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jc3737 posted:
The guy who discovered PSA now says its a useless test to detect prostate cancer but My urologists says that PSA velocity,free PSA percentage, and steady PSA rise over 6 yrs is highly indicative of cancer.My PSA is 13 up from 4.1 in 1996 and my free PSA percentage is only 4% which my doctor says almost guarantees cancer.But then I have read studies on pubmed that say PSA velocity is not predictive and PSA is worthless.
RandomPseudoNym responded:
Nobody can make you get a biopsy, and without a biopsy, you don't know. If you are old enough to have gotten your PSA checked in 1996 you might well fall into the large camp of "men that will die of something else first" and don't need to bother with it, but without a biopsy, you don't know what, if anything, you have. So get one or don't as you prefer. If you are blissful in your ignorance, you can be ignorant if you choose. It may not be a good choice, or it might be.

You can find studies to support nearly any position you care to take, particularly in something with as many small and compromised studies as this disease appears to have. If you pick and choose which ones you read (or believe) based on what you want to hear, you'll read what you want to hear in them. Getting anything useful requires maintaining an open mind and assessing the value of all the available information, not just that which would lead you to think you might not have cancer...

Based on what I have learned, in reading and assimilating many (often contradictory) studies, papers, etc. I'd be surprised if a biopsy came up negative on you, particularly with that low of a free percentage. I had considerably better numbers and was unsurprised (not at all thrilled, but not actually surprised) when I came up positive.

Pay attention to "free vs bound" PSA when doing research - the correlation there is rather better than raw the PSA number - as your urologist has already told you.
jc3737 replied to RandomPseudoNym's response:
Thank you for taking time to respond.(I'm 62)One of the problems with a biopsy is the possibility of taking a minor contained cancer(that may never need treatment)and spreading it.I have read this from several sources but don't know if its reliable info.

I'm also concerned when I look at the very minor differences in mortality from treated to non treated patients.From the stats it looks like any decision I make isn't going to make a big difference.
RandomPseudoNym replied to jc3737's response:
My understanding is that the biopsy is not prone to doing anything to spread the cancer - though it is a procedure that has some risk of its own, primarily that of infection. But I'll hope someone more authoritatively informed will weigh in on that aspect for you. I did ask my doctor about it, as I recall.

You might want to consider that men who have had a biopsy and know they have Gleason 7 8 9 10 are also more likely to get treated than men who have a Gleason 6 - which likely impacts those "treated .vs. non-treated mortality numbers."

I'm quite serious about the low quality of a lot of the research - not that I think any ethics board should approve the sort of study that would be inhuman, but result in "good science." Still, you have to smell carefully for cooked numbers - I was looking though what I can get from the local library's journal databases and noticed one study claiming "little difference between erectile function at 18 months post-treatment" for radiation .vs. surgery. Given what I've read elsewhere, I smell a radiation rat, as 2-3 years is a commonly given figure for decline of function after radiation treatment...

If I was your age with my cancer, I'd be a lot more hesititant to cut it out (I'm 47 and leaning towards removing it, despite being a Gleason 6) but if I were your age and had a high Gleason score I'd be thinking about some sort of treatment. Without a biopsy, you don't know if you have a Gleason 10 or Gleason 6 (or the statistical oddball that manages no detectible cancer with 4% free.)

On the third hand I also came across a study from a group of nutjobs who went around "educating" about the "dangers" of PSA and DRE, and decided not to include any possible benefits of either in their "educational" materials because it "confused" the audience. ie, they didn't care to engage in the actual complexity of this disease, they just wanted more people to ignore it until it was too late to do much, because statistically that would be "better" - unless you happen to be one of the statistics. Not getting a biopsy would make them happy, though not getting your PSA checked in the first place would have made them even happier. Your call.
(Health Services Research, 46.4, Aug. 2011, p1200)
az4peaks2 replied to jc3737's response:
Hi jc3737, - It depends on the quality and location of your research. Your initial Post refers to a statement by Richard Ablin, who CLAIMS to be the discoverer of PSA (Prostate Specific Antigen).

However, there is great debate as to whether what he discovered is the same element as what we know as PSA today and since PSA was originally a generic term, it could refer to any antigen thought to be exclusive to Prostate origination.

In fact, the antigen that is now identified as PSA has proven NOT to be EXCLUSIVELY specific to the Prostate but it is, by far, the most prolific producer of the element in the blood we now measure with commercial PSA assays. Since it is the only really clinically significant source of such measurable levels, the term PSA has remained in tact and a U.S. Patent was issued under that designation, but not to Ablin.

I have an interesting Paper that chronicles the complicated "discovery" of "PSA" and the varied contributors to its evolution into the worlds most widely used and clinically viable diagnostic marker for detecting Prostate abnormalities. However, the results, by themselves, are NOT Cancer specific.

I would be happy to E-mail this enlightening summary of relevant medical literature to anyone specifically requesting it to - (aka) az4peaks
I would
Raynman40409 replied to az4peaks2's response:
John- I would be very interested in reading the paper you have that chronicles the "discovery" of PSA. Though I've already had a surgical intervention & my PSA is now undetectable at this time, I still feel a need to learn as much as I can. My first question though, is, how reliable is the information? In other words, has the author skewed the information in any way to satisfy adherance to their own hypothesis? This seems to be prevalent in many studies I have read over, not only concerning PCa research, but in many of the abstracts I have reviewed pertaining to the field in which I am involved namely, Respiratory Therapy. Misleading information seems, at times, to be the norm when it comes to medical "research".
Raynman40409 replied to Raynman40409's response:
...guess I should give you an address to send it to!
az4peaks2 replied to Raynman40409's response:
Sent on 9/19/11 - (aka) az4peaks
sms1190 replied to az4peaks2's response:
I am 60 and have a positive biopsy for prostate cancer with a upcoming consultation with my Urologists. Please send me your summary. Thanks
az4peaks2 replied to sms1190's response:
SMS - Need an E-mail address! send with request to - (aka) az4peaks

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