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Behind the Headlines-23

Us TOO FLORENCE - BEHIND THE HEADLINES-23
BY BOB HORNEY - PROSTATE CANCER SURVIVOR - Us TOO CHAPTER LEADER
(Published February 10, 2016, The Siuslaw News)


Dreamily: Oh, how I'd love to grow up and be a urologist specializing in the diagnosis and treatment of prostate cancer - man's most frequently diagnosed non-skin cancer and man's number 2 cause of cancer death.
Just think, I'd have access to the PSA blood test, one of the best early cancer screening tests available, giving me the potential to save lives and keep families together. Plus, I would be able to build on the PSA era's 40 percent reduction in mortality from prostate cancer with the use of today's advanced diagnostic tools and treatment therapies.
Early detection of this deadly disease received a big boost in 1991 when Dr. William Catalona published the results of his own study showing that the PSA test was the most accurate method of detecting prostate cancer. Moreover, the PSA test could detect many prostate cancers that were missed by both the rectal exam (DRE) and ultrasonography. Dr. Catalona's finding that PSA could be used as a first-line screening test for prostate cancer was a remarkable step forward in the early diagnosis of that life-robbing disease.
During the PSA era, the cooperation within the medical profession pursuing early detection of prostate cancer resulted in an efficient and effective process. Family/primary care physicians were screening with the PSA test and referring men with elevated or rising PSA results to the urologists. Prior to the PSA test, referrals resulted primarily when men presented with symptoms or an abnormal DRE which is why, according to Patrick Walsh of Johns Hopkins, only 68 percent of newly diagnosed men had localized cancer and 21 percent were metastatic.
Thanks to the PSA test, men were suddenly being referred 5-10 years before becoming symptomatic or having an abnormal DRE which, again according to Patrick Walsh, raised the diagnosis of localized disease to 91 percent with only 4 percent having metastases.
But all was not well. The prostate gland is located just below the bladder and right in front of the rectum, making it difficult to treat with either surgery or radiation. In addition to being in a difficult location, the urethra goes right through it. Early referrals and earlier diagnoses meant more life saving treatment, but...
The problem was those early treatments, surgery and radiation, were leaving many men with serious erectile, bladder and rectum damage. Removing the prostate meant the urethra had to be cut and stitched back together and the nerves controlling erections were removed as part of the surgery. Radiation caused its own share of collateral damage.
I have a ton of respect and appreciation for those who went ahead of me and paved the way to the precision surgery and radiation treatments of today. Thanks to their sacrifices, the above side effects are now usually quite minimal and largely correctable, when they do occur.
Fast forward to 2016 and we find, in spite of early detection and improved treatment resulting in saved lives, times have changed! In 2012 the PSA era came to a screeching halt, thanks to the U.S. Preventive Services Task Force (USPSTF) and its recommendation that healthy men should no longer receive PSA tests. As if that wasn't bad enough, the American Academy of Family Physicians (AAFP) agreed. With that move, the high level of cooperation within the medical profession ground to a halt.
All of a sudden, referrals to urologists were down sharply because PSA screening rates dropped. Naturally, as fewer men were screened, fewer men were found with elevated or rising PSAs, thus fewer referrals. At the same time, the detection of early-stage prostate cancer decreased and more men were presenting with higher PSAs, including a higher percent of symptomatic/advanced/metastatic disease, all within 2 years. No surprise there!
Ok, I'm rethinking what I said at the beginning... More to come.


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