But what is a positive PSA finding? Is there such a thing?
Surely the PSA trend over time, the rate of escalation, DREs and any ancilliary information such as prostatic inspection during cyctoscopy should be or could be used to determine whether a biopsy would be adviseable.
Once a biopsy and perhaps a second opinion on that confirm cancer then a decision has to be made as to whether to do anything and if anything is to be done then what to do?
The prostate problem seems to me to be threefold.
Firstly at what stage does one decide to have one biopsy, two biopsy three or four, given that in anything other than a 22/24 core a negative is only a ponderable.
Secondly of course what to do if a positive Gleason is confirmed.
Thirdly and since no one wants to risk one or both of the usual possible prostatic treatment side effects, how can one determine the rate of mestasis of any cancer. There's not a lot of point in excising the gland if the cancer is so slow moving that something else will get you and if you live for long enough, medical science might have developed a painless cure?
Even if you have a radical prostectomy it seems to me that you're very much in the hands of the surgeons and the nerve sparers. In that regard, MD Anderson in Houston comes highly recommended. I think you need to budget around $100,000 for the whole two months down there but the man I know who did thinks that every $ was a bargain.