Prostate Cancer

[offset]

I have been told that I have Prostate Cancer and I am looking for a good doctor for a second opinion for the best treatment, I see Dr Viroj Chodchoy from Bumrundrad has been recommended for general Urology but I am hoping to find a specialist in Prostate problems

[crusty240]

I have been told that I have Prostate Cancer and I am looking for a good doctor for a second opinion for the best treatment, I see Dr Viroj Chodchoy from Bumrundrad has been recommended for general Urology but I am hoping to find a specialist in Prostate problems

[kennkate]

Hi Offset Sheril is a mod and has a very good medical background.

Maybe you could look her up and PM her I am sure she will help you with your choices

Did you have Biopsies done ?

I have had 2 lots of biopsies Both Neg Thankfully.

I understand that Cancer contained in the Prostrate will not Kill, The worry is IF it gets out

as far as treatments go there are options.

No doubt if you need treatment your doctor will tell you all about the treatments available.

[camerata]

I have been told that I have Prostate Cancer and I am looking for a good doctor for a second opinion for the best treatment, I see Dr Viroj Chodchoy from Bumrundrad has been recommended for general Urology but I am hoping to find a specialist in Prostate problems

I think Dr Viroj is a specialist in prostate problems. His profile states:

Special Clinical Interests:

- Reconstruction, Cancer, BPH, Stones, Pediatric Urology

He was the doctor who correctly diagnosed my problem after I had incorrectly been diagnosed as having BPH (enlarged prostate). In my experience, he is someone you can trust.

[offset]

Hi Offset Sheril is a mod and has a very good medical background.

Maybe you could look her up and PM her I am sure she will help you with your choices

Did you have Biopsies done ?

I have had 2 lots of biopsies Both Neg Thankfully.

I understand that Cancer contained in the Prostrate will not Kill, The worry is IF it gets out

as far as treatments go there are options.

No doubt if you need treatment your doctor will tell you all about the treatments available.

Yes first one was in Jan a 12 core which was all clear but PSA was still high this month so I had MRSI and CAT scan done both clear but my doctor convinced me to have a 24 core biopsy done last week which today seems to show a small tumour

I do not want to scare you but biopsies do not show that you do not have cancer they have to be considered in-conjunction with your PSA and Free PSA readings

[offset]

I have been told that I have Prostate Cancer and I am looking for a good doctor for a second opinion for the best treatment, I see Dr Viroj Chodchoy from Bumrundrad has been recommended for general Urology but I am hoping to find a specialist in Prostate problems

I think Dr Viroj is a specialist in prostate problems. His profile states:

Special Clinical Interests:

- Reconstruction, Cancer, BPH, Stones, Pediatric Urology

He was the doctor who correctly diagnosed my problem after I had incorrectly been diagnosed as having BPH (enlarged prostate). In my experience, he is someone you can trust.

Did he deal with your problem

[camerata]

Did he deal with your problem

Yes. I've been seeing him for over 5 years now for three different problems (none particularly serious) and his advice has always been sound. Two of those problems had been wrongly diagnosed by other doctors.

[tim armstrong]

I have been told that I have Prostate Cancer and I am looking for a good doctor for a second opinion for the best treatment, I see Dr Viroj Chodchoy from Bumrundrad has been recommended for general Urology but I am hoping to find a specialist in Prostate problems

Dr. Thanoo Choovichan at Samitivej Hospital in Sukkumvit is great, and has been used by several TV members, including myself. Have a look at previous posts on this forum about prostate cancer, as there are many. If you come from Australia, the UK, or some other countries, most of your treatment may be free if you go back there. My advice - read a lot, talk to people who have been through the process and avoid alternative 'cures' - as well meaning as they might be, they just don't work. Treatment options will depend on how advanced your cancer is , and where it is located. Feel free to PM me if you want to discuss anything. Best Regards

[ding]

Sorry to read this man. I'd say- take care of yourself, be happy and let go. My buddy has had it for 16 years and is going along just fine, happy as a clam. His doc said wait and watch, as it progressed he did hormone treatment. I think I'll call him now

[offset]

Thanks for your advice guys sorry I have not replied sooner but I have had a lot on my mind

I am going to see Dr. Viroj Chodchoy at Bumrungrad on Wednesday if he does not agree with the first doctor that I have been seeing I might then make an appointment with Dr Thanoo Choovichian at Samitivej the problem that I am worried about if 2 doctors give conflicting advice who do you believe that is why I am thinking of a third opinion if this happens hoping 2 out of the 3 agree

[Sheryl]

Dr Thanoo and Dr Viroj are both very well qualified specialists with a great deal of experience in treating prostate cancer so you are in good hands.

One point you need to understand though is that there are often several possible treatment choices, each with its own rate of success and risks in terms of undesirable consequences, and only the patient can make the ultimate decision. Different people react differently. Some men are almost more afraid of loss of potency than of death and will accept a lower chance of cure in exchange for less risk of loss of sexual function. Other people want to get the best possible chance of complete cure, period. These are gut feelings that can neither be predicted in advance (what someone thinks they would want often changes when they are faced with the reality) nor argued with.

All the docs can do is tell you the odds for each type of procedure in your particular case. Based on that, you have to decide.

[offset]

Dr Thanoo and Dr Viroj are both very well qualified specialists with a great deal of experience in treating prostate cancer so you are in good hands.

One point you need to understand though is that there are often several possible treatment choices, each with its own rate of success and risks in terms of undesirable consequences, and only the patient can make the ultimate decision. Different people react differently. Some men are almost more afraid of loss of potency than of death and will accept a lower chance of cure in exchange for less risk of loss of sexual function. Other people want to get the best possible chance of complete cure, period. These are gut feelings that can neither be predicted in advance (what someone thinks they would want often changes when they are faced with the reality) nor argued with.

All the docs can do is tell you the odds for each type of procedure in your particular case. Based on that, you have to decide.

Thank Sheryl for your comments I understand fully what you are saying and I know I have a difficult decision to make in the end but I do not feel that I was given all the options or more important the risk and cure ratio for each treatment by the doctor that I was seeing so I just need to make sure that I get all my options before I have to decide

[krading]

About 10 years ago I had PSA levels high enough for my doctor to send me off for all the tests. Ultra sound, xrays, nail-gun up the pooper, Dr Longfinger, the whole ordeal and they found nothing. I asked about PSA levels and was told it's not all that accurate. Why bloody well do it then?

[Thongkorn]

I have just been told by my Doctor i have prostate cancer. Its a common thing in guys over 50 , if you live in the Uk you can get a blood test from your GP , but you have to ask for it.

Edited May 24, 2009 by Thongkorn

[offset]

About 10 years ago I had PSA levels high enough for my doctor to send me off for all the tests. Ultra sound, xrays, nail-gun up the pooper, Dr Longfinger, the whole ordeal and they found nothing. I asked about PSA levels and was told it's not all that accurate. Why bloody well do it then?

Did you ever do a follow up check

[offset]

I have just been told by my Doctor i have prostate cancer. Its a common thing in guys over 50 , if you live in the Uk you can get a blood test from your GP , but you have to ask for it.

Sorry to hear your news did it come as a bit of a shock

I was expecting it in my case they have been chasing it since January I was told on Thursday and a least it has settled my mind that I have to look forward and find the best solution for a cure I feel that we must be positive on these occasions

[Sheryl]

Yes indeed, and with prostate cancer there is much reason for optimism these days.

Offset, agree totally that you should get clear explanation form docs about the odds of both complications and cure for the various treatment options. Hopefully your 2nd and 3rd opinions will provide this.

BTW there is a "Prostate Cancer for Dummies" book (seriously!) which many patients find helpful preparation for talking to their doctors, and in general.

Best of luck.

[tim armstrong]

Yes indeed, and with prostate cancer there is much reason for optimism these days.

Offset, agree totally that you should get clear explanation form docs about the odds of both complications and cure for the various treatment options. Hopefully your 2nd and 3rd opinions will provide this.

BTW there is a "Prostate Cancer for Dummies" book (seriously!) which many patients find helpful preparation for talking to their doctors, and in general.

Best of luck.

There are 2 other books as well - amongst the many, that are easy to read, but have all the details:-

- Localised Prostate Cancer - a guide for men and their families, produced by the Australian Prostate Cancer Collaboration. As the title suggests it discusses treatment options when your cancer has not spread outside the prostate. But good general info too. You can get it online at www.prostatehealth.org.au Its free.

- The second one is American, very comprehensive, but maybe a little dated now on some treatment options as it was published in 2003. But it gave me the best overview of any book.

The Prostate Cancer Treatment Book, by Peter Grimm., John Basko et al... McGraw Hill 2003. You can get it from Kinokuniya bookshop in the Emporium, Sukkumvit Rd. Cost: Baht 673.00, - they also have a small but useful selection of other books on Prostate cancer, and can get anything for you. Best Regards.

[Tolley]

I believe that a biopsy is the only accurate way to detect if you have prostate cancer.

PSA is only an indicator and not a very accurate one.

If you have localised prostate cancer and you are over a certain age then no treatment is the best option as you are likely to die of something else first.

If you are under 70 and it is localised then you have to consider your options.

As it is often slow growing then you might want to adopt a wait and see philosophy.

The risks are of course that it might spread outside the prostate then the chance of cure is much much lower and the complications worse.

On the other hand all of the treatments have undesirable consequences even for localised prostate cancer eg incontinence, impotency etc

To make it even more difficult a few studies have come out recently saying that the life expectancy wasnt any greater for those that had therapy for localised cancer and those that didn't.

Plenty to mull over.

[offset]

Thanks for your advice guys sorry I have not replied sooner but I have had a lot on my mind

I am going to see Dr. Viroj Chodchoy at Bumrungrad on Wednesday if he does not agree with the first doctor that I have been seeing I might then make an appointment with Dr Thanoo Choovichian at Samitivej the problem that I am worried about if 2 doctors give conflicting advice who do you believe that is why I am thinking of a third opinion if this happens hoping 2 out of the 3 agree

Just come back from Bumrungrad hospital quite impressed with the doctor on first impressions, stuck his finger where the sun does not shine confirmed that there is a growth there (doctor in Pattaya checked on two different occasions one only last week and said he could not feel nothing there) sent me for a bone scan this afternoon and I go back tomorrow morning to discuss the options open to me but they are generally the same as in Pattaya if the bone scan come back clear (bone scan was not suggested in Pattaya) the treatment would change if there was cancer in the bones

[Jay jones]

Hello, Read my story and it may answer or clear up some info in the threads I 've just read. I will find out June 9th,09 what my situation is. I had my prostate removed in 2002 at age 60. PSA went up, had biopsy, that showed one side clear, the other was 3/4 cancer.

A week later they took out my Prostate. I regained continence after a month or so but, not the ability to have sex. Tried the pump, the pill, a injection into penis, Stopped before I had implant. They have a fixed one and a pump system. Seemed pretty good, Pump the thing up to 100 PSI and your ready to go. (a little humor) After the prostate is removed the PSA is extremely accurate The reason some people say it isn't, is when you still have the prostate you get an enlarged an irritated and inflamed prostate (BHP ) and this causes the PSA to go up even thought there IS NO cancer..

I went on with my life, my wife left me because of my inability to have sex. So you see that some good comes from a bad situation. I bought a dog. For six years I had my annual check up and tests at the VA hosp. First two years, PSA 0. Then it - started to go up .01% a year. When it got to .05 = 1/2 of 1. I went to the Doctor and I found out something they didn't tell me after the surgery ! They send the prostate to the lab and it showed that the cancer was to the Margin. Which means it was to the point that it was cut. Chances are 50% or more that it was past that point and they did not get it all. " Make sure you ASK if you have the prostate removed. ( So when they wanted to operate so fast, it wasn't that the Dr.'s mortgage was due" The lab was at fault!

The Oncologist wanted to start Radiation, but after 6 years, we had no idea where the cancer was. So radiation can't work unless you know about where it is. We decided to wait for a while, but not to let it go past 1. Two more years go by and in Nov.08, I had it checked and it was .07, Not Bad......In Feb.09, I had a blood test for another reason and to my surprise it had JUMPED to 4.9 in

(4.2 increase) in 4 months. I remember him telling me at the beginning that the longer you wait the harder it is to treat, and 10 was the highest he wanted it to go before treatment.

Let me say, THERE IS NO CURE FOR PROSTATE CANCER. There are treatments that will slow the growth But No cure.!

The treatment I am on is Hormone treatment. There are several types and degrees,. A pill - a 3 month shot - I can't spell the real name, so I will just say "Deballed". They even give you two little bags of salt water to replace what is missing. Or you can go find some made out of Brass. (The only problem is, it sounds like a billiard game when you walk) There goes my sick humor! Since I am a former Marine, I am going for the Brass ones. All of this treatment is for one thing. The Cancer Needs Testosterone to grow and all these treatments are to lower or completely stop the production of the testosterone..They also may inject you with a female hormone, but this has the most side affects.

If you had your prostate out, and the cancer comes back, the only treatment is as I describe. HORMONE>> When the hormone treatments stop working, usually about 2 to 3 years That is it. 6 -12 18 Months.

There is only one thing you can do is go on a diet . If you want it to work go on it NOW. Age 40 and Up, cancer or no cancer. The worst that can happen is you will be healthier and if you have cancer you may be able to change the time limits, I just wrote about. Since I just started the Hormone therapy I have 2 to 3 years to do what I can to get a few extra months or a few extra years added on to what they say.

I spent several days on the net and I will list some of the foods that slow the cancer and the foods that makes it grow faster.

All of these foods are researched BY Organizations like the National Cancer Assoc. and such. Not " Joe's Special Cancer Juice."

I'll post it tomorrow JKJONES, Sorry this was so long.. Also Chemo does almost nothing, It kills cells that divide Fast. Good cells or Bad. It ruins your Immune system and about all it might do is make you terribly sick and Maybe add 2 to 3 months of time...

[krading]

About 10 years ago I had PSA levels high enough for my doctor to send me off for all the tests. Ultra sound, xrays, nail-gun up the pooper, Dr Longfinger, the whole ordeal and they found nothing. I asked about PSA levels and was told it's not all that accurate. Why bloody well do it then?

Did you ever do a follow up check

The pain I was having that led to the 'ordeal' was caused by Irritable Bowel Syndrome which was eventually detected during a colonoscopy / bowel cancer check-up after being mis-diagnosed as a bladder infection followed by prostrate. Colon also clear except for a couple of small polyps which got the hot-wire treatment.

Edited May 28, 2009 by krading

[offset]

Hi Jay

Thanks for taking the time and effort telling me your story sorry thing are not going good at the moment things are moving quite quickly in prostate care (not quick enough for you and me) a good site that I find very useful is http://www.healingwell.com/community/default.aspx?f=35 it is American but there are a few foreigners on there and they do give good advice and they have all had good and bad results with there treatment

I have been for all the scans and it looks like it is confined to the prostate but you never know until much later I will have to wait and see

On a side not I left my wife 3 years ago because of no sex available it looks like I have got my just rewards but on the good side I have a 3 month old baby boy so what ever happens on ED side I think that I am ahead of the game so to speak

[offset]

I have seen a few doctors and have decided to have my prostate removed the problem is the best procedure I am quite happy if I have open surgery to use Dr Dr Viroj Chodchoy but it seems the best treatment is via using a Robotic machine which is does not do and I have seen a Dr Srinualnad about him carrying out this type of surgery he talks a good operation but I am a bit worried about the level of experience in Thailand using this machine has anybody used this doctor and is there anywhere on the Internet that I can check the results of his prostatectomies

Thanks to all so far for your comment I take note of them all any more will be most welcome

[Sheryl]

You are asking all the right questions! While the robotic technique does offer advantages over open prostatectomy this is true only in experienced hands. One does want to guard against being part of the "learning curve"of someone eager to become, but not yet, proficient in its use.

It is a very new technique and I would be surprised if any of our members have experience with it, certainly have not heard of anyone.

Dr. Sittiporn Srinualnad is an Assoc. Professor at Mahidol/Siriraj, probably the country's best medical school, and board certified in urology in the UK, so all together very well qualified. He has published on results of use of robotic prostaectomy in Thailand, see this link

http://www.ncbi.nlm.nih.gov/pubmed/18575292

From his article one gathers that it has been done in Thailand since March 2007, with 34 cases in Siriraj between March and November that year. Presumably more in 2008 and first half of 2009. I suggest you ask him specifically how many total cases he personally has done. From what I have read (see http://www.medscape.com/viewarticle/489212_6) about 20 cases would usually be sufficient to achieve a good level of skill in this particular technique.

[offset]

You are asking all the right questions! While the robotic technique does offer advantages over open prostatectomy this is true only in experienced hands. One does want to guard against being part of the "learning curve"of someone eager to become, but not yet, proficient in its use.

It is a very new technique and I would be surprised if any of our members have experience with it, certainly have not heard of anyone.

Dr. Sittiporn Srinualnad is an Assoc. Professor at Mahidol/Siriraj, probably the country's best medical school, and board certified in urology in the UK, so all together very well qualified. He has published on results of use of robotic prostaectomy in Thailand, see this link

http://www.ncbi.nlm.nih.gov/pubmed/18575292

From his article one gathers that it has been done in Thailand since March 2007, with 34 cases in Siriraj between March and November that year. Presumably more in 2008 and first half of 2009. I suggest you ask him specifically how many total cases he personally has done. From what I have read (see http://www.medscape.com/viewarticle/489212_6) about 20 cases would usually be sufficient to achieve a good level of skill in this particular technique.

Thanks Sheryl I was hoping that you would comment I did ask the questions and he did quote me about 100 operations with 2 minor problems with the Robotic he also does Laparoscopic prostectomies which I would think would give him a good grounding in the robotics but the thing that worried me was that I see another doctor after seeing Dr Srinualnad and when I was talking numbers to him he suggested that anybody could quote numbers but how are you to be sure they are correct which left me back to square one

I was told the only machine was in the Siriraj hospital which I was a bit concerned about the quality of care there because I have not heard about it before, I see Dr. Sittiporn Srinualnad at the Bumrungrad and he told me that they did not have a Robotic machine there only a Laparoscopic machine so my mind is still a mess. the last thing is the cost the Robotic is much more expensive that the other two which I do not mind paying but only if I an not used as a practice patient

[Sheryl]

Thanks Sheryl I was hoping that you would comment I did ask the questions and he did quote me about 100 operations with 2 minor problems with the Robotic he also does Laparoscopic prostectomies which I would think would give him a good grounding in the robotics but the thing that worried me was that I see another doctor after seeing Dr Srinualnad and when I was talking numbers to him he suggested that anybody could quote numbers but how are you to be sure they are correct which left me back to square one

I was told the only machine was in the Siriraj hospital which I was a bit concerned about the quality of care there because I have not heard about it before, I see Dr. Sittiporn Srinualnad at the Bumrungrad and he told me that they did not have a Robotic machine there only a Laparoscopic machine so my mind is still a mess. the last thing is the cost the Robotic is much more expensive that the other two which I do not mind paying but only if I an not used as a practice patient

Did he, personally, do these 100 procedures or is it the total done at Siriraj? Feel free to go back and ask him this if you are not sure. If he personally did anywhere near that or even a third that number then he should be thoroughly proficient, I would not worry on that score. However as they are compiling statistics at Siriraj on this procedure he would be understandably eager to get more cases so would be good to get another opinion, if you have not already, as to whether or not you are a good candidate for this type of procedure. The other point you need to be clear on is the proven benefits of the procedure. It is known for sure that it results in a much shorter hospital stay, less blood loss, and quicker recovery. Control of urination (continence) and sexual function return more quickly than after either laporoscopic or open prostatectomy, but sexual function does not return in all patients. I believe about two third of patients under age 60 get it back, fewer of patients older than that, but check out the links I posted before to be sure, and also ask the doctor what he estimates to be your chances given your specific age, current level of function, extent of disease etc.

Not enough time has passed to definitely show whether there is a long-term difference in the percentage of patients who ever regain normal urinary control and sexual function with this procedure compared to lap or open. it is expected it will be greater, since return to fucntion coccurs more quickly, but it is not yet known.

I assume you have already asked about the pros and cons of surgery versus brachytherapy but if not, do. Should consider all options.

As for Siriraj Hospital, no need to worry there. It is one of the (many would say the) best government hospitals in the country and where the Royal family go for treatment. Reason not many foreigners use it is that, like all government hospitals, a lot of red tape, long waits and language barriers involved in getting registered and treated. However this ought not to apply if you see the doctor privately and he arranges your direct admission. Another reason Siriraj is not so popular with expats is its location, it's across the river on Thonburi side, but presumably you'd need make that trip only for the surgery and could do all follow-up at Bumrungrad.

In summary: I would not hesitate re the hospital, doctor is quite eminent but should verify how many of the 100 procedures he personally performed, veruify with a doctor who does not perform the procedure (eg dr Viroj or Thanoo) that you are a suitable candidate for it and (if you have nto already) assess the pros and cons of a surgical approach over brachy.

Lastly if you do decide to go for the surgery specify with Dr. S that you want him personally to do the procedure, no interns or residents (Siriraj is a teaching hospital). As a private patient that should be possible.

Good luck and let us know how it goes.

[offset]

Sheryl thanks again for your time it is much appreciated and required

I see 3 doctors at the Bumrungrad. and all seem to think at my age surgery was the best option for me against brachy. The first doctor I saw was Dr Viroj who only does open surgery which if I was to go that way I would use when I talked about laporoscopic or Brachy he gave sorted me out with appointments with the other two doctors of which Dr Srinualnad was one the other done Brachy (he said to go surgery at my age) but I never ask Dr Viroj about Robotic when I ask him about the difference between laporoscopic and open all he said was he could feel the prostate with the laporoscopic they could only feel the instrument

The number of operations still concern me but I read the first link and it said that the 2 groups of 34 operations were done by the same surgeon so I am guessing that he done then all so working on the numbers it is possible that he has done the 100 operations but I will ask him again if I go that route

The last consideration that I have to take is that when I had my appendix out many years ago I was told by the doctor that I bleed alot although I had alot of test done they could not find any problems I was looking at the reduced blood lose in the robotic proceedure which is much less which might be better for me

[maxjay]

About 10 years ago I had PSA levels high enough for my doctor to send me off for all the tests. Ultra sound, xrays, nail-gun up the pooper, Dr Longfinger, the whole ordeal and they found nothing. I asked about PSA levels and was told it's not all that accurate. Why bloody well do it then?

There seems now to be some new thoughts on PSA screening...food for thought:

http://www.drweil.com/drw/u/QAA400572/Give...-PSA-Tests.html

Q Give Up on PSA Tests?

What do you make of the new studies showing that the PSA prostate cancer screening test may not be worthwhile? Is this test really necessary?

A Answer (Published 5/13/2009)

This is a controversy that has been going on for many years. The gist of the latest (and preliminary) findings from two big studies reported in the March 18, 2009 issue of the New England Journal of Medicine suggest that screening with the prostate-specific antigen (PSA) test and digital rectal exams saves few lives and may do more harm than good. But despite the headline grabbing conclusions, the ongoing studies haven't yet answered the question of whether the benefits of screening (finding cancer early) outweighs the risks of treating men whose prostate tumors are slow growing and unlikely to ever endanger their lives. Those risks - the potential side effects of treatment - include urinary incontinence, impotence, pain and bleeding. The new data suggest that physicians would have to treat 48 men unnecessarily to save one life.

One of the studies, sponsored by the National Cancer Institute, divided 76,600 men into two groups: those who received "usual care" and those who had annual PSA tests for six years and digital rectal exams every year for four years. The results showed little difference in prostate cancer death rates between the two groups at seven years and again at 10 years.

The second study, in seven European countries, involved 182,000 men between the ages of 50 and 74. Here, too, the men were divided into two groups - a control group and one in which the men had PSA screenings every four years and digital rectal exams twice during that period. After nine years, the researchers reported that screening reduced prostate cancer deaths by 20 percent but added that, on average, 1,410 men would have to be screened and 48 more cases of prostate cancer would have to be treated to prevent one death from the disease.

Both studies had limitations. An important one is whether the time periods reported on were long enough to give a true picture of the effectiveness of screening for a cancer that typically grows very slowly.

PSA is valuable clinical tool to monitor for cancer recurrence after treatments such as surgery and radiation, but what we really need is a test that can distinguish aggressive prostate cancers from the much more common nonaggressive ones. We could then spare many men from unnecessary surgery and radiation and their life-altering side effects. Until we have such a test, I still recommend PSA screening only for men at high risk: African-Americans, those with a family history of prostate cancer, and men whose diets are high in animal fat.

Andrew Weil, M.D.

Edited June 2, 2009 by maxjay

[offset]

About 10 years ago I had PSA levels high enough for my doctor to send me off for all the tests. Ultra sound, xrays, nail-gun up the pooper, Dr Longfinger, the whole ordeal and they found nothing. I asked about PSA levels and was told it's not all that accurate. Why bloody well do it then?

There seems now to be some new thoughts on PSA screening...food for thought:

http://www.drweil.com/drw/u/QAA400572/Give...-PSA-Tests.html

Q Give Up on PSA Tests?

What do you make of the new studies showing that the PSA prostate cancer screening test may not be worthwhile? Is this test really necessary?

A Answer (Published 5/13/2009)

This is a controversy that has been going on for many years. The gist of the latest (and preliminary) findings from two big studies reported in the March 18, 2009 issue of the New England Journal of Medicine suggest that screening with the prostate-specific antigen (PSA) test and digital rectal exams saves few lives and may do more harm than good. But despite the headline grabbing conclusions, the ongoing studies haven't yet answered the question of whether the benefits of screening (finding cancer early) outweighs the risks of treating men whose prostate tumors are slow growing and unlikely to ever endanger their lives. Those risks - the potential side effects of treatment - include urinary incontinence, impotence, pain and bleeding. The new data suggest that physicians would have to treat 48 men unnecessarily to save one life.

One of the studies, sponsored by the National Cancer Institute, divided 76,600 men into two groups: those who received "usual care" and those who had annual PSA tests for six years and digital rectal exams every year for four years. The results showed little difference in prostate cancer death rates between the two groups at seven years and again at 10 years.

The second study, in seven European countries, involved 182,000 men between the ages of 50 and 74. Here, too, the men were divided into two groups - a control group and one in which the men had PSA screenings every four years and digital rectal exams twice during that period. After nine years, the researchers reported that screening reduced prostate cancer deaths by 20 percent but added that, on average, 1,410 men would have to be screened and 48 more cases of prostate cancer would have to be treated to prevent one death from the disease.

Both studies had limitations. An important one is whether the time periods reported on were long enough to give a true picture of the effectiveness of screening for a cancer that typically grows very slowly.

PSA is valuable clinical tool to monitor for cancer recurrence after treatments such as surgery and radiation, but what we really need is a test that can distinguish aggressive prostate cancers from the much more common nonaggressive ones. We could then spare many men from unnecessary surgery and radiation and their life-altering side effects. Until we have such a test, I still recommend PSA screening only for men at high risk: African-Americans, those with a family history of prostate cancer, and men whose diets are high in animal fat.

Andrew Weil, M.D.

Very interesting there is a lot going on in USA about this and whether if you have high PSA it is worth waiting and watching what happens with the PSA one of the problems is a biopsy can only tell you if you have cancer but it cannot say that you do not have cancer and if you have cancer as in my case (after twice having a biopsy first one did not show cancer) there is no way of telling how long before the cancer escapes the prostate or if it ever will everything about it is guesswork even having the prostate taken out you will not know if cancer is still in your body somewhere it is only then that the PSA seems to be very useful

The most difficult decisions that have to be made after you have been told you have cancer it is more like Russian Roulette