Refinements in prostate cancer screening.

[limpbiscuit]

First, I know this is generally off topic for an ED board. However, many of the members on this board have had a run-in with prostate cancer and interventions for prostate cancer.

Here is a link to a podcast- and I'm recommending #32. The others are good too.
https://grandroundsinurology.com/prosta ... h-podcast/

The gist of what this lecturer is saying is that the field of urology has been good at detecting prostate cancer in men. It has also been good at intervening with prostate cancer. Many of the interventions are what landed us as members of this list. (Prostatectomies, radiation and other interventions.)

And the lecturer is saying that there is a huge difference between detecting a prostate cancer, and detecting a prostate cancer that could metastasize and invade other tissues in the body. That is, many men develop prostate cancer as we age. A few, perhaps very few, develop a prostate cancer that is dangerous. And the ones that require treatment are the ones that are higher risk. The lower risk ones may require no intervention. If all the prostate cancers are treated the same, men are exposed to the risks of the surgery, and the impairments due to the surgery.

And at this point I recommend you give the podcast a listen.

[limpbiscuit]

And to follow up on this thread, the standard method by which men get diagnosed with prostate cancer runs something like this:

Rising PSA->Referral to urologist-> prostate biopsy-> cancer detected-> treatment planning -> Intervention-> manage side effects of intervention.

There are several problems with this course to diagnosis.

1. The PSA is an indicator of "something is happening in the prostate". It is not an indicator specifically of prostate cancer. The something that is happening in the prostate could be bph, infection, cancer or several other possibilities. Many of these are treatable, understandable, and not in need of massive intervention.

2. There are problems with a needle biopsy of the prostate. In essence, the biopsy involves inserting a probe in the rectum. The probe fires hollow biopsy needles at sectors of the prostate. The needles remove small samples of tissue. This is a bit like the game of Minesweeper. The needles may, or may not randomly extract samples of tissue that are sent for assessment at a pathology lab. Probes may hit sections of the prostate where cancer is growing and create an impression that the gland is riddled with cancer. Or, there could be small tumors of risky cancers that the random firing of needles does not detect.

And for many men who have been through this process, there may be a diagnosis of cancer. Up to the last few years all diagnoses of cancer of the prostate were treated equally- that is, they were treated as potentially capable of metastasizing and posing a threat to life and health. We are subjected to the indignity and pain of the prostate biopsy, the referrals for cancer care, the intervention which may involve surgery, radiation, hormone treatment or other interventions. And then men are left to recover from the losses stemming from the intervention.

However, the vast percentage of prostate cancers are of a type that are slow growing and not particularly dangerous. Most men die with prostate cancer but few men die of it.

And up to this point urology and cancer care has focused on detecting and treating prostate cancers. It has not focused on a further assessment of whether a particular man's cancer is one of the risky ones.

And Cal Ripkin enters our story. He is a prostate cancer survivor, and is on the Internet now speaking of a urine test that will assess for the presence of cancer. No biopsy guns up the rectum, no biopsy needles fired into our tissue. And this particular urine test is sensitive to detecting the type of cancer. That is, it can help with the decision of whether this is a cancer we can live with and observe through a course of active surveillance or whether this is one of the types of cancer that require a more assertive course such as surgery or radiation.

Wish that had been an option five years ago when I was navigating through the the treatment planning process.