# Is prostate cancer really a big deal? **URL:** \ **Category:** Factual Questions\ **Created:** [June 14, 2008, 2:46am UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890 "2008-06-14T02:46:32Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![KlondikeGeoff](https://avatars.discourse-cdn.com/v4/letter/k/3e96dc/32.png) [@KlondikeGeoff](https://boards.straightdope.com/u/KlondikeGeoff)\ **Post date:** [June 15, 2008, 8:17pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/21 "2008-06-15T20:17:54Z")
[QUOTE=Otto] I asked my doctor about it at my last appointment because my mother’s been pestering my brother and me to get examined and despite my dad’s diagnosis he still says I can forgo screening until I turn 50. [/QUOTE] He’s right, **Otto** , you _can_, but why not be safe and sure? Find another doc or clinic who will do it for you. Call the Cancer Society for recommendations. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [June 15, 2008, 8:25pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/22 "2008-06-15T20:25:44Z")
[QUOTE=KlondikeGeoff] That is like saying, “I have these severe pains in my chest and down my left arm, but because this does not necessarily indicate a heart attack, I’ll just ignore it.” [/QUOTE] No it’s not. It’s more like saying “I’m 50 and I have a heart, I’d better get a heart catheterization”. If one has no symptoms and no real increased risk of heart trouble, best avoid the cath, as many patients die each year due to complications of heart catheterization. ---
**Author:** ![KlondikeGeoff](https://avatars.discourse-cdn.com/v4/letter/k/3e96dc/32.png) [@KlondikeGeoff](https://boards.straightdope.com/u/KlondikeGeoff)\ **Post date:** [June 15, 2008, 9:54pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/23 "2008-06-15T21:54:15Z")
[QUOTE=Qadgop the Mercotan] No it’s not. It’s more like saying “I’m 50 and I have a heart, I’d better get a heart catheterization”. If one has no symptoms and no real increased risk of heart trouble, best avoid the cath, as many patients die each year due to complications of heart catheterization. [/QUOTE] Well, Doctor, are you equating a PSA/DRE exam with catheterization? Hardly the same risk factors, eh? Or, discomfort factors either. 😃 And, unfortunately, there are seldom any symptoms with prostate cancer, at least until it’s too late, so why take a chance when such a simple and quick test is available? I just don’t get it. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [June 15, 2008, 10:51pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/24 "2008-06-15T22:51:27Z")
[QUOTE=KlondikeGeoff] Well, Doctor, are you equating a PSA/DRE exam with catheterization? Hardly the same risk factors, eh? Or, discomfort factors either. 😃 [/quote] I’m stretching your own analogy. And it’s never good to argue by analogy. So I’ll stop doing so in this thread. > [@](#): > > And, unfortunately, there are seldom any symptoms with prostate cancer, at least until it’s too late, so why take a chance when such a simple and quick test is available? I just don’t get it. I’m sorry I haven’t been able to make it clear to you. The tests are simple, quick, and not very reliable. The result of mass screening of low risk individuals may well be that lots of people will get further testing and treatment, who would otherwise have never gotten sick from, or died of, prostate cancer. Some of these people will get sick from, & die of, those further tests & treatments. Again, \*\*the approach you advocate so strongly _may_ harm more people than it helps. \*\* ---
**Author:** ![plnnr](https://avatars.discourse-cdn.com/v4/letter/p/7ea924/32.png) [@plnnr](https://boards.straightdope.com/u/plnnr)\ **Post date:** [June 16, 2008, 5:00pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/25 "2008-06-16T17:00:23Z")
Not to mention that if you have a false positive it is going to come into play should you try to get insurance. I recently had a prostate infection and I specifically asked if I should start thinking about get regular DREs or PSA tests (I’m 44). My doctor said, “You aren’t an African American male, you don’t have any symptoms, and you have no first degree relatives who’ve had it - there’s no reason to start looking.” Aside from the absolute joy I take in having my prostate manipulated, I’m taking her advice. ---
**Author:** ![nivlac](https://avatars.discourse-cdn.com/v4/letter/n/3bc359/32.png) [@nivlac](https://boards.straightdope.com/u/nivlac)\ **Post date:** [June 16, 2008, 6:00pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/26 "2008-06-16T18:00:57Z")
It’s an open debate right now on the right course for detecting and treating prostate cancer. At the end, it’s the patient’s personal decision. No one should listen to just one doctor’s or friend’s opinion. He should talk to as many experts as he can, read up on the latest research (there are free on-line alert services available), study up on books on the subject, and make up his own mind on what to do. There are a lot of plusses and minuses in detection and treatment options and the decision is yours alone. ---
**Author:** ![FoieGrasIsEvil](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foiegrasisevil/32/16638_2.png) [@FoieGrasIsEvil](https://boards.straightdope.com/u/FoieGrasIsEvil)\ **Post date:** [June 16, 2008, 8:50pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/27 "2008-06-16T20:50:31Z")
I’ve always been someone that can’t really hold his pee very long. When I gotta go, I gotta go. Drinking a gallon of water a day probably doesn’t help. I always attributed this to some kind of weakness of the bladder. Is there any connection to this condition and the likelihood of getting prostate cancer? ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [June 16, 2008, 9:37pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/28 "2008-06-16T21:37:30Z")
A bit of Googling seems to indicate that the standard PSA test has a specificity of 63.1%, and a sensitivity of only 34.9%. Is that correct? Because that doesn’t really look much better, to me, than no test at all: If I’m remembering my definitions correctly, I should be able to construct a coin-flip “test” with any specificity and sensitivity I want adding up to 100%, and those figures don’t even do that. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [June 16, 2008, 10:14pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/29 "2008-06-16T22:14:23Z")
[QUOTE=FoieGrasIsEvil] I’ve always been someone that can’t really hold his pee very long. When I gotta go, I gotta go. Drinking a gallon of water a day probably doesn’t help. I always attributed this to some kind of weakness of the bladder. Is there any connection to this condition and the likelihood of getting prostate cancer? [/QUOTE] What you have there is a symptom. One not commonly associated with prostate cancer, but still only a symptom. Check it out with your doctor to see what diagnosis you might have. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [June 16, 2008, 10:24pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/30 "2008-06-16T22:24:59Z")
[QUOTE=Chronos] A bit of Googling seems to indicate that the standard PSA test has a specificity of 63.1%, and a sensitivity of only 34.9%. Is that correct? Because that doesn’t really look much better, to me, than no test at all: If I’m remembering my definitions correctly, I should be able to construct a coin-flip “test” with any specificity and sensitivity I want adding up to 100%, and those figures don’t even do that. [/QUOTE] Your definitions of sensitivity and specificity must be off. Ideally we physicians like our tests to be 100% sensitive and 100% specific. Sensitivity represents the proportion of truly diseased persons in a screened population who are identified as being diseased by the test. It is a measure of the probability of correctly diagnosing a condition. Specificity is the proportion of truly nondiseased persons who are so identified by the screening test. It is a measure of the probability of correctly identifying a nondiseased person. PSA issues are just getting muddier and muddier. Look at the risk of cancer associated with PSA levels once considered to be normal!!! [http://www.swog.org/Visitors/Download/Clinical%20Trials/PCPT\_PSA\_Summary.pdf](http://www.swog.org/Visitors/Download/Clinical%20Trials/PCPT_PSA_Summary.pdf) 1st value PSA range. 2nd value risk of prostate ca 3rd value risk of aggressive prostate ca \<0.5 7% 1% 0.6 - 1.0 10% 1% 1.1 - 2.0 17% 2% 2.1 - 3.0 24% 5% 3.1 - 4.0 27% 7% So prostate cancer risk is still quite high, even with low readings, but usually the cancer found is not the aggressive variety. Throw in the factoid that there are now at least six different ways to look at serum PSA: total PSA, free PSA, age-adjusted PSA, ethnically adjusted PSA, PSA velocity and PSA density. Summary: Answer unclear, ask again later… Sorry my attempt at a table was so messy… ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [June 16, 2008, 10:51pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/31 "2008-06-16T22:51:13Z")
> [@](#): > > Your definitions of sensitivity and specificity must be off. Ideally we physicians like our tests to be 100% sensitive and 100% specific. Yes, I get that. So ideally, the sum of specificity plus sensitivity would be 200%. But suppose, on the other hand, I have a “test” consisting of “Flip a coin. If heads, I tell the patient he has prostate cancer; if tails, I tell him he doesn’t”. Such a test would tell half of the diseased patients that they have cancer, and it would tell half of the non-diseases patients that they don’t. So a coin-flip test would have a sensitivity of 50%, and a specificity of 50%. I think we can all agree that a coin-flip test is useless, so that gives us a benchmark: If the specificity plus sensitivity of a test is less than 100%, then the test sucks. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [June 16, 2008, 11:04pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/32 "2008-06-16T23:04:36Z")
[QUOTE=Chronos] If the specificity plus sensitivity of a test is less than 100%, then the test sucks. [/QUOTE] OK, I gotcha now. I always hate the specificity/sensitivity questions on my recert exams… ---
**Author:** ![FoieGrasIsEvil](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foiegrasisevil/32/16638_2.png) [@FoieGrasIsEvil](https://boards.straightdope.com/u/FoieGrasIsEvil)\ **Post date:** [June 17, 2008, 2:02am UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/33 "2008-06-17T02:02:28Z")
[QUOTE=Qadgop the Mercotan] What you have there is a symptom. One not commonly associated with prostate cancer, but still only a symptom. Check it out with your doctor to see what diagnosis you might have. [/QUOTE] But I’ve always been like that. it’s not like I can’t hold it at all, but (especially when drinking copious amounts of water, alcohol or a diuretic) I seem to not be able to hold it as long as the average person. So this is actually one of the prostate cancer symptoms, but could also be completely unrelated? I’m only 38, and this has been going on since I was about 19, and I’ve never had any problems. In fact, long car rides I don’t have to go more than anyone else, it’s when I’m drinking tea/alcohol/lots of water where (duh) I have to go more often, but I don’t seem to be able to wait as long as everyone else I’m hanging with while drinking. ---
**Author:** ![Autolycus](https://avatars.discourse-cdn.com/v4/letter/a/22d042/32.png) [@Autolycus](https://boards.straightdope.com/u/Autolycus)\ **Post date:** [June 17, 2008, 4:14pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/34 "2008-06-17T16:14:41Z")
If the cancer grows large enough that surgery is required, this can result in impotence. I think that qualifies as a big deal to those affected. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [June 17, 2008, 7:21pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/35 "2008-06-17T19:21:57Z")
[QUOTE=Otto] Prostate cancer helped to kill my dad. So yeah, kind of a big deal. [/QUOTE] :::checks location::: :::determines you aren’t my brother::: Yeah, here too. Dad died at age 75. A year after being told by his doctor “You won’t die from this!”. :rolleyes: This was even though it was known it had spread outside the immediate area; the doctor insisted the hormonal treatments would keep it in check. ---
**Author:** ![plnnr](https://avatars.discourse-cdn.com/v4/letter/p/7ea924/32.png) [@plnnr](https://boards.straightdope.com/u/plnnr)\ **Post date:** [June 17, 2008, 7:56pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/36 "2008-06-17T19:56:27Z")
The flip side is that my uncle was diagnosed with prostate cancer in 1968 (or there about) and the preferred treatment was surgery. He told the doctor in no uncertain terms “You’re not coming anywhere near me.” He died two years ago at the age of 96. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [June 17, 2008, 8:03pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/37 "2008-06-17T20:03:38Z")
[QUOTE=plnnr] The flip side is that my uncle was diagnosed with prostate cancer in 1968 (or there about) and the preferred treatment was surgery. He told the doctor in no uncertain terms “You’re not coming anywhere near me.” He died two years ago at the age of 96. [/QUOTE] Did he have any sort of treatment? ---
**Author:** ![plnnr](https://avatars.discourse-cdn.com/v4/letter/p/7ea924/32.png) [@plnnr](https://boards.straightdope.com/u/plnnr)\ **Post date:** [June 17, 2008, 8:12pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/38 "2008-06-17T20:12:36Z")
[QUOTE=Qadgop the Mercotan] Did he have any sort of treatment? [/QUOTE] None that I’m aware of. He came from a family of long lived people (my aunt - his sister- died at 101 the year before he died) and lived a very rural lifestyle (up before dawn, work on the farm, eat whatever the hell he could produce, drink home-made liquor, go to bed when the sun went down) so maybe it was just a mixture of genetics, plain living, and being tough as an old shoe. ---
**Author:** ![Kyrie\_Eleison](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kyrie_eleison/32/7682_2.png) [@Kyrie\_Eleison](https://boards.straightdope.com/u/Kyrie_Eleison)\ **Post date:** [June 17, 2008, 8:56pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/39 "2008-06-17T20:56:08Z")
[QUOTE=CC] [QUOTE=KGS] [Masturbation works, though.](http://news.bbc.co.uk/2/hi/health/3072021.stm) [/QUOTE] I’m all in. [/QUOTE] You’re doing it wrong. When you’re all in, we call it something else. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [June 17, 2008, 10:24pm UTC](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890/40 "2008-06-17T22:24:24Z")
[QUOTE=plnnr] None that I’m aware of. He came from a family of long lived people (my aunt - his sister- died at 101 the year before he died) and lived a very rural lifestyle (up before dawn, work on the farm, eat whatever the hell he could produce, drink home-made liquor, go to bed when the sun went down) so maybe it was just a mixture of genetics, plain living, and being tough as an old shoe. [/QUOTE] That’s what makes the decision-making process so tough. There’s lots of guys out there like him, whose prostate cancers _never_ harm them. Take these guys, biopsy 'em, give 'em radiation, chemo, surgery, what have you, and a lot of them will succumb to the treatment rather than the disease. I wish we had better tests, and better ways of predicting which folks need what intervention. ☹ [Previous page](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890.md?page=1) [Next page](https://boards.straightdope.com/t/is-prostate-cancer-really-a-big-deal/452890.md?page=3)