Screening & too much bad news

[pjoshea13]

This is a continuation of yesterday's post:

"68 Ga-PSMA & too much bad news"

The concensus seems to be that men want to hear bad news. Which is what one would expect from men who might have died by now had they not been screened for PCa.

But I have to defend my GP who no longer automatically does once-routine blood tests, so as to protect patients from over-treatment. I believe that the Canadian health system also takes that approach. The issue seems to be that patients want every anomaly investigated & fixed, & the process can be worse than the health risk. Many out-of-normal-range results are merely suggestive of disease. These test results often lead to increasingly invasive tests with, ultimately, a low probability of uncovering serious disease. A prostate biopsy due to a PSA of 4-10 has only a 20% chance of finding cancer. And there are serious cancers with lower PSAs.

Patient-driven treatment has been case with many Gleason score 3+3 cases. They hear the word "cancer" & want it gone. Urologists get the blame - after all, there is a profit motive - but patients have had a significant role in the over-treatment problem & have contributed to the ludicrous U.S. Preventive Services Task Force (USPSTF) guidelines.

(But if I had been a Gleason 3+3 and been offered active surveilance [AS], I would have been leery after hearing that 25-30% of Gleason 3+3 cases progress. And AS seems to be based on regular future biopsies, rather than up-front further tests, such as the 4K Score. Why wait until your 3+3 has become a 4+3?)

(A peculiarity of PCa (in the U.S. at least) is that having it increases one's chance of being diagnosed with thyroid cancer - & vice versa. This has been dismissed as being a case of hypochondriacs (that word wasn't actually used) being over-screened for both conditions. (Apparently. thyroid cancer is another disease that is over-detected & over-treated.) The justification for the conclusion was the biological implausibility of a connection, although iodine is important to both organs and insufficiency is common.)

The trend of doing less screening is due to a desire to protect the group, at the expense of a minority of individuals in the group. Hopefully, the pendulum will swing back, due to the availability of better screening tools.

-Patrick

[cesanon]

The answer is better diagnostic protocols, not institutionalized ignorance.

[YostConner in reply to cesanon]

I agree. And until we have better screening, I choose better treatment education over ignorance.

[cujoe]

I was detected early and NOT encouraged to treat, but to go on AS. So when I later did do surgery, the PCa was out and about. (So now I will for sure either die with PCa or more likely from it.) I also have two blood relatives in the next generation who both had RPs in their mid 50s, i.e., a full 10+ years before me. I also have sisters who all had breast cancer. There is not a particle of regret in any of them for acting on their situations when they did. The two of us who chose to delay diagnostic scans or early treatment are the ones with regret. In one case it resulted in a 12 year battle with continuous cancer treatment and ever diminishing QOL and, in my case, the lost opportunity for a possible curative surgery.

So, its very much and individualized game we play with our own health and that of our loved ones. The issue of over-treatment is pretty much embedded in the medical "industry". As we all know by now, if you have a biopsy that suggests the need for treatment, the RO says RT is the right way to go, and the Uro surgeon says it is surgery. In the end, everyone's in the game of healthcare to make a profit. No ones getting paid to not treat.

As always, Just my 2 cents. Be Well - cujoe

PS I agree with Nalakrats re: T testing. I was never tested until the pre-op before my RP. I now get tested every 3 mos along with PSA.

[Hidden]

Psa 4.2. Gleason 8 tumor out of the prostate. If I had test earlier easy fix. 20 percent is a lot of people. Biopsy is a no brainer. Get the test. Waiting kills.

[Crabcrushe]

Saw a LED in front of a clinic- "FREE PSA SCREENING" IN '07 or so, and my lizard brain flash-banged "FINGERWAVE!!!" and I passed it up.

Probably a common mistake, leading to early flights out of Earth's atmosphere, IMO.

CRABCRUSHER

[Stegosaurus37]

Get screened regularly but don't sweat the frequency. Too frequent screening is what leads to anxiety and overtreatment.

[monte1111]

I don't care what anyone says. Shouldn't have had my 1st psa test at 66 years and told "Oh, wow, you have Stage 4 prostate cancer". I was forced to get immunization shots as I kid. I remember those well.

[Hidden in reply to monte1111]

Me too

[Hidden]

Anyone who thinks there is too much testing going on knows through testing they don’t have it. There are so many guys that got tested and were told they didn’t have it and did. That’s sad. Hell there is a huge group of men in their 50s and 60s that still are not aware of the risk. Those are the guys that walk in with metastatic apc. I’d like to see a flashing sign on every block shouting get tested until it is common knowledge. We might need better testing.

[Hidden]

Amazing that you know that and my urologist did not. Or my family Dr. They did the tests and said nothing or knew nothing. Stupid me was happy just because they said no cancer.

[Adam10]

Thanks for the tip about the book. I will look at that.

In 2014 I was diagnosed with under-active thyroid (hypothyroidism and Hashimotos).

In 2017 I was diagnosed with hypogonadism (low testosterone caused by testes although my endocrinologist says it is caused by pituitary gland under-activity).

In 2018 I was diagnosed with PCa (Gleeson 3+4). I have high frequency treatment and am awaiting with nervousness my post-op PSA test.

I was taking hormone replacement therapy since 2017 (Nebido injections 1,000 mcg every 3 months). My urologist stopped the Nebido for now.

I was shocked to read that there could be a connection between the three. Which comes first or causes the other? Does anyone know?

[Adam10]

Thanks for posting as always. My PSA was 6.8 in May 2018. My urologist recommended a biopsy. I researched and had several telephone consultations with professor urologists in London,. They agreed. My biopsy in September 2018 showed a tumour at 3+4 Gleeson scale. I had HIFU procedure in November 2018 and will have PSA test next week.

I am beginning to feel that only MRI scan can show precise situation (if tumor is still there, has grown etc). However, I am nervous at having the PSA test - I want a low score.

I was diagnosed with Hashimoto's disease and hypothyroidism in 2014 and currently take 125 mcg of T4 levothyroxine (synthetic form of the thyroid hormone). Could this provide iodine to help avoid further PCa? Grateful for any ideas.

[pjoshea13 in reply to Adam10]

Adam,

The T4 levothyroxine will not provide iodine.

If your diet is rich in shellfish & seaweed, your iodine status might be good. Most Americans no longer use a lot of iodized salt. A plant-based diet is hit or miss, since the iodine content of soil is hit or miss. Ironically, meat & eggs have some iodine since it is added to animal feed.

I have been taking Iodoral nightly for 12-13 years. Seems to be safe. LOL

-Patrick

[Adam10 in reply to pjoshea13]

Thanks for the good info Patrick. I will search for Lodoral where I am living and will discuss it with my doctor this weekend. Even if he is indifferent about supplements, which they are, I shall try Lodoral. Thanks again

[pjoshea13 in reply to Adam10]

Adam,

"Iodoral":

swansonvitamins.com/?Source...

-Patrick

[Adam10]

Many Thanks Patrick