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CalEden
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Here is a prostate cancer link:
http://www.healthcentral.com/prostate/
There is some debate in the medical field in the treatment of prostate cancer and the aggressiveness of the treatment during the cancers initial stages. Considering the slow growth rate of this cancer and the side effects of radical treatment. Making second opinions even more important as far as the course of treatment for prostate cancer. Modern medicine is getting very effective at diagnosing prostate cancer in its early stages, as a result many more men are being diagnosed with prostate cancer, exacerbating the treatment debate.
I do not work in the medical field. This is just my understanding of some of the issues regarding prostate cancer. Don't get me wrong, men do die as a result of prostate cancer. I just think it is important that more men have a better understanding of prostate cancer.
This post was originally posted in this thread:
http://bkkx.com/cgi-bin/forum/topic.cgi?forum=9&topic=1449&start=0
I started a new thread so that this topic could be easily found.
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Thai Girls : Meet Sexy Thai Girls
Posted on: 7:05 pm on May 21, 2006
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CalEden
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MSNBC.com
New advice on prostate cancer test: Weigh risks
Routine screening can lead to unnecessary treatment, cancer society says
The Associated Press
updated 3:36 p.m. PT, Wed., March. 3, 2010
ATLANTA - Months after experts discounted the importance of routine mammograms and Pap smears for many women, the American Cancer Society is warning more explicitly than ever that regular testing for prostate cancer is of questionable value too, and can do men more harm than good.
The cancer society has not recommended routine screening for most men since the mid-1990s, and that is not changing. But the organization is urging doctors to talk frankly with their patients about the risks and limitations of the PSA blood test when offering it.
Two big studies last year suggested prostate cancer screening doesn’t necessarily save lives, and any benefits can come at a high price. The widely used PSA test often spots cancers too slow-growing to be deadly. It can yield false-positive readings that result in unnecessary biopsies. And it can lead to treatments that can cause impotence and incontinence.
“We had a revolution” when PSA tests became available and prostate cancer screenings kicked into high gear, said Dr. Len Lichtenfeld, the cancer society’s deputy chief medical officer. “Now we’re having an evolution. We’re learning more about what PSA really tells us.”
He added: “We don’t know that it truly saves lives the way people want it to save lives.”
Some doctors and advocates are troubled by the new guidelines.
“Prostate cancer is still something to be respected if not feared, and we still need to be vigilant. I hope primary care docs or insurance companies don’t use the ’softening’ of the guidelines as an excuse to not do screening at all,” said Dr. David Roberts, medical director of an Atlanta clinic that caters to businessmen.
Dr. Stephen Freedland, an associate professor of urology at Duke University Medical Center, warned that the medical establishment seems to be moving backward on cancer screening.
“We have seen dramatic drops in mortality from breast, prostate and cervical at a time when screening has been increasing, and now we are stepping off the pedal. I don’t think that is the right answer,” he said.
Men will need to weigh their fear of having a potentially aggressive cancer versus treatment that can cause ugly side effects. Another option if cancer is found is watchful waiting — that is, doing nothing — but that can mean high anxiety.
The cancer society’s new guidance released Wednesday urges doctors to:
Discuss the pros and cons of testing with patients, offering written information or videos that discuss the likelihood of false test results and the side effects of treatment.
Stop routinely giving the rectal exam because it has not clearly shown a benefit, though it can remain an option.
Use past PSA readings to determine how often follow-up tests are needed and to guide conversations about treatment.
Cancer experts have been having second thoughts in recent years about the value of regular screening to detect certain types of cancer in its early stages. Last year, a government task force said most women don’t need mammograms in their 40s, and a doctors group said most women in their 20s don’t need annual Pap tests.
The new advice on prostate cancer runs counter to what men have been told on TV and other public service campaigns for several years.
Prostate cancer screening became a medical mantra in the 1990s, thanks to the development of the PSA test. Some celebrities became advocates for regular testing, including former New York Mayor Rudy Giuliani, who credited a PSA test during a routine exam with helping him beat prostate cancer a decade ago. Actor Brad Garrett from “Everybody Loves Raymond” had an on-the-air digital rectal exam for a TV special.
For American men, prostate cancer is the second-deadliest cancer after lung cancer. An estimated 192,000 new cases and 27,000 deaths from it occurred last year in the United States. But it is often a slow-growing cancer, and depending on a man’s age, he may be more likely to die of something else.
Another problem with the PSA test is that an elevated or fast-rising PSA reading can indicate the presence of cancer, but can also be caused by something minor, such as an infection or an enlarged prostate. A biopsy is needed to confirm cancer, and that can cause unnecessary pain and fear.
The new recommendations could be “game changers” in two respects, said Dr. John Davis, a urologist who directs prostate cancer screening for the University of Texas M.D. Anderson Cancer Center in Houston.
First, it may mean many doctors will stop routinely giving the PSA test during regular physicals and will discuss it with their patients first, he said. About 41 percent of men 50 and older get annual prostate cancer screenings, he said.
Second, the guidelines could have a chilling effect on community screening clinics in which hundreds of men line up and get free, quick exams, Davis said.
That was the intent, said Dr. Andrew Wolf, a University of Virginia physician who led the group that wrote the new guidelines.
“Yes, the guideline was explicitly crafted to put a damper on those community prostate screening activities that do not offer men the opportunity to make an informed decision whether to screen,” Wolf said.
Last year, the American Urological Association — a longtime proponent of regular prostate screening — backed off its call for annual tests after age 50. The group said men should be offered a baseline test at 40, with follow-ups based on each man’s situation.
The group also has stood by the rectal exam as a standard part of screening, saying it can find cancer that the blood test does not.
The cancer society last issued guidelines in 2001, which said merely that doctors should offer screening and discuss the risks and benefits. The new guidelines back away even more, dropping the sentence that doctors should offer prostate screening.
Instead, the society said that some evidence indicates periodic screening can save lives but that there is uncertainty about the value of finding prostate cancer early. Screening should not take place unless the patient is fully informed of the trade-offs, the society said.
Men at average risk should get detailed information around age 50, the society said. Men at higher risk, including blacks and men with a father or brother who had prostate cancer before age 65, should get the information beginning at 45. Men with more than one close relative with prostate cancer before 65 should get such information at 40.
For men who want to be screened regularly, the new guidelines recommend every other year if the PSA reading is less than 2.5, a measure of prostate specific antigen. Annual tests are recommended for 2.5 or higher, and a 4 suggests consideration of a biopsy.
Early prostate cancer has no symptoms. Advanced disease may interfere with urination or cause blood in the urine. Many men with slow-growing cancers have been successfully treated after symptoms appear.
There are few good treatments for very advanced cases, though researchers reported Wednesday that an experimental drug extended survival by 10 weeks. They were hopeful that the drug, cabazitaxel, might be more effective in stopping earlier cancers.
The society’s new guidelines rankle Skip Lockwood, president and CEO of Zero — The Project to End Prostate Cancer, formerly known as the National Prostate Cancer Coalition.
Lockwood’s group recommends annual PSA tests for men beginning at 45, and conducts mobile prostate cancer screening programs. The group provides information about the risks and benefits of screening, and connects men to follow-up care if needed, he said.
What bothers him most in the new guidance is “the certainty of its tone,” Lockwood said.
“We acknowledge that the PSA test is lacking. I think nobody disagrees on that fact. I think that we all understand that this is not cut and dry — not an all-or-nothing situation,” he said.
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
URL: http://www.msnbc.msn.com/id/35688845/ns/health-cancer/
MSN Privacy. Legal
© 2010 MSNBC.com
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Bangkok Women : Meet Sensual Bangkok Women
Posted on: 10:48 am on Mar. 5, 2010
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CalEden
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New Prostate Cancer Guidelines Aim to Empower the Patient
Diagnostic test not infallible, can lead to unneeded treatments with unwanted side effects
By Amanda GardnerHealthDay Reporter
FRIDAY, March 5 (HealthDay News) -- New American Cancer Society guidelines on prostate cancer screening mean that many men will be faced with a cascade of decisions, with a growing responsibility for those decisions falling on their shoulders.
The guidelines, issued Wednesday, de-emphasize routine prostate-specific antigen (PSA) testing and re-emphasize the need for patient-doctor discussions on whether such tests are appropriate for individual patients.
PSA tests, which measure levels of a protein called prostate-specific antigen that's produced by the prostate gland, do detect cancers. But, they can make the situation worse by revealing malignancies that wouldn't cause a problem over a man's lifetime, leading to unnecessary treatments and undesirable side effects, such as urinary incontinence and impotence.
The new guidelines acknowledge the uncertainties surrounding PSA tests, which have been controversial for some time because assorted studies have produced conflicting results about the value of the screenings.
Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, found himself in a similar situation recently. Although he is of a generation where routine PSA testing is basically a reflexive practice, he was jarred when his PSA levels, after long years of quiescence, rose dramatically.
Thinking it might be an infection, his doctors prescribed antibiotics. A month or so later, the levels had come down, but not to their prior low point. Lichtenfeld was supposed to go for another test six months later.
"I just didn't do it. I found myself conflicted about the value of getting that follow-up test," he said. "I waited a year, and I had anxiety about it."
Fortunately, at the end of that year, Lichtenfeld's PSA levels had returned to their baseline and he wasn't faced with additional hard choices about whether to seek treatment and, if so, which therapies to pursue.
"The problem is we still can't predict which patients are going to live with their [prostate] cancer and which are going to die from it," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La.
According to a statement posted Wednesday on the American Cancer Society Web site, men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least another 10 years should make an informed decision with their doctor about prostate cancer screening after learning the uncertainties, risks and potential benefits associated with such screening. These talks should start when a man turns 50. Men with no symptoms who are not expected to live more than 10 years -- whether due to age or poor health -- should not be offered prostate cancer screening because the risks probably outweigh the benefits.
The cancer society continues to recommend that men at high risk of prostate cancer -- such as blacks and those with a father, brother or son diagnosed with prostate cancer before the age of 65 -- start those conversations earlier, at age 45. And men at even higher risk -- those with multiple family members diagnosed with the disease before age 65 -- should start those discussions even earlier, at age 40.
If a man still can't reach a decision about screening after these conversations, the cancer society is recommending that the physician make the decision, based on knowledge of the patient's health preferences and values.
In advising patients on an appropriate course of action, doctors, who are typically pressed for time, need to take into account a man's total medical profile, according to the American Cancer Society and other experts.
But how reasonable is that?
"Great theory, lousy practice," Lichtenfeld acknowledged. "The reality is that everybody is so pressed for time these days it's hard to have that conversation."
But, he added, "you have to have the conversation. It's time that we all be honest with each other about what we know and don't know."
Even with all the murkiness surrounding PSA testing and the life course of prostate cancer, doctors do know some things.
"You have to look at what the patient's life expectancy is," said Dr. Basir Tareen, physician-in-charge of urologic oncology at Beth Israel Medical Center in New York City. "Someone you would expect to live 15 years or more may derive a benefit from PSA screening."
But an 85-year-old patient who has multiple other health problems is probably not a good candidate for the PSA test, said Tareen, who thinks it's "reasonable" to stop checking PSAs that have stayed normal once a man turns 75.
And let's say a physician treats an 80-year-old man with Lupron shots rather than surgery and radiation. Testosterone levels will decline and the patient is more likely to suffer a heart attack or fall and break his hip due to weakened bones, Brooks said.
"You have used a screening test to make a diagnosis that you didn't need to know and now you have thinned bones and an increased risk for a hip fracture which he'll probably die from," he said.
For reasonably healthy men in their 40s or 50s, it makes sense to at least get a baseline PSA level, then have a discussion as to whether or not you want to pursue regular testing, Tareen said.
Lichtenfeld said: "People are not potted plants as patients. This is part of personal-responsibility decision-making, a process that more of us need to do. We need to find out where we are in this situation. There's a lot about screening we want to believe, but the evidence is not as clear-cut as we would like. This does attack our fundamental beliefs, wishes, desire that we've done something right but we don't know if we can point to an individual man and say we made a difference."
The cancer society's most recent estimates state that slightly more than 192,000 new cases of prostate cancer are diagnosed in the United States each year, and nearly 27,400 men die from the disease annually. It's the most common type of cancer found in American men, other than skin cancer, and the second leading cause of cancer death in men. One in six men will get prostate cancer during his lifetime, and one in 35 will die from it. More than 2 million men in the United States who've had prostate cancer at some point are still alive, and the death rate is declining.
The revised prostate cancer guidelines mark the third time in four months that medical experts have revised the advice on cancer screenings.
Last November, women were told by the American College of Obstetricians and Gynecologists that they don't have to get their first screening for cervical cancer -- including a Pap test -- until age 21. And, rather than an annual Pap test, most women need to be screened every other year or less, depending on their age.
And earlier in November, new U.S. Preventive Services Task Force guidelines suggested that the average woman need not have a mammogram to screen for breast cancer until age 50 and, after that, should have the test every other year rather than annually.
Those suggested changes stirred a firestorm of debate.
More information
The American Cancer Society has more on prostate cancer.
SOURCES: Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society; Jay Brooks, M.D., chairman, hematology/oncology, Ochsner Health System, Baton Rouge, La.; Basir Tareen, M.D., physician-in-charge, urologic oncology, Beth Israel Medical Center, New York City
Copyright @2010 HealthDay. All Rights Reserved.
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Thai Girls : Meet Sexy Thai Girls
Posted on: 10:50 am on Mar. 5, 2010
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peterpan
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CalEden thank you for taking the time to let the forum know about a serious subject.
I have been coming to Bangkok for about ten years and travelled most of the far east.
Eighteen years ago I had a turps operation,by laser and even then my prostate was enlarged, hence the op.
I have always have trouble going to the toilet since then it also burnt my nerves, so sex has been nearly a no no.
Two years ago I had a PSA test and it came out at 11,
my doctor booked me into see a cosultant, who sugested I have a biopsy. This was very painful.
I bled for three days and.The axiety wating for the results were very worrying, mostly worrying if I had a
agressive cancer.
The results came back that I did have cancer,at about 4% and now I had to have a scan to see if it had got into my bones, no was the result.
I booked into see the consultant, who knew that I swam every day 20 lenght,yoga on thursday,and was due to travel to Bangkok then to Angor Wat.
Outcome was that my quality of light was two good to
do anything his words,watch an wait come and see
me in six months.
had the holidy and at six months PSA had gone up,
and was booked in to see a new doctor, who would look to see what treatment I would have.
read my notes, ask a few questions and said.
"COME AND SEE ME IN THREE MONTHS" I was troubled,
was he putting me off
Let me clarify I have no symptoms,apart from a few pains going to the toilet,I went back again and saw my other doctor who my PSA had gone up,few questions.
You cannot believe it "COME AND SEE ME IN SIX MONTHS"
last week I saw him again he ask me what he wanted me to do. We went through all the possibilities of the
side effects which would have rendered a complete
stop to my life style, and possible at some time unable to drive again.
I ask him what he thought was the best for me.What is your flow like when you go to the toilet,very good I said.
GUESS: He just looked a me with a grin and said."You are so stoic in your lifeSTYLE COME AND SEE ME IN SIX MONTHS" He shook my hand and I left.
I am looking to atake my usual two month to Bangkok
in June, I have no axiety now if I can go on for some
time I know sometime I will have to have treatment
I will live life to the full.
CalEden hope this gives a insight to what happens to
someone who has this disease
thank you again PP
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Bangkok Girls : Meet Sexy Bangkok Girls
Posted on: 4:04 pm on Mar. 8, 2010
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Loung Steeb
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MSNBC cannot be wrong.....I need hairy knuckle Keith to check me out....
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Thai Women : Meet Matured Thai Women
Posted on: 4:39 pm on Mar. 8, 2010
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CalEden
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Peterpan, thank you for taking the time and effort to post your experiences. I wish you the best of luck in your treatment. Continue to enjoy your lifestyle and your trips to LOS.
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Bangkok Women : Meet Beautiful Thai Girls
Posted on: 6:28 pm on Mar. 8, 2010
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bkkfella
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I have BPH which means I have a large prostate.
My PSA is around 14 - 16.
A biopsy 10 years ago showed no sign of cancer.
I check my PSA every 6 months and if it should start to rise rapidly, I will look at treatment options.
I do not see why anyone would not have a PSA check.
It is information and more info is better than less when making any decision assuming one keeps irrational fear out of the picture. In the case of prostate cancer, since it moves so slowly, there is little need for fear.
The reason PC kills people at all is because there are no symptoms until it is too late.
I am pretty sure those who die from this disease did NOT have any PSA testing done.
So why not get the PSA information as it could allow an operation to save you ?
Also, not many know that there is an additional test you can get with the PSA test. It is called the "Free PSA to Bound PSA ratio". A high reading above 25% means you have very low probability of cancer. Low readings under 25% as low as 10% increase your liklihood/probability of having cancer.
It cost me an extra 500baht at St Louis Hospital but it was well worth it to see my result of 37%.
I think everyone should get this additional test too.
JMHO
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Bangkok Girls : Meet Attractive Thai Girls
Posted on: 9:57 pm on Mar. 8, 2010
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S M E G M A
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Many with untreated prostate cancer die for reason unrelated to the cancer. Most never even found during their lives that they had it.
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Thai Girls : Meet Active Thai Girls
Posted on: 11:22 pm on Mar. 8, 2010
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CalEden
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The point of my posting: If diagnosed with prostate cancer through PSA testing. Seek other medical opinions and with your "team" of Doctors make an informed decision on the proper course of treatment for you. Do not rush into radical treatment due to one positive test or one Doctors recommendation. There are too many men unable to achieve an erection and wearing adult diapers due to prostrate surgery.
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Thai Women : Meet Matured Thai Women
Posted on: 8:42 am on Mar. 9, 2010
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peterpan
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Smegma.
Your words are often spoken at the hospital, and I had a friend who was having horemone treatment and had a massive stroke and died two days later. I often wonder if this was for the best.
BTW I am 79 years old I have a PSA every three months and a emergency number for 24 hr call.
The hospital I am treated at is the Leicester Royal Imfirmary The cancer centre is one of the fineness in Britain. And I found the empathy of the staff first class.
I can only guess that if my PSA is higher on my next
test in july they will start treatment.
pp
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Bangkok Girls : Meet Attractive Thai Girls
Posted on: 2:18 pm on Mar. 9, 2010
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