My father died of prostate cancer which spread to his bones at the age of seventy two. This happened despite his going every year for a PSA, and digital rectal examination. He was otherwise perfectly healthy. Since so many men develop this disease at advanced ages why not just remove the Prostate as a "standard procedure at around the age of sixty. After all “they” have developed a modified form of radical retropubic prostatectomy which is usually “nerve sparing” (meaning that you don’t lose your ability to have sex). Losing the prostate wouldn’t even necessarily mean that you would lose your ability to father children since the Prostate doesn’t supply the sperm, only nutrients that support sperm viability.
Well, this isn’t like lancing a boil. Removing the prostate is major surgery, and it happens to be located in an inconvenient place among a rather charming bundle of nerves that oversee things like erections and bladder control. An accidental nick to any of these clusters can make the remainder of a man’s life pretty damn unpleasant, even if the spectre of prostate cancer is removed.
By the same token, you can argue that women beyond their child-bearing years don’t really need their breasts any more, so they may as well have them removed to fend of breast cancer.
Several sites available by searching “cancer incidence with age” on Yahoo! indicate, at least on casual reading, that the incidence of cancers in general increeases with age. So you wouldn’t have to just remove the prostate, but almost everything else as well.
As Bryan Ekers pointed out, there are a few things that are not needed in old age (sob!) but most of us wouldn’t like to have them cut off.
I really have no idea, but aren’t hysterectomies performed for a similar reason as the OP is suggesting for the prostate? I recently had a prostate infection and I’m all for removing the damn thing before it becomes more of a litteral pain in the you know where…though not for a while yet.
Roland, it’s possible that some of your previous posts make this one a little harder to take seriously but I don’t think it’s as crazy as it first seems. Oh it is crazy, just not that much. I have heard of women getting pre-emptive mastectomies if they believe they have exceptional risk of breast cancer. Personally I’d rather keep using my prostate until there is something wrong with it.
Not any more. In the past, some surgeons viewed hysterectomies as money making tools. Hysterectomies are MAJOR surgery, and should not be performed without a really good reason. I’ll let the medical professionals go into detail, if they want.
However, I’ve had a hysterectomy (and had my ovaries removed, too) for a really good reason, and I’m happy about it. Recovery wasn’t fun at all though, let me tell you. Even if there are no complications, the woman needs at least six weeks to heal up completely, and she’s still not up to speed for some time after that.
Well, not to take anything away from my previous posts on the same types of subject this is different. Almost every man will develop prostate cancer if he lives long enough. It’s not like lung, or brain cancer where it’s a one in a million crapshoot. Now it is true that most men will die of something else before they even notice their prostate cancer. However, some people (I suspect like my father) have a defective oncogene like P53 or Ras (probably not these particular genes since such defects would likely produce neoplasms at a far younger age) and they can go from having a normal PSA test one year to full blown metastatic disease the next. In a perfect world we would have tests more sensitive than PSA (in fact I think the borderline docs over at www.lef.org tout some sort of blood test that can supposedly detect cancer including prostate cancer much sooner than PSA, however this has not been accepted by mainstream science ie validated by clinical trials ect). Ideally, we would be able to identify those at higher risk for prostate cancer, and utilize the prostatectomy before cancer had a chance to develop or spread.
I have nothing to add except the fact that a friend of mine went in for a vasectomy in December and they botched it. He’s in extreme pain, swollen (you know whatsits), on serious pain medication, etc.
Worst things:
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They may have to…ummmm…TAKE the…balls if the infection doesn’t clear up.
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He is currently unable to fly, and may lose his medical forever. A double-whammy, so to speak. Not only do you lose your manhood, but you lose your livelihood as well.
Result for me: stay the hell away from the boys, for whatever reason. When I turn 60 and retire (luckily a long ways away) hopefully they will have a non-invasive procedure for this.
Roland: Obviously a diagnosis of a problem would change things, but as far as pre-emptive removal: No thanks!
There is a procedure called radio frequency ablation that might safer than excision. It works by using RF waves to “cook” the tissue (I think that it is mainly used for primary hepatic, cancer).
I find this difficult to believe, and would request some evidence to back it up.
In other words…
Cite?
Roland, I’m surprised that a medical professional would even ask such a question.
First off, what you’re suggesting is not just a tumor removal, but removal of the entire prostate, including the part, as Bryan Ekers notes, that’s tangled up with “a rather charming bundle of nerves.” If you don’t remove every speck of prostate tissue, there’s still a chance that cancer can arise.
Secondly, as you well know, there’s no such thing as “safe” surgery. For the moment, I’ll accept the assumption that most men might eventually develop prostate cancer if something else doesn’t get them first. However I don’t believe, from a public health standpoint, the benefits of removing the prostate of every male over 60 would outweigh the risks. I’ve talked to my urologist, and he isn’t 100% thrilled with RF ablation, either.
Doctors no longer routinely remove tonsils at the first sign of infection. Parents are not automatically considered freaks if they don’t have their sons circumcised and, as Lynn notes, elective hysterectomies are pretty much discredited. The prevailing concept in medicine is for fewer invasive procedures, not more.
Now, if a more accurate screening test were developed to predict an individual’s risk, I could see an argument for prophylactic surgery on a case by case basis. But until then, let’s leave things alone until necessary.
Well, my dad was diagnosed with prostate cancer last year and one of the first things his doctor told him was that every man will get it if they live long enough. Googling “prostate cancer lives long enough” turns up a bunch of cites that reference studies that say the same thing. WebMD says that 80% of men over 80 are diagnosed with it.
I have 3 friends who have had prostate surgery. For 2 of them, this has resulted in loss of erectile functioning (1 partial, 1 complete). With odds like that, I think I’d avoid this surgery until it is absolutely required!
Okay, I think that the potential erectile dysfunction is a big issue. On the other hand so far as I know my dad didn’t have sex for the last thirty years of his life. However, at seventy two he was living pretty good, playing horseshoes, fishings, traveling really starting to enjoy retirement. He had a PSA test every year and this wasn’t enough. As I’ve stated in previous posts I would gladly accept, chemical castration even now at age thirty five. When I hit sixty or so the prostate goes if I can find a doctor willing to remove it (hopefully, by then I will be a CRNA and able to afford/ find one who will). On the other hand bladder dysfunction is a more scary potential side effect.
By the way I’ve never claimed to be a “health professional” only an inquisitive nursing student comitted to asking the questions that others won’t.
I have absolutely no idea how much sex, if any, my dad had for the last 30 years of his life. And I don’t want to know! Euwww!
P.S. Actually, looking at my younger brother’s birthdate, I can assume that my father had sex at least once in the last 30 years of his life. But I really don’t want any more info than that.
Prophylactic prostate removal is not desirable mainly because the morbidity and mortality from the procedure would far, far exceed the morbidity and mortality from the disease of prostate cancer. While prostate cancer is very prevalent, frankly most men with prostate cancer (as diagnosed at autopsy) died of something unrelated to their prostate cancer before their prostate cancer even became symptomatic.
There are also not enough urologists trained to do the procedure on every man in the population past the age of 70, much less 60. Nor are there enough health care dollars out there to pay for all these procedures.
In short, the cure would be far worse than the disease.
QtM, MD
In layperson’s terms, the esteemed Qadgop is saying (I think) that while you may die from prostate cancer, you’re a lot more likely to die from having your prostate removed, due to complications in surgery and healing and suchlike.
I’m sure he is right at age sixty, esepcially if you consider impotency to be an aspect of morbidity (as most men do). I think that the risk to benefit ratio becomes much closer by age seventy especially if we consider risk factors such as family history. Also, I think that certain procedures such a RF ablation could further narrow this gap.
My fall back position is to have a full body, spiral CT scan every year after about the age of forty (with heart scoring). In my part of the country they run about $900.00 and the hospital where I work will do them for half price for employees (a radiologist I sometimes chat with there said he could even get a full body MRI and PET scan thrown in for about an extra grand total, but I think that amounts to overkill).
The way look at it I spend more than this on cable television so it’s worth the cost (not just for me but also for my wife since if nothing else she is a reliable income stream which need to be maintained).
<hijack>Yet women have cesarean deliveries every day, for good reasons, bad reasons and no reasons, and they’re pretty much expected to be up and about and taking care of the baby and the house within a few days. What’s with this?</hijack>