All About Prostate Cancer

prostate-cancer-ribbonProstate Cancer Is Called the Tortoise of Cancers. It Usually Takes a Lifetime to Develop. Most Men Will Get It If They Live Long Enough, and Few Will Die From It. With Proper Screening, Almost No One Need Die of It.

Prostate cancer is the second most common cancer in men, after skin cancer. Annually, in America, 230,000 are diagnosed with it and 30,000 will die from it—largely unnecessarily. Current guidelines are tending to suppress screening, so the number of men dying unnecessarily is destined to increase. It should be perfectly clear from the numbers—230,000 diagnosed, 30,000 die—that this is a survivable cancer. The travesty is twofold. First, 30,000 die needlessly; and second, unnecessary (but expensive and lucrative) life altering procedures are performed on hundreds of thousands of men annually—men are getting treated that do not need it. The medical profession has realized that the disease is over-treated, so to solve this, they have decided to “reduce” the amount of disease by reducing the amount of screening. Sound absurdly Orwellian? You are not alone if you think so.

A Reality Check on Prostate Cancer:

Prostate cancer is the tortoise of cancers. It takes decades to develop.

Almost all men eventually will get it. The odds a man has it are approximately equal to his age.

Most men aren’t screened. If all men were screened, the number of new cases would be more like two million a year. Very few of these men will die because of prostate cancer. Perhaps 1%.

The low rate of death from undiagnosed or untreated prostate cancer, plus the high incidence of unnecessary and aggressive treatment has resulted in a policy decision to stop screening. This may make some sense in the grand scheme of things, but this will kill in excess of 30,000 men per year.

Stop Over-Treament by Stopping Screening. What kind of goofy solution is this?

2608-DoctorThere really should be some way to stop practitioners from rushing their frightened clientele into unnecessary procedures, while, at the same time, treating men that actually need it—at least you would think so. Some people look at the big cost picture and say don’t screen, don’t treat. Others look at their six figure incomes derived from treatment and form other opinions. Altogether this is medicine at its worst.

Why Do Men Even Have a Prostate?

The prostate’s sole function is to manufacture and ejaculate semen. Making semen is a glandular function, and propelling it is a muscular one. For most post-adolescents, this occurs once a day or less, so metabolically, little is going on, things run very slowly, and a cancer is usually very slow to develop as well.

If the Prostate Is Sick, Why Not Simply Remove It?

It’s location, location, location again. The prostate lives in one of the more inaccessible spots imaginable, nestled between the penis and the rectum. The urethra, the duct for urine, runs through it, as well as the nerves controlling erections. Therefore its removal or destruction by radiation will frequently affect these functions, along with the “quality of life” associated with them.

The prostate is a hormone driven gland. It “runs” on dihydrotestosterone, a very “high octane” version of ordinary testosterone. Cancer is but one of several possible defects in the prostate that will cause it to spill some of its internal stuff, called Prostate Specific Antigen, or PSA, into the bloodstream. Not much is spilled, though, as it’s measured in nanograms/milliliter. The rule of thumb has been to suspect prostate cancer if PSA is over 4. This is the wrong rule. To detect prostate cancer, change is needed, and the rate of change. A person with a PSA of 1, that went to 2 in six months probably needs treatment. On the other hand, a person with a PSA of 4, that hasn’t changed much in a decade may have prostate cancer, but it is stable, and no immediate treatment is needed.

Our Screening Recommendations

In an ideal world, at least how Quantitative Medicine imagines it, all men’s PSA would be measured when they are young, say 40. At this point, twice-a-year measurements would begin. Any sudden lurch would be investigated, and if necessary, treated. Non-aggressive prostate cancers would be left alone, or possibly treated with dihydrotestosterone blocking drugs, which starve the prostate and slows things down even more. Practitioners would not be allowed to bully frightened patients into meaningless treatments that degrade the quality of life while providing little benefit.

The confidence to take this sane and measured approach lies in data; in Quantitative Medicine. Rate of change from a long term known baseline is the best the profession currently has. Get your number and graph it over time. But keep an eye out for better testing techniques. There have been dozens of tests touted as better than PSA—we have no doubt one will come along—however they have all so far failed.

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