Justification for "routine" psa testing in males >50yrs. [Archive]

obgraham

4th Aug 2010, 15:48

Gingernut, this topic is a hot one in the US right now. The evidence suggests that routine PSA screening is not effective in that false positives and the morbidity associated with unnecessary biopsies (as indicated in the story above) outweigh the benefits.

The real questions are: do the cases revealed by PSA screening really need aggressive treatment? And are aggressive prostate cancers adequately detected by routine screening PSA? The evolving answers to both of these is "no".

Unfortunately is is very difficult to stuff these genies back in the bottle. The PSA providers, oncologists, etc., prefer to ignore the evidence that doesn't support them. And everyone who undergoes successful treatment is convinced that they were "saved" by the test.

The bottom line is still simple: we do not yet know how to predict which prostate cancers will be aggressive, and which will sit till you croak of something else.

These three NY Times articles were written by experts in the field:

http://www.nytimes.com/2009/03/19/health/19cancer.html
http://www.nytimes.com/2010/08/03/health/03patt.html?_r=1&ref=health
http://www.nytimes.com/2010/03/10/opinion/10Ablin.html?scp=1&sq=great%20prostate%20mistake&st=cse

Loose rivets

4th Aug 2010, 16:06

Using the PSA as one of the warning lights, is perfectly sound. Treating a reduced flow with Flowmax or some such, without doing anything else, is suicidal in men over 45.

Remember: Prostate Cancer is the second biggest killer of men in the USA. It creeps into the spine just when you relax with "huh, that drug's got my flow better."

Prostate Cancer is "The best kind of cancer to have." Spinal cancer is the one you don't want. The first can lead to the second.

PSA takes a moment of time at the GP's 'office' as they call it here. Digital is something they should do for you anyway. If they don't, ask. If they still don't, go to someone that will.

Watchful waiting is something that should be only done in men that are over 100 years old, and are deaf, blind, and generally mutilated by old age. Yes, I feel strongly about it. It was suggested for me at 67, and I paid for a biopsy here in the US. I had a Gleason of 4+3. (worse than 3+4 for some reason) and was warned to part with my prostate within a couple of months.

It was still connected to my favorite toy, so I elected to go for Brachytherapy. I was a tad past borderline, but I'm glad I did. It really was a free lunch. If it fails, then so beit. So far the PSA down from 8.3 to 1.2.

Here, if I was rich, I'd have gone for a combination of Brachytherapy and External beam. Followed up by Color-Flow scanning . A 97% success rate is claimed. The highest on the planet. But I aint rich. So I'll take the chance that is now supposed to be equal to external beam.

gingernut

4th Aug 2010, 17:46

Thanks Chaps, and thanks for the links Graham. Glad to sy, they're stopping here.

obgraham

4th Aug 2010, 18:29

I figured you'd be along, Rivets, and I accept your case history. All the best to you.

But looking at the "macro" situation, I'm sticking to what I said. We lack good predictive tools in this disease, and screening by blood testing has not panned out.

NOTHING I've said is to suggest that a symptomatic man should not get a timely urologic workup .

Loose rivets

5th Aug 2010, 05:26

PSA. Yes, just one of the warning lights.

"Free PSA" gets the youngsters here confused. Can I have a Free PSA check? No, you have to pay. No, I mean . . . :ugh:

I have to say that I was concerned that a biopsy might release dangerous cells into the bloodstream. Everyone I asked about it seemed to dismiss the idea. I was particularly interested as one of my oldest friends is having his second biopsy about now.

My GP at home was fairly dismissive about PSA levels in the early stages. He seemed to accept the value of them after treatment. Odd that. As mentioned, with the right funds, I'd go for that Ultrasound 'ColorFlow' system to see what was happening.

I asked if I needed any further investigation, and the surgeon's office just replied with how pleased they were with the latest PSA. I get the distinct feeling that I have been given a huge increase in life-expectancy, but now am on a latter-day kind of watchful waiting.

If this is true, I'm happy with that. There are a lot of younger people out there that need treatment, and to be 3 X 20 + 10, and soaking up precious resources, is really unacceptable when they've slewed the odds in my favor for me.

Just a thought for those considering which route to take: I gather the removal of the prostate after Brachytherapy, is very difficult if not downright impossible.

Loose rivets

5th Aug 2010, 06:10

Having now read the links I'm even more confused. Good job I'm not bothered by it. Mind you, I would be if I could stop the back pain I've had for ten years or so. Perhaps without that, I'd be more gung ho about life. Still, the science interests me, and I see that they seem to think that there is a use for PSA readings post procedure. That seems to tally with what I was told.

The above mentioned friend still plays racquet ball, runs, and has more hi-tec hobbies than one can shake a stick at. At 71, he's got a huge amount to live for. He's also able to soak up medical information well, for a layman at least, and is I'd imagine, really trying to assess what path to take.

Mac the Knife

5th Aug 2010, 18:06

Interestingly enough, I was discussing this with one of our urologists the other day because of a mutual patient who has a persistently raised PSA and who has had 3 negative biopsies.

I think obgraham sums it up very well - "The evidence suggests that routine PSA screening is not effective in that false positives and the morbidity associated with unnecessary biopsies outweigh the benefits"

Our current oncological dilemma is that current screening techniques only allow us to identify "cancer-like" cells - we cannot differentiate between those that will regress or fail to progress and those that will progress aggressively and eventually metastasise.

In the words of Professor Michael Baum, when it comes to cancers (particularly breast and prostate), we cannot tell the difference between a Chihuahua puppy and a Rottweiler puppy - we have to wait for them to grow up (or not).

This is a very active area of research and molecular biology is starting to identify the different genes that are expressed in aggressive and non-aggressive cancers, though this is complicated by the individual immune response to the abnormal cells.

One of our local oncology units is offering a (currently very expensive) genetic analysis of tumours, which looks at 70 genes known to be implicated in tumour aggression and tailoring therapy to fit. Unfortunately the jury is still out as to how effective this is.

But the molecular biologists are getting smarter every year and eventually we should have the diagnostic tools to enable us to predict tumour behaviour more accurately.

Mac

gingernut

5th Aug 2010, 20:05

Hi LR, thanks for your insight, as you're interested in the science, I'll try and explain where I'm coming from. I think I have since answered my own question from the 3rd of August.

I help care for a population of aproximately 12,000 people.

Half of them are men. A third of those men will die of cancer. The 2nd most common cause of cancer in these men, will be prostate cancer. A quarter of those with prostate cancer will die of prostate cancer, the other three quarters will trundle along, with or without treatment, until they are hit by a bus, or as is more likely in my area, Ischaemic Heart Disease.

It's rare in those under 50, it's as common as having a bald head in those over the age of 80 (60%).

The science I'm looking at is screening.

As obsgraham points out, if you have symptoms it's a different ball game. What I'm talking about is actively devoting resources at a "well" population. In other words, when 50 year old Mr Bloggs comes in with his sore toe on a Friday night, should I test him for prostate cancer. Or even better, should I set up a system to actively seek and test men over fifty?

I'm not really interested in looking at the subset with established disease, as I "hand over" these chaps to my learned colleagues in the hospital.

There are probably two tests I can perform....either DRE, or PSA blood testing, and this was my original query, will it save any more of my 6000 men from dying of prostate cancer than if I didn't do it.

The question to screen is based on quite an old criteria, Wilson's criteria. It's been updated recently, but it's probably still apt today...
The Wilson criteria for screening emphasise the important features of any screening program, as follows:

The Wilson criteria for screening emphasise the important features of any screening program, as follows:

the condition should be an important health problem
the natural history of the condition should be understood
there should be a recognisable latent or early symptomatic stage
there should be a test that is easy to perform and interpret, acceptable, accurate, reliable, sensitive and specific
there should be an accepted treatment recognised for the disease
treatment should be more effective if started early
there should be a policy on who should be treated
diagnosis and treatment should be cost-effective
case-finding should be a continuous processPSA testing falls down on several of these points, mainly because the test doesn't do what it says on the tin, and, at the moment, the progression to the next stage of investigation involves risky unpleasant investigations.

It can be quite easy to dress this sort of stuff up in pseudo-science, but, as obsgraham points out, the "macro" picture is the important one. Sometimes doctors and nurses get a little hooked up on the figures, (don't get me started on cholesterol:)), thinking more like engineers than pilot's, but the answer to my original question,

does routine psa testing in asymptomatic males >50yrs save lives

then the answer has to be no.

And since my original posting, I've found the evidence to support that.

Loose rivets

6th Aug 2010, 04:54

Despite me being in the aged and treated group, I still find it an interesting thread. I can see that the PSA red warning light is very similar to some of the W/Ls that we inherited on the DC3 after the military had finished with them. Along with drift sights and Vary pistols, there were warning lights that no one knew the function of. One even came on about half way to where we were going - no matter where that was, and no logic could ever be found to account for this. I think PSA figures are probably more illuminating that that.

Not much has been said about Free PSA. As you will know, the numbers work in the opposite direction. Just how good a tool this is I don't know.

I went to have some fluid taken from a specialist in a 'Strip Mall.' Everything seemed quite professional, and the costs were not vast. While the poor soul did a digital, he squished one side of my prostate and, I think at that stage, collected some fluid. He then went to the other side and the dialog went something like: "Now we'll take some from . . . Oh. No need to bother. You need a biopsy. Soon.

I went to a Methodist's Hospital in Texas, and a wonderful surgeon waived a large part of his fees. "I believe if the sun shines on you, you should spread it about." (Sic) but close. I paid for little more than the pathology.

Now here's a thing. So many people have complained of it being painful. It stung slightly, but that's it. Nothing else at all.

Mac, I'm not entirely clear if only allow us to identify "cancer-like" cells is referring to the lab's findings after receiving the samples. My Gleason Score of 4 + 3 caused my GP at home to change from advising Watchful waiting, to being admitted for tests within a couple of weeks. The results were spelled out to me to be an indication of a fairly aggressive cancer.

Are even the tests done on a biopsy sample not conclusive?

I had a couple of detailed X rays following (I suppose) a radio-opaque dye injected into the blood. Something like that, anyway. I was told that the cancer was contained.

Since I'd been having severe lower back pain, I really thought that I may have had limited time to put my affairs in order. But no, not connected. I was then sent to Colchester to see someone that would confirm whether or not I was too late for Brachytherapy. I was past the level on the leaflet, but they said go to Southend or (one other place.)

The procedure under Mr Lodge at SEN then required 'Volume Studies." under general anesthetic. I rather thought that very careful mapping of the location and shape was also a good indicator of at least a high probability of the malignancy.

After the seeds had been ordered from Canada, I had to present myself exactly on time. Too late by a number of hours and the seeds are discarded. I turned up, got given Picolax again, and waited. Good stuff that. :ooh:

Showered at jumped on the gurney. Two minutes later, 'wake up Mr Rivets.' Nothing hurt . . . oh, until I pee'd Then it stung.:{ Next day home, and it was done.

Since then I've filled in a form and sent in the PSAs. My fellow traveler had to rush in for a catheter, however.

Nookie after the event is a tad odd, but after a while I thought I'd been given radioactive batteries. All I need now is a girl with a fetish for old crumblies. ;)

mmciau

6th Aug 2010, 06:55

Here is a helpful site. Various summaries of Prostate examinations

Prostate Cancer Survivors - PSA between 5 and 10 at Diagnosis (http://www.yananow.net/Chart-PSA.htm)

Mike

Rory Dixon

6th Aug 2010, 21:04

gingernut,
I almost totally agree to your post. Just one thing:
you stated: 'There are probably two tests I can perform....either DRE, or PSA blood testing, and this was my original query, will it save any more of my 6000 men from dying of prostate cancer than if I didn't do it.'
If you really go for this question, the true answer will be 'yes'. This is, because you will most certainly find a few men in your population, where you catch a prostate cancer at an earlier stage which might be cured. Unfortunately, some otherwise healthy will die or suffer due to the performed tests. Thus, the question rather should be (for a screening environment, where you look for healthy people):
...will after performing the test (and all what this test then implies, like biopsies, surgery ... causing adverse events) reduce the rate of deaths in my cohort.
For sure, for the person with an early diagnosis and cure screening is good, but for the one suffering major adverse events for wrong positive test results, it's no good. Only the effects of screening to an entire population or cohort, but not to the single individual, are relevant for the question you have raised.
PSA is very unspecific, this type of cancer has a very pronounced variability, and screening with PSA will provide significant lead-time bias, length-time bias, and overdiagnosis bias. Taking all that togehter, your conclusion is absolutely justified.
If I recall right, there was an interesting article in The Lancet, I think in 2002, 'How we cured symptomless prostate cancer'. The botomline was: yes, symptomless prostate cancer exists (and many man die with it, but not from it), but with a positive PSA finding, these patients will never again be symptomless. They have a cancer diagnosis. And that is the true burden of PSA testing.

gingernut

6th Aug 2010, 22:59

Thanks Rory, interesting post.

Guess I'll stand by my earlier post that psa screening in asymptomatic men doesn't work.

cavortingcheetah

7th Aug 2010, 20:14

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.

Loose rivets

8th Aug 2010, 04:18

Having a SIL that spent $144,000 on a FOUR HOUR procedure, that hundred grand sounds like a bargain.

(Spinal surgery through the neck, just four hours away from HOU.)

411A

8th Aug 2010, 04:31

The evidence suggests that routine PSA screening is not effective in that false positives and the morbidity associated with unnecessary biopsies (as indicated in the story above) outweigh the benefits.

This is the opinion of my physician, and he is an expert in the field.
PSA...far from satisfactory.

stilton

8th Aug 2010, 06:28

Just in case you haven't heard of it and are looking for natural relief via
the Herbal route I cannot recommend 'Saw Palmetto' enough.

twentygrand

8th Aug 2010, 09:30

I started having annual PSA tests about 5 years ago. I was spooked by so many of my friends who had prostate problems. I am aware of the limitations of the PSA test, but I wanted (with the agreement of my GP) to set a baseline for my PSA level (currently about 1.7). I will be 70 next year.
I've no symptoms as yet but I want to keep an eye on things!

airborne_artist

9th Aug 2010, 07:52

Guess I'll stand by my earlier post that psa screening in asymptomatic men doesn't work.Worked for me. At 50.5 with no familial malignant prostate (or breast) issues,and no symptoms I asked for one. Came back at 4.8 (threshold 3.0), second one 5 months later 6.0, and a 25% rise is more than enough to get a urologist referral. Biopsy came back showing 9 of 10 needles had tumourous cells, averaging > 60% of each needle, and a Gleason of 7 (4+3).

That's a high-ish Gleason for the PSA, so at my age and with that rate of development I can be pretty certain that within the next five years it would have metastased - which is another ball game.

Routine screening for men over 50 - you bet. Sorry if it's not scientific, but it may have saved my life, and as the carer for an MS sufferer, it's saved her quite a bit too.

Loose rivets

9th Aug 2010, 16:34

a a

I can be pretty certain that within the next five years it would have metastased

I'm not sure about this, but cells in the blood or lymphatic system are not what kills most people with prostate cancer. I'd gathered the danger to be a contiguous formation reaching the lower spine. I guess the difference is somewhat academic to the sufferer.

With those findings, and at your age, what did you do - or what are your intentions?

Those were my Gleason figures, and a surgeon in Texas said get on with it . . . "two, maybe three months, no more." And I was 17 years older than you at diagnosis.

The thing is, that 4 + 3 is borderline for Brachytherapy, and you may well want to consider what is a very easy option with regard to treatment.

Taking the figures from the NHS brochures handed out at the time, and the consultant's verbal briefing, the 5 year results for Brachytherapy are now equal to external beam.

As mentioned above, this was in the UK.

airborne_artist

9th Aug 2010, 18:09

With those findings, and at your age, what did you do - or what are your intentions?

I'm waiting for the MRI results to ensure that it is still contained, and I anticipate opting for brachytherapy.

Loose rivets

9th Aug 2010, 21:34

I had the dye/X-ray and an MRI within a few days. The former seemed pretty important in the decision making. Have they covered that in briefings?

Good luck with the results.

mmciau

9th Aug 2010, 21:53

Airborne Artist
With those findings, and at your age, what did you do - or what are your intentions?
I'm waiting for the MRI results to ensure that it is still contained, and I anticipate opting for brachytherapy.

When I was leaving Hospital after my Radical Prostatectomy in April 2009, the nurse who was taking me to my car stated the following:

Her husband had the Brachytherapy Procedure 7 years earlier. He had since found out that the Prostate Cancer had come back. She told me that it is not possible to have Radical Prostatectomy after a Brachytherapy Procedure because the Brachytherapy creates a lot of 'scar tissue' and thus surgery is nigh impossible. She was not at all confident about his future because of the return of the Ca

Please carefully consider all your options.

Mike

Loose rivets

10th Aug 2010, 05:12

You'll note that I mentioned the burning of bridges in an earlier post.

I really wouldn't want to try to bias anyone towards a particular procedure. In the UK, there is free dedicated counseling and unbiased advice. It's odd, I didn't really like the counseling, I think to make a 'command decision' like this, one needs to listen to the surgeons (in my case two plus one specialist doctor) then decide what's better for that particular set of circumstances.

Even 7 years ago the positioning and power of the radio iodine 125 'seeds' was notably less accurate. The Volume Studies is a fairly complex procedure, and I guess this is the crux of the matter.

The claim that the 5 years figures are the same as external beam is something I've bet the farm on, but to some extent I took a line of least resistance cos of a slew of personal issues.

I was offered a radical procedure both here and at home. Here it was offered at $23,000 for the compete hospital package. They were to use the da Vinci machine.

The kind young surgeon that did my biopsy, refers most, if not all of his patients now, to a colleague that uses the robotic machine. He said that after seeing the accuracy, he would not do the conventional surgery again.

At home, the surgeon said that he would do the conventional procedure, but if I wanted, I could opt for the da Vinci. A longer wait, and more travel in my case. It became academic, but I would have had a problem telling him that I didn't want him to do it. Seems like a vote of no confidence.

Google Image Result for http://www.drewprops.com/graphics/article_photos/2009/mysurgery_003.jpg (http://www.google.com/imgres?imgurl=http://www.drewprops.com/graphics/article_photos/2009/mysurgery_003.jpg&imgrefurl=http://www.drewprops.com/2009/07/scars-from-the-cancer-grenade/&usg=__4WyIBNEVBIMv5t7wlWFQVjsiS68=&h=392&w=525&sz=35&hl=en&start=0&tbnid=vLAG6V1VG6n9pM:&tbnh=164&tbnw=214&prev=/images%3Fq%3Ddavinci%2Bmachine%26um%3D1%26hl%3Den%26sa%3DX%2 6rls%3Dig%26biw%3D1440%26bih%3D789%26tbs%3Disch:1&um=1&itbs=1&iact=hc&vpx=992&vpy=92&dur=14022&hovh=194&hovw=260&tx=78&ty=211&ei=L99gTPe6FMGC8gblm6CICQ&oei=L99gTPe6FMGC8gblm6CICQ&esq=1&page=1&ndsp=25&ved=1t:429,r:5,s:0)

airborne_artist

10th Aug 2010, 08:30

Please carefully consider all your options.

I am carefully considering them - and as LR says, brachytherapy has come a long way already. We don't know if the man's PCa had already become metastatic at the time of his brachytherapy, which seems one possibility, though I agree it is more likely that his brachytherapy was not done as well as it might be.

Equally there are risks with RP - it's not simple.

Molemot

20th Aug 2010, 13:52

Back in spring 2007 I was in France and got gout. Went to the GP in the village..gout treated and OK..but he said "You need the following tests" and listed several, which I had already had, plus a PSA test. I'd been peeing a bit more often in recent months, and had started taking Saw Palmetto..so when back in the UK I had a PSA test at my usual GP. He gave me the "false positives" story...but the result came back at 26. So, no question, biopsy etc...T3a Gleason 9 (5+4). Since then I have had hormone therapy with 12 weekly Zoladex implants, a daily bicalutamide pill, Intensity Modulated Radio Therapy and a Trans Urethral Resection of the Prostate. My PSA is now 0.17 and I am asymptomatic, going back to the Royal Marsden every 6 months for a howgozit. Prof. Dearnaley tells me I am the Worlds Most Irradiated Man!! Whatever, it all seems to be working OK at the moment, so I'm quietly optimistic.

I feel that routine PSA blood tests would be a life saver..agreed the results need careful interpretation, but if it wasn't for my gout I probably wouldn't have had the test and not be here now. As for Saw Palmetto and Flomax...they will kill people, sure as eggs. If you have any suspicion of these sort of urinary problems, bite the bullet and get tested. Things can be done to cure/treat them nowadays.

bcgallacher

22nd Aug 2010, 06:07

The PSA test may not be a very good indicator of Prostate cancer but it appears to be all we have -I believe that soon there will be more effective blood or urine tests.In my case I had no symptoms but had a medical checkup for a Philippine residence visa and this showed elevated PSA levels,a biopsy showed cancerous cells.I was given the option of surgery or radiotherapy,I took the surgical option as it appears on the information given to be the best of the two in my case. Without the PSA test the cancer would have progressed until I had symptoms and by then possibly it would have been too late for effective treatment. After two years of routine tests all seems to be well - it was not a very pleasant experience especially the biopsy but it is better than being dead!

mmciau

22nd Aug 2010, 07:17

bcgallacher

The PSA test may not be a very good indicator of Prostate cancer but it appears to be all we have -I believe that soon there will be more effective blood or urine tests.

...

Without the PSA test the cancer would have progressed until I had symptoms and by then possibly it would have been too late for effective treatment.

Agreed - the PSA Test is only an indicator - its the trigger to be become alert.

In my case, it concerned my GP just how quickly the PSA numbers increased and it was his absolute insistence I see a Urologist.

I had the Radical Prostatectomy in April 2009 and my last PSA Test last week (17 August) was <0.04!

Mike

bcgallacher

24th Aug 2010, 12:35

As you say - the PSA test is just an indicator.A high PSA reading as I understand it can only show you may have a prostate problem,not neccessarily cancer. A biopsy is usually required to try to diagnose the problem - this may or may not indicate cancerous cells. Even if cancerous cells are found there is as yet no way to tell if this is the relatively benign slow growing cancer which requires little or no treatment or the more aggressive type that requires rapid attention as it is capable of being fatal in a relatively short time. In my case there was no doubt that my prostate was cancerous and only the decision as to treatment was required. It appears to me that all we can do at present is to make assessments and decisions on probabilities - having a good urologist who gave me honest and precise information on what he could and couldnt do made it a lot easier. I was just fortunate that I was diagnosed when it was in the cureable stage - a few months later and it may only have been treatable.

Loose rivets

24th Aug 2010, 14:19

A biopsy is usually required to try to diagnose the problem - this may or may not indicate cancerous cells. Even if cancerous cells are found there is as yet no way to tell if this is the relatively benign slow growing cancer which requires little or no treatment or the more aggressive type that requires rapid attention as it is capable of being fatal in a relatively short time.

You sure about that?

bcgallacher

24th Aug 2010, 14:24

From what I have learned from my own experience it appears to be so - I hope that someone can tell me different.

mmciau

24th Aug 2010, 20:15

Here is an explanation of the Gleason Scale which has an association with a Prostate biopsy.

Mike

How the Gleason Score is Calculated

The scale (1-5) is made up of a Gleason grade (1, 2, 3, 4, 5) from your prostate biopsy.
1 being the least aggressive and looking mostly like normal prostate cells, and 5 being the most aggressive and looking mostly like irregular prostate cancer cells.
Your Gleason score is based on combining the grades of two differant biopsy sections (primary and secondary).
- The primary section (at least 50% of biopsy).
Graded from 1 to 5.
- The secondary section (5% to 50% of biopsy).
Also graded from 1 to 5.
Therefore your Gleason score consists of 2 Gleason scale grades.
1 to 5 (primary) + 1 to 5 (secondary) = 2 to 10 (your Gleason score).
i.e. 4 + 3 = 7. A Gleason score of 7.

Gleason Score for Prostate Cancer Levels

- Low Grade (well differentiated): 4 or less.
- Intermediate Grade (moderately differentiated): 4 to 7.
- High Grade (poorly differentiated): 8 to 10.

Low Gleason Score: 4 or Less

Your biopsy test results indicate prostate cancer cells that still look like regular prostate cells and will tend to spread slowly. Intermediate Gleason Score: 4 to 7

Your prostate cancer cells look somewhat like regular prostate cells but there are noticable differances, and may tend to spread at a faster rate. High Gleason Score: 8 to 10

Your prostate cancer cells have clear indications of irregular shape and size, and may spread at a fast rate. Prostate Cancer Treatments

Which treatment you and your doctor decide upon will depend on both your Gleason scores and stage of prostate cancer. The factors of whether the prostate cancer has spread outside your prostate gland and it's rate of growth, are the major determinants for the best treatment approach.

airborne_artist

4th Sep 2010, 11:12

er husband had the Brachytherapy Procedure 7 years earlier. He had since found out that the Prostate Cancer had come back.

And about 35% of people having a Radical Prostatectomy (RP) will need some form of additional treatment within six years, my surgeon tells me, so it's not at all clear cut.

I'm having a robotically-assisted RP now. My prostate is too small (27ml) and too diseased (about 65-70% tumourous cells) for radio-based therapies. Highly likely that it's an aggressive sort, I gather. If I hadn't had the PSA test this year or next I'd probably not have seen 60, my man tells me.

Loose rivets

4th Sep 2010, 14:28

As always, good luck, and let us know how you get on as soon as possible after the procedure.

mmciau Thanks for your post. It would be nice to have something we might call a Prostate Specific Sticky - filtered to contain posts like yours.

mmciau

8th Sep 2010, 22:34

Loose rivets

...

mmciau Thanks for your post. It would be nice to have something we might call a Prostate Specific Sticky - filtered to contain posts like yours.

Loose rivets

I agree.

As you well know, my experiences are included in Jet Blast - Bugger, I've got Cancer. It can get buried in other issues in that Jet Blast Category

I believe it would be appropriate if a "Prostate Specific" category was included as a permanent subcategory of Medical and Health as I believe it would serve as a reminder that the Prostate's condition is a matter every male must consider as their lives progress .

Would you be kind enough to make representaions to the Moderators for such a sub category to be created?

Regards

Mike

Bad medicine

9th Sep 2010, 00:15

We can certainly merge any new threads regarding prostatic disease into one (probably this one if the members think this would be useful). It is already done with some of the other major topics, but this does generate both positive and negative feedback.

Cheers,

BM

mmciau

9th Sep 2010, 00:38

Bad Medicine,

Yes I believe a sub-category called Prostate Specific Issues would be appropriate.

The Prostate in males has had elevated interest over recent years as a potentially critical male health issue.

I'm a lucky one as my Ca was identified at an early stage and treated.

Mike McInerney

bcgallacher

18th Sep 2010, 20:54

In the last week or so articles have appeared in the press about some research that recommends a PSA test at 60 - studies show that prostate cancer will appear in 90 % of those with high PSA levels which will need treatment,the majority of those tested with slightly high or normal PSA will require no further action. Those with high levels will be in a minority. This seems to be the best procedure that we can hope for at present as in theory it will minimise the number of those being treated unneccessarily

cavortingcheetah

19th Sep 2010, 17:35

Studies show those asymptomatic males whose PSA that lies between 7 and 10 have a lesser risk of the rise being caused by cancer if their free PSA as opposed to serum PSA is higher than 25. Yet this easy test (same blood sample as the serum PSA specimen) is neither available nor known in the UK. It is a result that one might wish to have as well as DRE, ultra sound and a rate of PSA change before undergoing a biopsy, a procedure which in any event and even with a 24 core procedure result in the negative is not conclusive.
Prostate cancer for which there is no screening in the UK is about to become as hot a male health political issue as breast cancer once was for women. As a result of the pressure of the female there is now NHS breast cancer screening. Alan Milburn's department has thought up a wheeze whereby it can adopt its own PSA baseline of say 1.8, 3.2, 4.5 or whatever it chooses for 60 year old men and then deny further screening for those whose PSA falls below that pre determined level. It's a very cynical way of manipulating the NHS statistics and heading off the pressure groups while at the same time attempting to hoodwink those males whose PSA lies below the predetermined level into false medical complacency. The government's official cut off level will undoubtedly be based upon the statistic that those whose PSA will be below the predetermined level at sixty will die of something else anyway. This may be the case but will those deaths then be attributed to natural causes rather than the eventual prostate cancer which grabs all men? The matter of PSA and prostate conditions is considerably clouded. I suggest this ersatz screening is a gimmick and that it should be challenged as precisely that.