If you have a low or intermediate risk prostate cancer your risk of dying from the prostate cancer without treatment is about three percent at ten year followup. Aggressive tumors are rare. But devastating. I still remember a 48 year old patient of mine who died of prostate cancer within a year of diagnosis.

https://www.reuters.com/...dUSTRE65H5MP20100618


Actually one can also make the argument that mammograms have their drawbacks too. Before ordering one it probably merits a discussion of risks and benefits.

https://www.ncbi.nlm.nih.gov/pubmed/17054145

https://www.nejm.org/...0.1056/NEJMms1409003

The current estimate is you have to screen about 2000 women for ten years for one woman to have her life prolonged by screening. In addition to that about ten of those 2000 women will be diagnosed as breast cancer patients and have unnecessary treatment. Although the estimates depend on who you ask. They may be as good as One in 800 for the 50-69 year age group. I'd bet if you ask the average person on the street what the chances of a mammogram saving their life is you would get a wildly lower number. We don't have very many good screening tests for cancer.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

It is true that most men will have erectile dysfunction and incontinence after surgery whether it's performed robotically or via an open incision. The USPSTF does not state when or how long men will have those side effects. All men have some degree of both immediately after the procedure but with time and intervention, those can and often do improve. The USPSTF does not indicate when these men were questioned regarding their ED or incontinence. And many men who undergo surgery already experience some degree of ED - as we get older the risk increases due to other medical conditions.

Screening is a personal choice just as making the decision as to which, if any, treatment should be performed if you are diagnosed. Every time I order a psa or counsel a man who was referred to me for an elevated psa, I review the potentially confusing path he may be headed down should that psa be elevated. With the USPSTF recommendation to stop all prostate cancer screening in 2012, many primary care physicians stopped ordering the psa. And we are now seeing more men in the last five years coming to us with advanced cases where there is no cure. I can't quote you stats on this yet, as this shift has been too recent but my urology group (and most others) are fearful that we are just now starting to see a significantly greater number of men with metastatic disease than we had prior to 2012. The trick is treating the more aggressive cancers and following those that do not appear to have a greater malignant potential. But that is not an easy science.

Thanks for the thoughtful post, I appreciate the data on what you're seeing now. I think this is much more helpful than asking whether or not somebody would rather be impotent or dead, which to me smacks of fear mongering (not claiming you were doing that, but that's how kind of came out to me reading a forum post).

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Taco cat spelled backwards is....taco cat.

My apologies - not trying to instill fear. Just letting these guys know that it's not quite as straightforward as some resources might suggest. That quote actually came from one of the wives of a survivor and I thought it kind of cut through some of the BS that newly diagnosed men were hearing from non-medical sources.

Update:
Had my appointment with my Urologist about a month ago. He said to be sedentary for the next week then get another PSA test, no running, no bike and no sex. Did that and came bake at 5.81 which was slightly higher than the other two PSAs. Scheduled a biopsy, took 16 core samples and three came back showing small amounts of cancer that is grade 1 with a Gleason score of 6 (3+3) which surprised and shocked me. He recommends that we do Active Surveillance and test PSA every four months along with the DRE to see what the trend is. He emphasized that I shouldn't worry and that whatever I have going on can be treated when and if that time comes. At this point I'm going to get on with my life and not let it consume me and my family, and just grateful it was caught early.
Thanks All!

That phone call when they tell you you're positive for cancer is a shocker! Good news is that they caught it early and you got lots of options (sometimes I thought too many). Take care and whatever you do don't let that beast out of the capsule!

Are you a urologist or practicing health care provider in the know? If not, probably not worth making uneducated comments like this, as prostate cancer incidence start to creep up by mid 40s.

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Colorado Triathlon Company, CO2UT 2021, Crooked Gravel 2022, Steamboat Gravel 2022

Glad it has worked out for you. I went through this dance earlier this year when my PSA shot up. I am 63. Was referred to Urologist and had a biopsy. Fortunately for me the enlargement of my prostate is benign. The naysayers out there would say that I went through an unnecessary procedure. But my brother, just 14 months older, had high Gleason score cancer and elected radiation (Tomotherapy followed by radioactive seed implantation in the last year). He is for the time being cancer free.

They say most men that live to old age die with prostate cancer. Not of it, but with it. This illustrates the fact that for all but the unlucky few, it is a slow growing cancer that stays put. That said, it can spread and kill you if it is the more virulent type, as indicated by a high Gleason score on your biopsy samples.

PSA is quite effective for tracking the progression of prostate cancer and how a treatment plan is affecting it once a person is already diagnosed. eg, the number going up or down

PSA can be helpful for men with family predisposition towards prostate cancer and for men over 50 years old to identify early suspicion and decide on possible treatment (or non-treatment) plans.

PSA is very sketchy for everyone else. It is not a very effective diagnostic tool.

I write this with the personal experience of being without any family history, before any previous problems "down there" and before any previous prostate exam, and only being 46 years old, now diagnosed with advanced, Stage 4 (already metasticized) prostate cancer. Might an earlier PSA have helped to catch the cancer earlier (before it got out into more of the body) so as to provide more chances for longer survival?

I say PSA is an affordable, non-invasive blood test even if paying out of pocket.

Thank you for sharing, My thoughts and prayers are with you as you fight this!
Take care

Hello markvoss and All,

Bummer!

As you likely know ... there are clinical trials for stage 4 prostate cancer.

Are there any clinical trials you can enter in Columbia?

If not .... are you an expatriate from another country that might be having clinical trials?

https://www.everydayhealth.com/...our-prostate-cancer/

Because new drugs are being developed all the time, you might also want to talk to your doctor about the possibility of joining a clinical trial for treatment with an experimental medication or other therapy.

https://www.pcf.org/...cer-clinical-trials/


Clinical trials bring life extending and curative new treatments to cancer patients. Clinical drug trials play a vital role in moving new treatments to patients who need them most, securing data so regulatory approvals can be obtained and new drugs can move into widespread clinical practice. Patients who participate in clinical trials provide an invaluable service both to treatment science and fellow patients.

There are currently over 130 Phase III drug trials and more than 600 Phase I/II trials in process for prostate cancer in North America and Europe. Those that are approved will join the eight new drugs that have been approved for men with advanced metastatic disease since 2010 and further improve outcomes for patients.

Good luck!

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Cheers, Neal

+1 mph Faster

Interesting thread. Like Cornboy, I too worked as a health professional (RN) in a large urology center. Some interesting stories and opinions came forth from years in the trenches. There are a number of men who WOULD rather die than be impotent. Saw several take their chances and did die. Prostate cancer bone mets are not a pretty way to go. Trust me on that one. Did a prostate biopsy on a twin that was grossly positive. The Urologist told the guy that maybe his brother needed a Urologist consult. Sure enough bro #2 had bad cancer too. Both had their prostates taken out on opposite sides of the country at the same time. 10 years both were doing great.

There is a lot of controversy over PSA testing, in my opinion if you can afford the blood test or a digital rectal exam, it don't hurt anything and may help save your life. Yea, getting a needle biopsy is no fun and the biopsy may miss all the cancer cells. I have seen some biopsy prostates look very normal on ultrasound and came back very positive, and some prostates with palpable lumps, and bad looking ultrasound images that were not positive by biopsy at all.

We have a long way to go with prostate cancer, but in my thoughts getting regular Urology visits, skin screens for cancer, working on the diet, not drinking and driving, regular checkups and eye/ dental exams seem like a reasonable and prudent thing to do in life. Be careful out there kids.