PSA testing on seniors

We Often Consider at What Age a Man Should Consider PSA Screening, But We Rarely Ask When Do Individuals Stop?

I just had an interesting conversation with an individual who asked me at what age do most men start thinking about NOT having an annual PSA test? To be honest, I didn’t have an immediate answer. It’s a complicated question and I am, to be honest, stumped. Age is certainly a factor as is the reality that there exist 24 types of prostate cancer that range from indolent to very aggressive.

We frequently read about suggested guildelines for PSA screening. I personally like the AUA recommendation that suggests a man should talk to to his doctor about a first screening to establish a baseline when he enters his 40s. From there, based on a man’s general state of health and family history, he can decide on a screening approach that is right for him.  But in the almost twelve months that I have been writing this blog and the years that I have been meeting fellow patients, I can’t remember a discussion that addresses the other end of the spectrum. I would think that a vibrant, active 78-year-old man with a form that appears to be aggressive would be grateful to have the data and take some sort of action. Of course, a man of the same age could be pleased to live out his life with little or no intervention if his numbers indicated a slower growing form of cancer that he could quite possibly live with.  But, how many give up, for whatever reason, wanting to know at all?

So, I have to ask four questions:

1.) Are there men out there in their 70s and 80s who choose to no longer have annual PSA screenings and why?

2.) Are there men out there in their 70s and 80s who insist on annual PSA screenings?

3.) Are there men in this age group who have been screened and diagnosed with cancer?

4.) If you were given a diagnosis of cancer in your 70s or 80s, what course of treatment did you decide upon?

Thank you to anyone and everyone who can provide some insight.

Treatment is a Complex Issue

The following is a a guest entry I wrote for KevinMD, one of America’s top ten leading medical blogs. It ran this morning.

 

As a patient, I feel for anyone who is given a diagnosis of prostate cancer.  Hearing the “Big-C” word can be upsetting enough. But the complexity of the disease—diagnosing it, trying to characterize it and selecting the appropriate treatment—can feel like insult upon injury.  We need to talk about prostate cancers. With 24 known sub-types of this cancer—from non-life-threatening to very aggressive—it’s no wonder so much time is expended on debating PSA screening and the potential for overtreatment.

While debates continue, more than 32,000 American men die from this disease each year, placing it on par with breast cancer in incidence and mortality.

Oddly, I still contend that when I was diagnosed last year, I was “lucky” enough to have clear diagnostic and prognostic data to inform my decision to have a radical prostatectomy, despite potential side effects .  My PSA had nearly doubled in a year’s time. As my urologist reviewed my biopsy results, the extent of the cancer’s involvement in my walnut-sized gland and my Gleason scores, I knew where I was headed. He dutifully began sketching out all treatment options currently available to patients when I told him to stop and move to the top two options. He gave me a dubious look before I shared with him that I had learned much about the disease in two years of working at the Prostate Cancer Foundation.

I was lucky once again when my surgeon’s professional instincts prompted him to remove some of my lower lymph nodes during my robotic procedure, something that’s not always done.  The post-surgical pathology report upgraded my diagnosis to Stage 4 metastatic disease with single Gleason 5 cells discovered in the nodes. (Not exactly the kind of upgrades I am accustomed to in my life…) As a result, I headed into seven weeks of radiation therapy and three years of androgen deprivation therapy—a palliative treatment that drastically cuts my production of testosterone, a fuel for prostate cancer growth and proliferation.  Today, I have a 60 percent chance that I will have to live with recurrent disease. I look forward without second guessing.

Not all patients have such clarity. Through My New York Minute, I meet many readers who are confused by the complexity of this disease. As a fellow patient who also works for world’s leading private accelerator of prostate cancer research, I remind them:

  1. The PSA test is not a cancer test—it’s a diagnostic tool for identifying potential problems, including cancer, in the prostate
  2. With 24 sub-types of this cancer, one size does not fit all for treatment
  3. Sometimes, the best treatment is no treatment and proactive surveillance
  4. Age and personal preference are important factors in treatment selection
  5. Once committed to a treatment plan, avoid the pitfall of second guessing

Science will someday, sooner than later, enable us to identify which prostate cancer a patient has and prescribe highly personalized treatments that will work best for their case. Until then, an in-depth understanding of the disease and the advice of a trusted healthcare professional remain the best tools for making treatment decisions with confidence.

The Power of a Moustache

It’s surprising how landmark deep science can be supported by deeply rooted fun like Movember.

Researchers have sequenced the genomes of prostate tumors from seven men–a landmark event that promises to one day help clinicians learn how to differentiate between those tumors that will be highly aggressive and require immediate treatment and those that are essentially benign and that can be simply observed through proactive surveillance. This project represents a transforming moment in understanding the underlying biology of prostate cancer.

Geneticists have been sequencing a variety of tumors of different types, but the effort on prostate tumors introduces a new level of complexity.  If the data for each genome were presented in the form of a printed telephone book, it would form a book 35 feet high.

All of this is deeply complicated science, indeed. And it’s promising news for millions of prostate cancer patients. But it is important to note that is was made possible by an entirely fun–even frivolous–annual campaign known as Movember. Each year, thousands of men around the world grow moustaches to raise funds that support crucial research that can ”change the face of men’s health.” In the case, whole genome sequencing of prostate cancer was made possible by unrestricted funds raised by Movember in the U.S. and donated to PCF.

What really surprised the researchers, said geneticist Levi Garraway from the Dana-Farber Cancer Institute, was the wholesale shuffling of large segments of the genomes, with relatively big chunks of DNA broken out from one site and reinserted elsewhere. The team found more than 100 such rearrangements, far more than had been observed in any other form of cancer studied so far. “Not only were they much more common than one might have imagined, but there were certain patterns,” Garraway said. “It’s important for prostate cancer, but it might be telling us something fundamental about how cancer genomes become messed up in the first place.”

Complete information on this historic sequencing of whole prostate cancer genomes can be found at PCF’s website.

Men of America: Grow on!