Prostate Cancer Case History – Diagnosis

prostate-cancer-ribbonI (Davis) Have Been Fighting a Six and a Half Year Battle with Prostate Cancer. It is a Battle I think I Have Won. I Examined Several Treatment Options in Detail, Eventually Trying Two of Them.

Prostate cancer is the tortoise of cancers. It takes decades to develop. On the other hand, it almost always will: the odds of a man having prostate cancer are roughly equal to his age. In the US, about 1.2 million men die each year from all causes, mostly disease. About 30,000 of these will die from prostate cancer. Not bad odds really, something like 1 in 30. However, perhaps a million of the men that died from something else had prostate caner when they died. A man’s odds of having prostate cancer when he dies are about 7 in 10. So prostate cancer is probably not going to be what kills you. So far so good.

More Fun With Numbers

The grand and wise policy-makers, who decide who gets tested and for what, have apparently decided that 1 in 30 is not a problem, so they have dictated: “No More Screening For Prostate Cancer.” Well, not really. Anyone can get a test if they want it. What they have decided is that Medicare won’t pay for the test. This causes doctors to refrain from prescribing the test, so millions of dollars are saved each year. But the 1 in 30? What about the 30,000?

I don’t know about the rest of you, but I am not very comfortable being in the same room with anything lethal that has a 1 in 30 chance of having my name on it. Especially if there is something I can do about it. Unlike a lot of other cancers, prostate cancer seems almost to have been “designed” to be caught and cured in a timely manner. It has two features that make this possible (which make it even more idiotic that the medical high priests have decided to toss this one under the bus.)

The first feature is this: prostate cancer leaves a trail. It leaks a protein into the bloodstream called Prostate Specific Antigen or PSA, which is easily and cheaply measured in a blood test. How cheap? LabCorp “retail,” $37. Second, prostate cancer is slow. You can keep an eye on it, and thereby keep it on a short leash.

The Best Way to Deal With Prostate Cancer

Here’s a real good strategy. Measure PSA when 30 or 40. This will establish a baseline, and it should be between 1 and 2 ng/ml. It could be a bit higher too. Above 4 is a level where people tend to get concerned. But it’s change we are primarily interested in.

There are three other things that can send a PSA number up, besides prostate cancer. These are usually ruled out before even talking about cancer. The first is Benign Prostate Hyperplasia, which is fancy talk for saying the prostate is simply enlarged. This happens naturally with age. I know a man who’s PSA went to 8, yet he did not have prostate cancer. Many surgeons would already be sharpening their scalpels at a PSA of 8. The second is infection. The bacterial route to the prostate is via the urethra and the lymph system. Given the slow metabolism characteristic of the prostate, the infection can linger for months, even years. Antibiotics will usually get rid of it, but the antibiotics need to get to the prostate, so it can require a long course of a strong drug. Finally, anything that puts pressure on the prostate can temporarily run up the PSA. The most common cause of this is bicycle riding.

Let’s suppose these are ruled out. The thing to keep an eye on is the rate of increase in PSA. One scenario, a common one, is that after years and years of bobbling between 1.5 and 2.5, is starts creeping up. First 3, then 3.5, then 4. If it took 10 years for this to occur, the disease is moving very slowly, and may stall out. Just keep an eye on it. On the other hand, if the PSA went from 2 to 4 in six months. Do something. That rate of increase represents an aggressive cancer that needs to be dealt with.

So the recommendation is two-fold. One: monitor PSA annually, more often after 60, and, on any change, monitor quarterly. Two: don’t panic. If you keep on top of it, you will win the war.

So Why Not Just Remove the Prostate?

In The Shootist, the frontier doctor, played by Jimmy Stewart, diagnoses prostate cancer in the main character, played by John Wayne. Wayne tells Stewart to get rid of the thing, and Stewart replies, “I’d have to gut you like a fish.” Herein lies the problem. If the prostate were situated next to the appendix, or some other handy locale, it would be a no-brainer. Unfortunately, it’s inconveniently located between the rectum and the bladder, the urethra runs through it, and the nerves that control erections run tightly around it. It’s virtually impossible to remove it or otherwise kill it, without some side effects. The two most discussed are, unsurprisingly, impotency and incontinence. On the other hand, all the assorted methods that have been cooked up to kill the prostate generally work—as far as getting rid of the cancer is concerned: success rates are from 75% to 95% based on various factors. Had the 30,000 men that died last year from prostate cancer followed the steps suggested above, 75% to 90% of them would still be around today.

Orgasms are All In Your Head

Since the prostate seems to be part and parcel of orgasms, it should come as some surprise that men with the prostate completely removed still have satisfying ones. Dry ones, obviously. Now since there’s nothing going on down “below” that could accomplish such a thing, it must mean that orgasms are in your head. Don’t agree? Well think about it a bit. Most men can fend off premature ejaculation by contemplating something distracting and mundane (I used to invert 3×3 matrices in my head). Now there is no way this could possibly work if something other than the brain were producing the sensation.

Making Babies

The semen is needed to deliver the sperm. If the prostate is out of action, you cannot get a woman pregnant. Men still intending to have babies can store sperm prior to therapy.

Therapy

There are at least eight different ways to attack a cancerous prostate. This will be presented in a future post.

  3 comments for “Prostate Cancer Case History – Diagnosis

  1. Jim
    February 2, 2016 at 6:30 am

    Dr. Davis,

    Glad to hear your situation is under control. Regarding the statement “I know a man who’s PSA went to 8, yet he did not have prostate cancer”, how was it determined that this individual did not have prostate cancer?

    • QMWebJockey
      February 2, 2016 at 9:01 am

      Hi Jim,
      The absence of prostate cancer was determined from multiple biopsies. Eventually his doc put him on both of the major dihydrotesterone blockers, Proscar and Avodart, and his PSA dropped to 2 and is stable.
      CHarles Davis

  2. Gordon Burrows
    February 3, 2016 at 2:07 pm

    aged 86.
    Visited my G.P. last Wednesday. Evening, to discuss my Blood Test results.
    P.S.A. 9. He made arrangements for me to see Consultant.
    Saturday morning saw Consultant
    Eleven days later (today), I went to the Royal MARSDEN and had a Bone Scan.
    HOW’S THAT FOR N.H.S. service .?
    As my brother died of prostate cancer, the odds are not in my favour,but I feel as though
    I have had a very good innings and a very exciting and fulfilled one.

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