Archive for the ‘Prostate Cancer’ Category

USPSTF Is At It Again

May 22, 2012

Today, as expected, the U.S. Preventive Services Task Force (USPSTF) released its report on the efficacy of PSA screening for prostate cancer with little change over the draft version released last fall. The USPSTF recommends against routine PSA screening of asymptomatic men no longer be screened for prostate cancer. The committee, that includes no one who deals with prostate cancer patients on a daily basis and is headed by a female pediatrician, cited statistics that more men die within a month of prostate cancer surgery than would have died from the disease. Given that 28,000 American men are expected to die from prostate cancer this year, it is hard to believe that a larger number would die within a month of prostate cancer surgery. Of course, surgery is only one of a number of treatments available for prostate cancer but the others are less likely to kill someone in the short run. I suspect that the comparison would be much different if the(infinitely small) death rates from other treatments were considered. The study also cited side effects, erectile dysfunction and incontinence, from prostate cancer surgery as a reason to avoid PSA screening. Again, some alternative treatments come with lower rates of these nasty side effects. I chose proton therapy for myself because it gave me the best chance of coming out of treatment whole.

The study ignores the benefits of building a history of PSAs for each patient. For example, researchers have found that rapidly increasing PSAs, more than 0.2 increase for two successive years, not only indicates a greater likelihood of having prostate cancer but a greater likelihood of having an aggressive type that needs to be treated soon. With no history of PSAs, many cancers that need to be treated promptly won’t.

African-American males, Vietnam veterans, and men whose relatives have had prostate cancer are all at higher risk of developing the disease. Not screening these groups (two of which apply to me) will surely increase the death rate from prostate cancer. The American Cancer Society’s annual report for 2012 shows that the death rate due to prostate cancer began declining when PSA screening started and continues to fall. This fact argues strongly against the USPSTF’s position that PSA screening doesn’t save lives.

Waiting until a men presents with symptoms of prostate cancer greatly increases the likelihood that he will die or suffer nasty side effects because the disease is generally greatly advanced before the patient becomes symptomatic. Something not discussed in the report is the high level of pain those who die of prostate cancer experience. For all its numerous faults, PSA testing is still the best available option. Fortunately, researchers are working to find better indicators.

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Another Government-Funded Group Recommends Against Prostate Cancer Screening

January 19, 2012

Earlier this month, another report recommended against mass screening for prostate cancer. This time it was a study funded by the National Institute of Health (NIH) and conducted by researchers at the Washington University School of Medicine in St. Louis. Their position is that annual screening of m their 50s and 60s does not save lives. A critic pointed out that their research model was flawed in that a control group of men who were not screened was not part of the study. This study fall on the heels of a government committee’s recommendation last fall that mass screening for prostate cancer be stopped because it doesn’t save lives.

This month, the American Cancer Society published its annual statistics on various cancer types. Included in this report is a chart that graphs the deaths per 100,000 men for the seven cancers that kill the most men on a year-by-year basis since 1930. Prostate cancer was the third leading cause of cancer death to men from 1930 to the early 1980s when its increasing death rate surpassed that of cancer of the colon and rectum’s decreasing death rate. The death rate for prostate cancer continued to increase through the early to mid 1990s at which time it began to decrease and continues to decrease at about the same rate to the present. (See graph below)

The reason for the decrease in the death rate is not known with certainty. The likely contributing factors are: mass screening, improved treatment techniques, and treating the disease in earlier states. To make matters even less clear, these factors are interrelated. For example, mass screening detects prostate cancer at a much earlier stage of development than if the patient presented with symptoms. Higher levels of success are likely when treating earlier, lower-grade cancers with improved treatments.

Eliminating mass screening would likely result in more men presenting with symptoms that generally are related with prostate cancer at more advanced stages and are more difficult to treat. It seems intuitive that the direction of the graph would change dramatically if screening is terminated. The American Cancer Society report can be found at: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012

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A Christmas Present from the VA

January 3, 2012

Disabled veterans got a Christmas present from the Veterans Administration in the form of a pay raise.  After receiving no increase the last two years, a 3.6% raise looks pretty good.  To put this in perspective, a 100% disabled veteran with a spouse and no dependent children or parents who was receiving $2,823 per month before the raise now receives $2,924 or $101 more.  It’s not a princely sum but it is better than we have been doing in recent years.  Because of the arcane way the VA assigns disability percentages, not everyone will get 3.4% more than they were getting.  In many cases, they will but others, with more complicated situations will get something a bit different.  Understanding the VA rate tables is essential to determining what one’s new compensation should be.  The VA rate tables can be found at: http://www.vba.va.gov/bln/21/Rates/comp01.htm

I think I may have figured out how the VA computes disability percentages for veterans with multiple disabilities.  It’s not simple.  If you have three disabilities– say a 60%, a 30% and a 10%–that total 10% under the normal rules of mathematics, you aren’t rated at 100% by the VA.  They determine disability percentages as being 100% minus an efficiency percentage.  If your first disability (in order of severity) is 60%, you are 40% efficient (100%-60%).  The second disability (30% in this case) leaves only 70% of the efficiency remaining after the first disability or 28% (40% times 70%).  The third disability (10%) leaves 90% of the efficiency remaining after the second disability was deducted or 25% (28% times 90%).  Subtracting the combined remaining efficiency from 100% yields 75% (100% minus 25%).  The VA rounds this percentage to the nearest 10% for a combined disability of 80%.  Eighty percent is a far cry from 100%, particularly the way the VA computes compensation.  An 8% disability does not get 80% of what a 100% disability gets.  For example, an 80% disabled vet with a spouse gets $1,602 per month, not $2,339 (80% of $2,924).  You can find the VA’s explanation of how they compute multiple disabilities at http://www.benefits.va.gov/warms/bookc.asp under section 4.25 Combined Ratings Table.

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Locating the Cancer in the Prostate

November 22, 2011

From what I understand, prostate cancer is different from most other cancers in that the exact location of the tumor(s) is not known. Apparently, x-rays, CT scans and MRIs are unable to identify prostate cancer cells inside the prostate. Biopsies of tissue core samples extracted from the prostate are needed to determine whether cancer is present or not in the samples. Biopsies do not determine the locations and extent of all the tumors in the prostate. As a result, treatments have tended to treat the entire gland by either removing it entirely or radiating the whole thing to make sure they get it all. The only sure way to determine the exact extent of the cancer is to biopsy the whole thing but that requires removing it from the body first. Someday, there may be some alternatives.

At least two teams of scientists, one in Belgium, the other at UCLA, are working on systems that use computer software to combine data from MRI scans and ultrasounds to map the locations of cancer inside the prostate gland.

The UCLA research team fuses data from a real-time 3-dimensional ultrasound with MRI data during a biopsy to reasonably accurately determine the location and size of prostate cancer tumors within the prostate and, thus, identify the best places to take core samples. It is expected that this technique will be especially beneficial for patients of advanced age with small tumors that will not grow fast enough to ever be life threatening. It is also expected to be useful for patients such as myself who have had high PSAs and a previous negative biopsy.

A Belgian company has developed a product called HistoScanning that couples ultrasound with “advanced tissue characterization algorithms to visualize the position and extent of tissue suspected of being malignant in the prostate gland.” According to the manufacturer, “Prostate HistoScanning™ offers the simplicity of ultrasound and results that are comparable to MRI in a format that can be made available to all patients in the physician’s office.”

Of course, it will be some time before either of these options become available for use in the U. S.

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Veteran Service Officers

October 25, 2011

My proton therapy treatment for prostate cancer was completed two months ago today. So far, so good.  Last Thursday, I spoke at the annual training meeting of the New Jersey Association of Veteran Service officers in Atlantic City. It was a great meeting. I was received well by the VSOs in attendance and learned much from other speakers. I was pleasantly surprised by the interest the VSOs showed in helping the vets they serve. VSOs are generally government workers who are employees of the counties in which their offices are located. Government workers can sometimes be less than interested in helping the public. Not so with the VSOs I met. Most of the men and women I met at the meeting were veterans. That surely influences how they relate to vets seeking assistance. Some of the VSOs were also disabled. If memory serves, three of them used motorized chairs to get around and another one used a manual wheelchair.

My talk was fit in at the end of a packed schedule. Even though they were attending a banquet a little later that day, most stayed for my talk and listened attentively. Some asked good questions and afterwards some informed me of benefits that aren’t widely known. For example, a 100% rating is not always the maximum. Under certain conditions, disabled vets can be awarded considerably more than 100%.  I doubt if I am eligible for Special Monthly Compensation (SMC), but the old sergeant I served with may be because he has a number of serious medical conditions, more than one of which is an Agent Orange disease.

Several people took copies of Prostate Cancer and the Veteran home with them because it contains some information that is new to them. Of course, they already knew all about dealing with the VA.

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My Absence

October 7, 2011

Early in the summer, I announced that posts to this blog would be irregular for a time without stating a reason for the disruption. The reason for my absence was that I was spending the summer in Bloomington, Indiana receiving treatments for prostate cancer at the Indiana University Health Proton Center.  Choosing a treatment modality, proton therapy, that is not widely known was the result of extensive research. The research uncovered some things that were completely unexpected. The one that had the greatest impact was that I was probably exposed to Agent Orange while serving in Vietnam in 1967. Those who served in Vietnam during the time that Agent Orange was sprayed are eligible for disabilities and treatment from the Veterans Administration.  Unfortunately, the government does not put the same emphasis on informing veterans who were harmed while serving their country that it does soliciting “clients” for its welfare programs.

Knowing that I was far from being an isolated case, I decided to write a small book that veterans can use to help them navigate the VA and healthcare systems. My treatment for prostate cancer is complete and, after only seven months since first applying, my VA disability was approved. Prostate Cancer and the Veteran should make their process a bit easier than mine was.

This blog won’t be back to its old regularity just yet because, the day before my last treatment, I had a bicycle accident that fractured a vertebra. I’m far from being 100% yet and it appears it will take some time for that to happen. I do have a blog article underway. Carlisle Indians vs the Big Ten may surprise some people.

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