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Life on a Scale of 1 to 10

April 23, 2009 By:
David C. Friedman, JE Feature
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A simple blood test saved my life.

The PSA test measures prostate specific antigen, a protein produced by the prostate tissue. The prostate gland, which is only found in males, sits near the rectum and produces semen. It is also one of the leading causes of cancer in men.

I was not overly alarmed when my last PSA test came back elevated.

After a second test confirmed the initial readings, I was referred to Dr. Robert S. Charles, chair of the urology department at Abington Memorial Hospital and part of a seven-physician practice called Urology Health Specialists. Charles immediately scheduled me for a biopsy of the prostate.

The next week, when the doctor called with the results, my anxiety increased dramatically.

"I have some bad news for you," he said. "Two of your biopsies came back positive. You have prostate cancer."

Six weeks later -- the minimum amount of time allowed after a biopsy -- I was on an operating table having my prostate removed.

Recently, two independent studies released by the New England Journal of Medicine and highly reported by the news media, shed doubt on the efficacy of the PSA test, and whether it significantly reduces men's chances of dying from the disease without risking potentially dangerous and unnecessary treatment.

"Every doctor in our group believes that the PSA test is extremely important," said Lee Schachter, also a member of the practice. He performed my radical prostatectomy, or removal of the prostate.

Utilizing a relatively new piece of equipment named the Davinci Robot, Schachter manipulated four robot arms to reach and extract the prostate, saving me from more extensive invasive surgery.

The PSA test, although specific to the prostate, is not specific to prostate cancer, explained Schachter: "There are other reasons the PSA may be high. These include enlarged prostate, inflammation or infection."

"Therefore, a PSA of between 4 and 10 may or may not mean it is prostate cancer."

Schachter agreed with the point made by the studies that there is little value testing men over the age of 75 or with a life expectancy of less than 10 years.

"The problem with both studies is that the subjects have been followed for less than 10 years, and we really do not expect much difference in results in less than 10 years," he said. "The real answers we are looking for are what are the differences in 20, 25 or 30 years. Over time, I think we will have some answers, and it will be proven that prostate screening is beneficial."

Schachter admitted, as the studies stated, that prostate cancer is over-treated by physicians.

"If we took 100 patients with prostate cancer and never treated them, chances are that a percentage would have no problem at any time of their life," he said. "Treating all 100 patients means some are being overtreated, but we do not want to under-treat the cancer," which, "if untreated, some of those 100 would succumb to prostate cancer."

The problem, he pointed out, is that physicians have no way of knowing which of the 100 treated patients will fall prey to the disease, and who will remain healthy.

"So we look at a variety of things," he said. "We look at the PSA test, we look at what is called a Gleason scale -- what stage the cancer is in, age and expected life expectancy."

That scale, he explained, determines how aggressive the cancer cells are; it runs from 1 to 10, with lower numbers indicating a less severe diagnosis.

At the High End

One of my lesions was a Gleason 8, which is at the top end of a scale where lower is better.

"Nobody may accurately predict the future, but we do our best to figure out who may have [future] problems with prostate cancer, and those are the patients we want to focus on and initially treat," he said.

Schachter explained that because one of my two lesions scored an 8, the chances of incurring future problems were substantial. "You were a perfect example of why we do screen," he said. "In your case, the PSA test probably saved your life."

It will be years before I know for sure whether or not my life was saved by my annual tests.

In support of the PSA, the doctor cited an article stating that "since 1992, which is about five years after the PSA test was introduced, deaths from prostate cancer had fallen approximately four percent a year."

"To me," he said, "that is convincing data and is an excellent indication of the effectiveness of PSA screening."

 

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