If you are older than age 55, have no previous diagnosis of prostate cancer and have a recent digital rectal exam and PSA test result, this calculator may be of interest:

http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp

Since my last PSA test over a year ago, my PSA level has risen to 3.01.  My previous high was 2.9.  So, not an alarming rise, but I will be seeing my urologist for an overdue annual checkup soon.

Fear is a powerful motivator to have surgery, once you have a biopsy.  But, with so many unnecessary biopsies done on the basis of PSA testing, perhaps it’s time this whole system is questioned.  According to new research, many men may not benefit at all from testing or surgery, depending on their situation.  If you have read my blog, I think it becomes very clear that prostate biopsies are making a lot of surgeons a lot of money and lead to a lot of unnecessary surgeries, too.  When will we finally get a tool for detection of these cancers that straight out of the 1950s and surgical methods that aren’t nearly as radical with fewer major side effects?

“The real point is that we shouldn’t focus on finding every prostate cancer because, as this study and all the screening studies show, the majority that you find don’t need to be found,’’ said Dr. Thompson, an author of the editorial. “What we should focus our screening on and our testing on are patients who are likely to have more aggressive tumors in which treatment seems to make a difference.”

http://well.blogs.nytimes.com/2012/07/18/questioning-surgery-for-early-prostate-cancer/

The PSA prostate-cancer test used by half of U.S. men older than 40 carries more risks than benefits and shouldn’t be used to diagnose the disease, a U.S. panel said, reaffirming its earlier advice.

Scientific studies suggest the number of deaths avoided by screening are “very small” compared with risks from testing or treatment that can include infections, incontinence, erectile dysfunction and death, the U.S. Preventive Services Task Force said in a medical journal today. The 16-doctor panel kept its recommendation from last October after some doctors and patient groups said discouraging the tests would cost lives.

The PSA exam searches for high levels of prostate-specific antigens. In a 2010 survey, 53 percent of American men older than 40 reported taking the test in the prior two years, according to the U.S. Centers for Disease Control and Prevention.

The panel based its recommendations largely on a U.S. study of 77,000 men who were screened and a European review of 182,000. In the U.S., researchers found no evidence the test reduced deaths. The European trial found the exam lowered the mortality rate. The improvement was due solely to results from Sweden and the Netherlands, while patients in five other countries fared no better after testing, the task force said.

 

http://www.bloomberg.com/news/2012-05-21/prostate-cancer-test-not-worth-risk-advisory-panel-says.html

Good news- more research on non-invasive testing for prostate cancer:

http://www.cancernetwork.com/prostate-cancer/content/article/10165/2027790

Initial results of a multicenter trial show that 2 biomarkers, PCA3 and T2-ERG, are found at high levels in prostate cancer compared to noncancerous prostate cells and correlate well with 2 indicators of aggressive prostate cancer, tumor volume and Gleason score. This study was conducted by researchers from the Fred Hutchinson Cancer Research Center, Stanford University, and Beth Israel Deaconess Medical Center, among others.

Something many of us have suspected for a long time, giving more credence to the purpose of this blog all the way back to the start of my journey a few years ago.  To read about more real life experiences with Prostate Biopsy and other testing, check out the comments in our popular “What to Expect” blog.  Here’s a snippet from an article by the Associated Press:

“Terry Dyroff’s PSA blood test led to a prostate biopsy that didn’t find cancer but gave him a life-threatening infection.

In the emergency room several days later, “I didn’t sit, I just laid on the floor, I felt so bad,” said Dyroff, 65, a retired professor from Silver Spring, Md. “I honestly thought I might be dying.”

 Donald Weaver was a healthy 74-year-old Kansas farmer until doctors went looking for prostate cancer. A PSA test led to a biopsy and surgery, then a heart attack, organ failure and a coma. His grief-stricken wife took him off life support.

 “He died of unnecessary preventive medicine,” said his nephew, Dr. Jay Siwek, vice chairman of family medicine at Georgetown University. “Blood tests can kill you.”

 Since Friday, when a task force of independent scientists said routine PSA testing does more harm than good, urologists who make a living treating prostate cancer have rushed to defend the test, as have patients who believe it saved their lives.

 Less visible are men who have been harmed by testing, as Dyroff and Weaver were. The harm is not so much from the test itself but from everything it triggers – biopsies that usually are false alarms, and treatments that leave many men incontinent or impotent for cancers that in most cases were not a threat.“

For those who missed the headlines last week, here is the summary and Bobby Bowden’s new awareness campaign.

http://www.ontheline.com/men/

He says men don’t want to talk about it.  While that may be true in general, you can talk about it here http://www.prostatebiopsyblog.com/?p=373#comments and find stories from many others who have undergone a biopsy or have heen diagnosed with a prostate condition.

This time, from my primary physician’s office.  The new result is 2.5.  They measured a 2.9 in 2009  and 2.4 in 2008.  All three results are probably within normal daily variations and margins of error.   This is good news, as all indications are that my PSA level is generally stable.  That doesn’t rule out cancer, but it does seem more likely that I simply have a slightly enlarged prostate, either from genetics, infection or BPH.

My latest PSA test measured a 2.6, from the same lab at my urologist’s office that measured 2.8 in March 2010 and a 2.7 about two years ago.  So, basically my PSA has been relatively stable for at least 2 years.  While that doesn’t really prove anything either way, because PSA levels are not a great indicator of prostate cancer, it is a relatively good result for me.  A slow increase in PSA levels can be due to benign issues, while a faster increase may be more indicative of cancer and result in additional testing.  Mine actually decreased slightly, but probably the ups and downs are well within the normal variations of daily and weekly fluctuations in the body and in the accuracy of the testing.

I had my annual checkup with my local urologist.  He found no change in the DRE.  My PSA result was 2.8, still slightly above where it was a year ago but not a very big change.  My local urologist believes there is no need for another biopsy at this time but suggested blood tests for PSA in another 6 months to make sure there was not a large change.  This is good news as far as I’m concerned.  It’s actually a hair lower than my test 6 months ago, but that could easily be within day-to-day variations and because the two physicians use different labs, too.

As for PSA screening, there is this article that is of interest:

http://www.nytimes.com/2010/03/10/opinion/10Ablin.html

So, more evidence that just a moderately high PSA level alone may not be a good reason for a biopsy without other factors!