Thursday, March 11, 2010

PSA and Me

I would like to speak about my individual case for a moment, rather than statistics.

I was not screened - which is what the main uproar is about - but rather tested after coming to my primary care doc with a complaint. There is a difference.

The complaint was increased night time urination. It was almost certainly a result of my tendency to hypochondria along with a little BPH.

So PSA testing resulted in me going to see a urologist years before I would have otherwise. He immediately did a biopsy, and did not try antibiotics, or watch my PSA velocity (this is a main complaint of the PSA pioneers Ablin and Stamey as I understand it - going straight to biopsy after one PSA).

Eventually, after several years, lots of PSA tests, and three biopsies, cancer was found. It was found by the trend, though--a sudden jump after a period where it was low--along with a positive DRE. It appears, based on Gleason and doubling time, that it was not indolent. It would have, and may still, kill me before other causes like my high cholesterol or blood pressure.

Did mass PSA screening play a role in saving me? No. It most definitely did not, because I did not get screened and I was years away from that. Testing may have played a role - and if you read PSA discoverer Ablin's comments (New York Times, March 10, 2010)carefully, he does not dispute that there is a role for testing, especially in high risk cases, nor does he dispute the value of PSA in post-treatment monitoring.

Again, PSA as a diagnostic tool *may* have helped me. Maybe I've been cured of a disease that would have slipped by, otherwise, and killed me early, a la Fogelberg or Zappa. But here's the thing - I don't know. It's possible that I have gone through surgery and radiation and in spite of my good results so far, my PSA will come zooming back and in the end, the result will be the same, maybe even the same timeline.

Only a lot of time will tell. I read, over and over again, on multiple forums, from men who have just been treated, that PSA screening has saved them. In some cases, they weren't really screened, but tested after presenting with a complaint. And in a lot of cases, they are saying that PSA testing saved them when it's too early to know that with any certainty. When Stamey spoke at the meeting I went to, there was a lot of anger from the men in the room, because what he was saying was essentially that although everyone hoped they had been saved by PSA, given enough time, a significant portion would find that wasn't the case, or that some of them had been "saved" from a disease that would have never threatened them.

Again, I'm not saying that I agree or disagree with the PSA pioneers, and I hope that PSA played a role in saving my life. The bottom line is, however, that I don't know.

Sunday, March 7, 2010

Has salvage radiation worked for you?

Did you have salvage radiation for a rising PSA, post-prostatectomy, years ago and are still free from progression?

I have for the past couple of years, scoured the Internet in hopes of coming across individuals who, after having salvage radiation after prostatectomy, have had no signs of cancer (i.e. they are progression-free) for several years.

I have found people who had salvage radiation a couple of years ago, and on a Google prostate cancer group, I think I read the story of someone who was 4 years out from SRT, with PSA still undetectable.

I am following the cases of several guys on who are having SRT now, or who recently finished (within the last 24 months).

I know from stats that there must be some folks out there who had their PSA rise after surgery, then had radiation, and who are still free from PSA progression 5 or more years later. Are you one of those people, or do you know one?

If so, add a comment here. I'd like to hear your story, and so would visitors to the blog.

I do moderate the comments, so you won't see your message until I have a chance to review it. Keeping the spammers at bay, you know.

Problem resolved

Sorry about the hijacked blog. A widget I had installed, a chess challenge, was apparently the culprit. I've deleted it and it seems to have fixed the problem.