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Comment by bryanlarsen | Hacker News Reader

I am not a doctor, but a Gleason score of 7 is not considered a high-grade/aggressive tumour according to cancer.org.

It's certainly possible that the intervention saved your life, but I'm highly skeptical. I think it just caused you unnecessary stress and trauma.

"Every old man dies with prostate cancer. Nobody dies from it." is the saying I've heard. Obviously it's hyperbole, but the core is valid.

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A psychologist told me that she analyzed men who have prostate cancer.

Long story short, she found out that men who simply go to the doctor every 4-5 months to make sure that everything's fine are happier than those who did an intervention. The reason lies in the fact that you lose self-confidence when you're impotent and incontinent.

Sounds plausible to me and the results had high statistical significance, therefore I agree to your skepticism.

IANAD but from what I understand the PSA test has a high false positive rate.

It can be flaky if used alone as a measure, but that's where the urine as well as Free PSA test comes in, which is used as a supplement. I just went through a PSA/Urine/Free PSA/12-needle core biopsy run. Not fun, but the doctors thought it necessary to rule out cancer.

After the third year of steadily increasing PSA scores, my doctor was concerned even though it was below the official "get worried" mark because of my relatively young age and the trajectory.

I went to a urologist, got a request for the MRI which the insurance company denied, and so had to follow up with the very unpleasant biopsy mentioned in the OP (including missed work, pain, peeing blood). All for the result to come back completely negative.

That was last year, and as luck would have it, this year's PSA score dropped significantly.

I don't know whether I'd say that I'm not glad to have a definitive negative answer, particularly since my father had prostate cancer. However, this false alarm did cost an appreciable amount of money, time, and suffering.

You're the classic argument against heavy PSA screening at a young age. Statistically it's probably a net negative what we're doing right now. My PC was actually caught with a digital (as in "finger") test, then followed up by a PSA.

To clarify, a Gleason score is not from a PSA test, but from a biopsy of the prostate. So, several steps removed from the initial PSA test.

Yes, huge false positive rate. My urologist said this: "Statistically there's a good chance you don't have cancer. The problem with statistics is: they may not apply to you."

In my experience it's really hard to keep your mind on the public health statistics of the nation when it's you sitting in the doctor's office.

3+3 is the lowest you can get and 3+4 (what I had) is considered very treatable. Age is important, though, I was in my early 40s when I got the 3+4 result and that was not really something the urologists wanted to just watch. I think the auther was mid 40s maybe, so still not such a great idea to wait until you get urinary tract problems and/or have the cancer metastasize.

He was 46 when he had his baseline, clean test, so probably 5-10 years older.

'Myth #1 - Prostate cancer is common, but few men actually die from it. In fact, prostate cancer is the second leading cause of cancer death among men in the United States and claims almost 30,000 lives in the United States each year.'

https://www.verywell.com/the-top-ten-prostate-cancer-myths-2...

That's exactly what I've always heard. On a long enough timescale, cancer is a virtual certainty.

So as a non doctor, do you think the surgeon choosing to operate was malpractice?

We know that overdiagnosis causes harm and isn't understood. Here's a cancer charity talking about the problem of overdiagnosis.

http://www.cancerresearchuk.org/about-us/cancer-news/press-r...

> Previous research has shown that around one in four women diagnosed with breast cancer through screening are overdiagnosed*.

Sure, it's absolutely something to be aware of as a patient.

But there is a big disparity in information between browsing cancer.org and being a surgeon that has looked at an MRI and biopsy.

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