 chambers loaded with four blanks (low-risk kitty cat neoplasms) and one deadly bullet (high-risk tiger ones) and that the genuine bullet has its deadly effect after say 15 years. As a person gets older, more bullets (mostly blanks, but some real ones) get loaded. Once a baddie is discharged (diagnosed), there is even an opportunity to duck (have treatment). Richards legitimate concern is that one won’t be able to duck fast enough.

    So yes, one does take a risk by doing nothing. One also takes a risk by treating.

    So, do you feel lucky, Punk?

    My job is to identify what types of bullets have exited the gun. The rubber ones I believe should be called neoplasms. (See

  4. Dr. O:

    That is a very different issue, and I absolutely agree with you. However, we aren’t going to solve that problem until we can actually develop test(s) that can accurately discriminate between clinically significant (and deadly) forms of prostate cancer and the truly indolent and clinically insignificant forms at the time of initial diagnosis.

    We tend to forget that most of that same group of middle aged men are simultaneously playing Russian roulette with their cardiovascular system … and that the gun they are using in that game has the same number of blanks (about four), but about 10 live rounds in the 30 chambers! As the men get older, the number of blanks in that gun starts to decrease!


  5. Why aren’t men like Richard in the first post prescribed finasteride?

    I have a friend who is 72, he took it and his PSA has been reduced to 1.

  6. Also, after radiation failure you can do HIFU. And if Richard had done HIFU in the first place, he could be retreated. Can he take finasteride now?

  7. Dear Ron:

    I think Richard was very pleased to be able to have surgery.

    I have no idea whether he was ever a candidate for treatment with finasteride or dutasteride (neither of which are approved for the first-line treatment of any stage or grade of prostate cancer). There are certainly men who do receive first-line treatment with these drugs (in combination with some form of expectant management), and in some of those patients this form of treatmewnt appears to be highly successful … but as yet we have very few formal data.

    With respect to whether Richard needs to take finasteride or dutasteride now, I have no idea — but presumably not if his surgery was successful.

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