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New Research Findings
USPSTF PSA Screening

Advanced Disease
Localized Disease
Metastatic Disease

Behind the Headlines-11

(Published July 9, 2014, The Siuslaw News)

Looking back at my friend's prostate cancer journey as he told it in May and June, there are a few points that I'd like to have us think about.
First of all, remember he was diagnosed nearly 14 years ago when PSA testing was the hottest thing since apple pie. We who were diagnosed with prostate cancer at that time usually had one thought - GET RID OF IT! Prior to the PSA test, prostate cancer was diagnosed because of symptoms or an abnormal DRE (digital rectal exam). In both cases, it was often incurable, too advanced to even consider "getting rid of it." Fortunately, the early diagnosis of prostate cancer made possible by the PSA test has resulted in a 40 percent reduction in mortality from the disease during what is referred to as the "PSA Era."
My friend's prostate biopsy Gleason Score was 3+3=6, one that is generally considered a non-aggressive cancer. However, that is NOT a guarantee, as many men know from experience. Today, a man with Gleason 6 is often a potential candidate for Active Surveillance, but that term wasn't even in our prostate cancer vocabulary 14 years ago. At best, the term would have been Watchful Waiting and a urologist's experience with it would have been minimal - and learning. The learning curve was over a decade long, finally arriving at the more descriptive and effective process now called Active Surveillance.
Could my friend have been over-treated in electing to have a radical prostatectomy? Sure, but if we put ourselves in his shoes at age 54 with both of our parents having died of a cancer, I can't think there would really have been much discussion about what to do. At Oregon Urology Institute (OUI), those decisions are made by the patient in consultation with his they should be. Even with all his problems (including MS), I have never heard my friend say, "If I had it to do over, I would have taken a chance with the prostate cancer."
If he had chosen Watchful Waiting, might he have been under-treated? Absolutely! Remember, the biopsy only "samples" the prostate. There could have been aggressive cancer that the biopsy needles missed.
My friend's story also points out his good fortune of moving to Florence and connecting with Dr. Mehlhaff. When he thanked Dr. Mehlhaff for giving him his life back, my friend didn't mean just keeping him alive; he meant his active life.
When he told Dr. Mehlhaff that he was ready for the (pouch-less) Urinary Diversion Surgery, he had to assure him that he would responsibly provide the care that life after the surgery would particular, an absolute total commitment to regular catheterizing. My friend convinced Dr. Mehlhaff that he understood the importance of that and would be responsible in doing it. Failure to follow the necessary catheterizing could lead to catastrophic medical problems and Dr. Mehlhaff wanted absolute assurance those wouldn't occur.
When he says he has catheterized himself 10,000 times without a single problem, it speaks to his total commitment to make his Diversion Surgery a success. He rightfully credits Dr. Mehlhaff with going the extra mile to make his surgery a success, but my friend needs to credit himself with doing his part in assuring its continued success.
We who have received an early stage prostate cancer diagnosis and chosen treatment, fully understand that our choice will likely work out fine even though there may be some side effects of varying degrees. Knowing we have the expertise of the urologists at OUI working with us, there is no way the threat of possible side effects of treatment should keep any man from getting tested and knowing his PSA number. Copyright © 2010 - 2024