Is prostate cancer really a big deal?

Factual Questions
41

[QUOTE=Qadgop the Mercotan]
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. :frowning:
[/QUOTE]

It did evenutally kill him (and from my father told me it was “hard time dying” - painful and I can imagine not a peaceful transition - he wasn’t the type of man to “go softly into that good night”), but only after nearly 40 years. To be honest, I don’t know that he ever saw a doctor more than a handful to times in his entire life - he even set his own broken nose.

42

If I understand QtM’s position, it’s not that a DRE (AKA “finger in the poop chute”) is dangerous, it’s that

That is, if the doctor determines that you might have a problem, the recommended diagnosis and/or treatment regimens may (do?) cause more trouble for more people than simply letting nature take its course.

Why is it that “my dad/uncle/brother died from prostate cancer” is a more compelling (i.e. told) story than “my dad/uncle/brother died from infection from the biopsy for prostate cancer that wasn’t really necessary since he didn’t have cancer in the first place”?

Qadgop speaks with conviction that the numbers of cancer problems vs. diagnostic/treatment problems are comparable. Does anyone have cites that state/suggest otherwise?

It’s not that men don’t die of prostate cancer, but rather that just as many (or more) die of trying to diagnose/fight it (who might not have died of the cancer).

43

[QUOTE=NoCoolUserName]
If I understand QtM’s position, it’s not that a DRE (AKA “finger in the poop chute”) is dangerous, it’s thatThat is, if the doctor determines that you might have a problem, the recommended diagnosis and/or treatment regimens may (do?) cause more trouble for more people than simply letting nature take its course.
…
It’s not that men don’t die of prostate cancer, but rather that just as many (or more) die of trying to diagnose/fight it (who might not have died of the cancer).
[/QUOTE]

No, I would not conclude that. A DRE or PSA test has virtually zero risk of any side effects. A biopsy has some (not high) risk of infection. And if there is an infection there are many ways to treat the infection. A good urologist will follow a biopsy to ensure that a possible infection will be taken care of. If cancer is detected, that is the time when a major decision is needed in regard to treatment – from doing nothing (“watchful waiting”) to lots of alternatives. From my own research and some personal experience the main argument against undergoing diagnostic tests for prostate cancer is that the tests are not good enough at this time and can lead to inconclusive or even contradictory conclusions. For instance, what if the PSA test result comes out high enough to suggest possible cancer while the biopsy is negative? Maybe it’s just benign prostatic hyperplasia (non-cancerous enlarged prostate). But maybe it’s just cancer that was missed by the biopsy? Really don’t know. And you’re left with a lot of uncertainty and worry. So if you don’t do the tests in the first place, you’re sort of left in a state of blissful ignorance. A lot of research is going on to find more conclusive diagnostic tools, but they’re not available yet. I highly recommend Dr. Lee Nelson’s book on prostate cancer.

44

The mathematics of screening diseases can be rather demanding.

The issues with prostate cancer aren’t so much about the screening, but are about the consequences of a positive screen.

If a positive screen leads to a positive biopsy, then one of two things happens:

“Watchful Waiting,” where the patient gets to live with a tumor and waits to see if it gets agressive.

Resection of the tumor, which may or may not lead to collateral damage of some rather important nerves, and which may lead to incontinence and/or impotence.

Radioactive “seeding” of the tumor, where small capsules of radiologically active material are placed within the tumor itself. This procedure may represent a less risky alternative to resection. But it isn’t a guaranteed treatment either.

Diagnostically speaking, it isn’t easy to distinguish prospectively between prostate lesions that will be well-behaved, slowly growing, non-metastatic creatures (with presentation similar to BPH) and those that are rapidly growing, metastatic cancers.

So a patient with a prostate cancer can either respond aggressively, or passively wait out the lesion. In many, many cases, the detected lesion is a slow growing lesion. In a few of these detected lesions, a slow growing lesion will flip out at some point and go aggressive. In cases in which a lesion is captured in an advanced state, it isn’t clear whether the lesion started out aggressively, or flipped at some point.

The slow growing cases are a bit like BPH - except in BPH, cancer isn’t involved. Unless, of course, the BPH is in reality misdiagnosed prostate cancer.

At some point, someone will develop a trans-prostatic stent, which would be deployed between the prostate gland and the urethra - this would fix some of the continence issues.

But the unfortunate extremes here are to either ignore a potentially dangerous cancer, or to needlessly watch over a basically harmless lesion.

45

[QUOTE=Mama Zappa]
:::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.
[/QUOTE]

In my dad’s case there was also a fairly aggressive pancreatic cancer that he was diagnosed with about a year after the prostate. I don’t know how much his weakened condition from battling the prostate cancer contributed to his death but I find it hard to believe there was no relationship.

Although he beat his prognosis at least three times in the course of the pancreatic.

46

There is no excuse for dying of prostate cancer these days. It’s so easy to detect and so slow growing you have to be really careless to let it spread beyond the prostate, and until then it won’t kill you.

Speaking of it spreading, have you noticed that 30 years ago you never heard of anyone dying of prostate cancer, but you often heard of people dying of lung cancer? One of the major organs prostate cancer spreads to is the lungs. I bet most of those lung cancer cases were really prostate cancer spread to the lungs. Prostate cancer has no symptoms (except trouble with urination) until it goes somewhere else, and before the PSA test it was virtually undetectible until it showed up somewhere else. In those days did doctors bother to verify that tumor cells in the lungs were anything other than cancerous lung cells?

47

[QUOTE=viccums]
In those days did doctors bother to verify that tumor cells in the lungs were anything other than cancerous lung cells?
[/QUOTE]

Considering that there are several types of lung cancer, which respond to treatment differently, and that this has been known for a long time, I would imagine that tumours in the lung were biopsied and examined by a pathologist even 30 years ago.

What didn’t exist 30 years ago was the advanced diagnostic imaging and staging techniques that are routine today (CT, MRI, PET etc).

ETA:

QtM, would PET scans be useful for screening a positive PSA or DRE? I knonw that they expose the patient to significant amounts of radiation (iirc about 6 CT scans or 600 cigarettes equivalent).

48

[QUOTE=viccums]
There is no excuse for dying of prostate cancer these days. It’s so easy to detect and so slow growing you have to be really careless to let it spread beyond the prostate, and until then it won’t kill you.

Speaking of it spreading, have you noticed that 30 years ago you never heard of anyone dying of prostate cancer, but you often heard of people dying of lung cancer? One of the major organs prostate cancer spreads to is the lungs. I bet most of those lung cancer cases were really prostate cancer spread to the lungs. Prostate cancer has no symptoms (except trouble with urination) until it goes somewhere else, and before the PSA test it was virtually undetectible until it showed up somewhere else. In those days did doctors bother to verify that tumor cells in the lungs were anything other than cancerous lung cells?
[/QUOTE]

I’m sorry, most of the above is factually incorrect but I’m on vacation and not in a position to do a detailed rebuttal. Hopefully one of our other capable dopers will be up to the task.

I just didn’t want to leave those statements out there unchallenged in GQ.