* I recommend everyone with a prostate get their PSA tested by age 45, or earlier if it runs in the family. It's a simple blood test but sometimes you have to ask for it.
* Early detection is key. A biopsy can assess how aggressive it is (the Gleason score). They can even genetically profile the tumor to further gauge risk (the Decipher score).
* Most cases are slow growing and may never escape the prostate. These are usually treated by simply monitoring them with more PSA testing, imaging and the occasional biopsy. Years ago these cases uses to be over-treated but now they have high quality data showing the safety of monitoring.
* If it hasn't left the prostate (stage 1 or 2) and they think you need treatment there are a few options. In lesser cases you can do focal therapy which is like zapping a small tumor. But it tends to be a multi-focal disease, so often you'll end up getting "definitive treatment": removing the prostate surgically or saturating it with radiation.
* Surgery typically uses a cool-ass remote-controlled robot called "the DaVinci" that operates through a set of small incisions.
* Radiation is done either via external beam -- you just lie there and get zapped -- or by inserting radioactive seeds directly into the prostate (brachytherapy).
* The main side effect of surgery is erectile dysfunction, because the nerves that control that run right along the prostate and nerves do not like getting manipulated. Recovery can take up to two years and you don't always get all your function back. I think that stat is something like 1/3rd get back to baseline, 1/3rd get there but with the help of meds (Viagra), and 1/3rd suffer permanent decline / need other interventions. There is also some incontinence but that typically resolves within weeks/months.
* Radiation also causes ED, as well as urinary bother and potentially some other issues. But these typically kick in later, possibly years later. There are also some short term side effects while undergoing treatment. It's a good option for older patients for sure but "younger" patients (<60 y.o.) have to consider the effects of radiation on healthy tissue decades out. You may also have to undergo a 6-18 month course of hormone therapy which I'll discuss next.
* If it escapes the prostate (stage 3 or 4) then there is an awesome new scan called a PSMA PET that can locate where it is with radiomarkers. They might do focal treatment on hot spots, but the main course of treatment is hormone therapy.
* Hormone therapy is essentially chemical castration. It removes all the testosterone from your body, and this weakens prostate cancer cells. By all accounts it is not fun: kills libido, saps energy levels. But it's also not as rough as chemotherapy, so we're "lucky" prostate cells work that way. There has been a lot of development here; often when you hear there's a new prostate cancer drug it's for hormone therapy.
* We all die but you don't want to die from prostate cancer. It's typically drawn out and painful. I watched my dad go through it, and it's why I got tested early. Fortunately it is very treatable if caught early.
I saw a study recently that showed colonscopies aren't actually bettering medical outcomes unless there is a different underlying reason that prompts getting one
Traditional colonoscopies are still the gold standard for colon cancer screening. One major benefit of them is that while they are performing the screening if they see something like a polyp it can be removed and tested.
It’s fine. I did 3 or 4 over the years. They stick a probe up your butt a little, with some numbing gel, which is uncomfortable but fine. There are a few pricks of local anesthesia and then you feel nothing or extremely little, apart from the pressure of the probe. You hear some clicks as they shoot needles in to take samples, but it doesn’t hurt. It takes like 15 minutes. You take an antibiotic and do an enema beforehand to ward off infection.
The worst part for me was you have bloody semen for weeks after. I thought that was so gross. But it’s harmless and resolves completely.
PSA tests are easy and cheap enough that any concerning single result should be followed up with several more to see if there's an increasing / accelerating trend. An elevated but flat trend could be BPH, and as others have mentioned, a single elevated result can be caused by many things (prostatitis, etc).
The recommendation to not do widespread PSA testing is extremely controversial. Also, as an individual, you should make decisions for yourself, not based on some population-wide study.
I think you should always do regular PSA testing, but don't automatically follow it up with a biopsy if it's not that high (just slightly elevated). Instead, do a second-line test like a 4Kscore test, and/or look at your PSA velocity, or look at PHI (Prostate Health Index) scores. Basically, the assumption that "anything over a certain cutoff should be biopsied" is dumb and they should actually just do second-line tests before biopsies, for borderline scores.
There are conflicting studies. This is common. It's tough to put together randomized trials over a multi-decade period to get the highest quality data. But among oncologists there is very widespread agreement on the benefits of PSA testing.
I agree to with the other reply to my comment that stated "Also, as an individual, you should make decisions for yourself, not based on some population-wide study."
That is, the tough problem for scientific recommendations like PSA screenings is they essentially need to apply to everyone, and "everyone" has to take into account that most people don't understand how to quantify risk and they usually see things in terms of black-and-white.
That said, I don't think the statement "But among oncologists there is very widespread agreement on the benefits of PSA testing." accounts much for anything. There have been loads of examples of highly trained specialists in the past recommending something based more on "well, logically it makes sense", only to not see it actually play out when studied more closely. I find this especially true that there is a general bias among all specialist professions (not just medicine) to "do something", when sometimes the best thing is to just do nothing.
Sure but we should still listen to specialists. They aren’t always right but they are wrong less often than the rest of us.
As for “doing something” actually there has been a consistent trend in the prostate cancer fields towards doing less. As the years go by they get better quality data from long term studies supporting “watchful waiting” for many lower grade cancers. I even had a more aggressive one and they let me go several years before surgery, just to maximize quality of life. That’s all due to new data. Data that definitely one needs specialist skills to interpret.
There is no single threshold above which you’d say it’s cancer.
PSA levels will vary between people, basically depending on the size of the individual prostate and physical activity (they should not take your PSA when you took your cycle to go to the doctor).
Which is why the best course of action is to get a series of (yearly) PSA values starting from you (mid-) forties. Such that you have established your personal baseline and can easily spot a significant uptick.
Yes but it is still an excellent first-level screening tool. A few things can cause elevated PSA. Typically you will get retested a bunch of times to see if it comes back down to normal levels. But if it stays up you may be a good candidate for an MRI-guided biopsy to look for tumors.
It kills libido and can sap energy levels to where it makes it hard to do many things in the day. It’s not necessarily permanent if you just do a short course. Testosterone can recover. But if it metastasizes you could be looking at long term therapy.
Tips:
* I recommend everyone with a prostate get their PSA tested by age 45, or earlier if it runs in the family. It's a simple blood test but sometimes you have to ask for it.
* Early detection is key. A biopsy can assess how aggressive it is (the Gleason score). They can even genetically profile the tumor to further gauge risk (the Decipher score).
* Most cases are slow growing and may never escape the prostate. These are usually treated by simply monitoring them with more PSA testing, imaging and the occasional biopsy. Years ago these cases uses to be over-treated but now they have high quality data showing the safety of monitoring.
* If it hasn't left the prostate (stage 1 or 2) and they think you need treatment there are a few options. In lesser cases you can do focal therapy which is like zapping a small tumor. But it tends to be a multi-focal disease, so often you'll end up getting "definitive treatment": removing the prostate surgically or saturating it with radiation.
* Surgery typically uses a cool-ass remote-controlled robot called "the DaVinci" that operates through a set of small incisions.
* Radiation is done either via external beam -- you just lie there and get zapped -- or by inserting radioactive seeds directly into the prostate (brachytherapy).
* The main side effect of surgery is erectile dysfunction, because the nerves that control that run right along the prostate and nerves do not like getting manipulated. Recovery can take up to two years and you don't always get all your function back. I think that stat is something like 1/3rd get back to baseline, 1/3rd get there but with the help of meds (Viagra), and 1/3rd suffer permanent decline / need other interventions. There is also some incontinence but that typically resolves within weeks/months.
* Radiation also causes ED, as well as urinary bother and potentially some other issues. But these typically kick in later, possibly years later. There are also some short term side effects while undergoing treatment. It's a good option for older patients for sure but "younger" patients (<60 y.o.) have to consider the effects of radiation on healthy tissue decades out. You may also have to undergo a 6-18 month course of hormone therapy which I'll discuss next.
* If it escapes the prostate (stage 3 or 4) then there is an awesome new scan called a PSMA PET that can locate where it is with radiomarkers. They might do focal treatment on hot spots, but the main course of treatment is hormone therapy.
* Hormone therapy is essentially chemical castration. It removes all the testosterone from your body, and this weakens prostate cancer cells. By all accounts it is not fun: kills libido, saps energy levels. But it's also not as rough as chemotherapy, so we're "lucky" prostate cells work that way. There has been a lot of development here; often when you hear there's a new prostate cancer drug it's for hormone therapy.
* We all die but you don't want to die from prostate cancer. It's typically drawn out and painful. I watched my dad go through it, and it's why I got tested early. Fortunately it is very treatable if caught early.