Prostate cancer cases worldwide likely to double by 2040, analysis finds
theguardian.com
theguardian.com
And it's 5% spread across every trip you take for the rest of your life.
It causes 30,000 deaths a year in the US, which is not insignificant - in comparison breast cancer kills 40,000.
Also worth mentioning that it's not just about surviving it, there's also quality of life. The earlier you catch it the better the outcome.
But it's not like we can always know it will stay slow growing forever. Some cancers can suddenly become aggressive and metastasize, so careful monitoring is important.
Tips:
* I recommend everyone with a prostate get their PSA tested by age 45, or earlier if it runs in the family. It's a simple blood test but sometimes you have to ask for it.
* Early detection is key. A biopsy can assess how aggressive it is (the Gleason score). They can even genetically profile the tumor to further gauge risk (the Decipher score).
* Most cases are slow growing and may never escape the prostate. These are usually treated by simply monitoring them with more PSA testing, imaging and the occasional biopsy. Years ago these cases uses to be over-treated but now they have high quality data showing the safety of monitoring.
* If it hasn't left the prostate (stage 1 or 2) and they think you need treatment there are a few options. In lesser cases you can do focal therapy which is like zapping a small tumor. But it tends to be a multi-focal disease, so often you'll end up getting "definitive treatment": removing the prostate surgically or saturating it with radiation.
* Surgery typically uses a cool-ass remote-controlled robot called "the DaVinci" that operates through a set of small incisions.
* Radiation is done either via external beam -- you just lie there and get zapped -- or by inserting radioactive seeds directly into the prostate (brachytherapy).
* The main side effect of surgery is erectile dysfunction, because the nerves that control that run right along the prostate and nerves do not like getting manipulated. Recovery can take up to two years and you don't always get all your function back. I think that stat is something like 1/3rd get back to baseline, 1/3rd get there but with the help of meds (Viagra), and 1/3rd suffer permanent decline / need other interventions. There is also some incontinence but that typically resolves within weeks/months.
* Radiation also causes ED, as well as urinary bother and potentially some other issues. But these typically kick in later, possibly years later. There are also some short term side effects while undergoing treatment. It's a good option for older patients for sure but "younger" patients (<60 y.o.) have to consider the effects of radiation on healthy tissue decades out. You may also have to undergo a 6-18 month course of hormone therapy which I'll discuss next.
* If it escapes the prostate (stage 3 or 4) then there is an awesome new scan called a PSMA PET that can locate where it is with radiomarkers. They might do focal treatment on hot spots, but the main course of treatment is hormone therapy.
* Hormone therapy is essentially chemical castration. It removes all the testosterone from your body, and this weakens prostate cancer cells. By all accounts it is not fun: kills libido, saps energy levels. But it's also not as rough as chemotherapy, so we're "lucky" prostate cells work that way. There has been a lot of development here; often when you hear there's a new prostate cancer drug it's for hormone therapy.
* We all die but you don't want to die from prostate cancer. It's typically drawn out and painful. I watched my dad go through it, and it's why I got tested early. Fortunately it is very treatable if caught early.
I think you should always do regular PSA testing, but don't automatically follow it up with a biopsy if it's not that high (just slightly elevated). Instead, do a second-line test like a 4Kscore test, and/or look at your PSA velocity, or look at PHI (Prostate Health Index) scores. Basically, the assumption that "anything over a certain cutoff should be biopsied" is dumb and they should actually just do second-line tests before biopsies, for borderline scores.
https://mcpress.mayoclinic.org/healthy-aging/the-psa-debate/
That is, the tough problem for scientific recommendations like PSA screenings is they essentially need to apply to everyone, and "everyone" has to take into account that most people don't understand how to quantify risk and they usually see things in terms of black-and-white.
That said, I don't think the statement "But among oncologists there is very widespread agreement on the benefits of PSA testing." accounts much for anything. There have been loads of examples of highly trained specialists in the past recommending something based more on "well, logically it makes sense", only to not see it actually play out when studied more closely. I find this especially true that there is a general bias among all specialist professions (not just medicine) to "do something", when sometimes the best thing is to just do nothing.
As for “doing something” actually there has been a consistent trend in the prostate cancer fields towards doing less. As the years go by they get better quality data from long term studies supporting “watchful waiting” for many lower grade cancers. I even had a more aggressive one and they let me go several years before surgery, just to maximize quality of life. That’s all due to new data. Data that definitely one needs specialist skills to interpret.
PSA levels will vary between people, basically depending on the size of the individual prostate and physical activity (they should not take your PSA when you took your cycle to go to the doctor).
Which is why the best course of action is to get a series of (yearly) PSA values starting from you (mid-) forties. Such that you have established your personal baseline and can easily spot a significant uptick.
The worst part for me was you have bloody semen for weeks after. I thought that was so gross. But it’s harmless and resolves completely.
Google Gemnini says: Not a cure: Hormone therapy is not a cure for prostate cancer, but it can significantly slow its growth and shrink tumors.
Often used in combination: Hormone therapy is frequently combined with other treatments like radiation therapy or chemotherapy.
Side effects: Hormone therapy can have side effects like hot flashes, fatigue, decreased libido, and bone density loss.
Your doctor will discuss these with you as you choose the best treatment plan.
Iirc, some ethnicities have a higher risk rate and the risk increases with testosterone supplementation. One of the lines of defense is attempting to block T after mid stage diagnosis.
“The study was limited to men with hypogonadism who had a low risk of prostate cancer, so it's not clear how TRT may affect higher-risk men or those who use testosterone in higher amounts, for longer periods of time, or for treating other conditions.”
Other things:
- There is a very new multi-cancer blood test called Galleri that might catch it, but I think you have to be above age 50.
- You could potentially do genetic testing to look for markers but it's probably not worth the expense unless you have family history.
- There's also the old fashioned Digital Rectal Exam that feels for abnormally sized prostates, but chances are your PSA would already be elevated.
maybe i need to experience anal sex to fix this problem