Likelihood of Prostate Cancer

You may have had PCa for many years: Research was done in 1980s, at The Cleveland Clinic, and later duplicated by Detroit pathologists in 1990, in all examining 600+ bodies. Both researchers examined people who had died for some other reason, who had evidence of PCa (and the women had breast cancer) from their 20s up. Note on the graph below that the probability of you having PCa is quite high and you have had it for decades without it interfering in your life. According to a 2004 article by Dr Thomas Stamey of Stanford Uni of California, a study conducted by researchers at Stanford concluded that a full 98% of all prostates removed at Stanford over the past five years were removed unnecessarily. Only 2% warranted removal due to cancers large enough to cause concern. This surprising result falls on the heels of other findings by Dr Stamey: for example, the elevated blood levels of an enzyme called PSA is a natural occurrence in men as they age and not a definitive mark of a cancerous growth. Though men with aggressive cancers sometimes exhibit elevated levels of PSA, mild elevation of this enzyme is natural and, as Dr Stamey explained, almost always relates to normal enlargement of the organ as the aging process in men continues –  Robert Bard’s book Prostate Cancer Decoded, p 32-33.

prostate cancer graph

The only alternative to ultrasound and DCE-MRI diagnosis is global biopsies – 24 to 50 cores. The studies are back on prostate biopsies. It is extremely damaging to the organ and highly likely to spread cancer and if there was no cancer before then ripping 50 bits of flesh from your prostate certainly may cause all types of problems, bleeding infection and inflammation….and metastases will surely be spread by blood and the lymph system if you do have some cancer.

The studies are definite…..


More Evidence Not All Prostate Cancers Need Treatment

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In a study of older men who had died from causes other than prostate cancer, almost half were found to have prostate tumors.
And up to half of those tumors detected on autopsy would have qualified for treatment had doctors known about them while the men lived, though none had been the cause of death.
That suggests the criteria for treatment “might be worth reexamining,” according to the study authors, and adds to a growing body of evidence that a wait-and-see approach might be better than treatment for many prostate cancers.

Editor’s Note:Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life

“The study suggests that the progression of early prostate cancer, including some more aggressive forms of the disease, is far from inevitable within a man’s lifetime as many such tumors are found in men who died from other causes when their prostate is analyzed on autopsy,” said lead author Dr. Alexandre Zlotta, director of Uro-oncology at Mount Sinai Hospital in New York.
“The study concludes that it is probably worth re-examining our current definitions of clinically unimportant and clinically significant prostate cancer,” Zlotta said.
He and his colleagues examined the prostate glands of more than 300 men over 60 who had died from a variety of causes, but not prostate cancer. They autopsied 220 men in Russia and 100 in Japan, both countries where the prostate-specific antigen (PSA) screening test is not as commonly used as in the United States.
Medicare currently covers a yearly PSA test for men over 50 who qualify.
Zlotta and his colleagues selected a Caucasian population of Russian men similar in lifestyle and risk factors for prostate cancer to U.S. men in order to look at how common the cancer is in older men who have not been routinely screened.
In the U.S., the number of tumors they found would have been much lower because many would have been identified by screening and treated or removed before death, Zlotta pointed out.
For comparison, he said, “we chose an Asian population in Japan because clinically detected prostate cancer and mortality are much lower among Asian men compared with Caucasian men and their lifestyles/diet are dramatically different.”
Though many fewer Japanese men are diagnosed with or die from prostate cancer than men in the U.S., the new study found that the disease is present in the same proportion of men, and serious tumors are even more common in Japan, based on posthumous prostate examinations.
Almost 40 percent of the Russian men, had tumors of the prostate, compared to 35 percent of the Japanese men, according to the results published in the Journal of the National Cancer Institute.
One in four tumors in the Russian men were deemed serious and would likely have been treated with surgery or radiation in the U.S., compared to one in two tumors in the Japanese men.
But there are still many differences between Russian and American men, so it is difficult to generalize the results, according to Dr. Stacy Loeb, a urologist at NYU Langone Medical Center in New York.
“We should be cautious about trying to apply the results to Americans where we have a very heterogeneous population including very high risk groups such as African Americans,” Loeb said.
In the United States, about 239,000 men are expected to be diagnosed with prostate cancer in 2013, but far fewer – less than 30,000 – will die of it, according to the American Cancer Society.
That’s still more than will die of the disease in Japan, despite the American men getting more screenings and treatments – a curious inconsistency researchers do not understand and Zlotta called the “million dollar question.”
Prostate cancer screening does ultimately reduce the number of painful advanced cancers and deaths from the disease, but it also picks up smaller cancers, and treating those aggressively could lead to unnecessary side effects, Loeb said.
Prostate removal costs about $13,000, and may lead to impotence or incontinence.

Editor’s Note:Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life

The study authors note that the lifetime risk of a man in the U.S. being diagnosed with prostate cancer is 17 percent, but his risk of dying from prostate cancer is 3.4 percent.
That suggests many of those cancers would not advance quickly or at all, and something else would kill the man long before the prostate tumor. The problem is how to know which tumors will be harmless.
Experts said a new screening test may be needed that differentiates between more dangerous cancers and the many tumors that will not eventually kill, thereby avoiding the expense and risks of treatment and removal.
“An example is the Prostate Health Index (phi) which was recently approved by the FDA,” Loeb said. “It is a simple blood test that combines PSA with 2 other tests, and was shown to better predict the risk of aggressive cancer.
“The holy grail is to find only those prostate cancers which are life threatening,” she said.
“The good news is that this is a very active area of research, and the whole process of screening and assessing continues to improve all the time.”

© 2013 Thomson/Reuters. All rights reserved.

It is obvious that slowly developing cancer never becomes a problem until some other major factor is introduced into our lives, eg, great stress, overweight, cessation of exercise, poor diet, depression, accidents, advancing age-related diminishing of the immune function. OR some surgeon deciding to disturb the sleeping cancer by taking multiple core biopsies – the norm is 24 cores – bound to inflame the gland, release cancer cells to grow elsewhere and give you serious metastasised PCa. Mammograms and biopsies do the same thing to women who have a small cancer (not going to kill them) that is spread by either biopsy needles, or the mechanical crushing of the cancer envelope while squashing the breast (especially small breasts) between mammography plates!

Most prostate removals unnecessary, expert says
Struggling to do the right thing when little is certain, urologists and patients opt to remove the prostate when it may not be necessary, expert finds.

M. ALEXANDER OTTO; The News TribuneThe Stanford team’s findings appeared in the October issue of the Journal of Urology. M. Alexander Otto: 253-597-8616

Last updated: December 10th, 2004 10:12 AM

Doctors could be removing far too many prostates and wasting millions of dollars on unnecessary prostate surgery due to a fundamental misunderstanding of a key lab value, according to one of the world’s leading authorities on prostate cancer.
Dr. Thomas Stamey of California’s Stanford University said only 2 percent of prostates removed at Stanford over the past five years had, upon examination, cancer large enough to warrant removal; 98 percent of those removed did not need to come out, Stamey and his team found.

If they are right, that could mean 191,100 unnecessary prostate surgeries each year in the United States. At a cost of thousands of dollars each, that translates to hundreds of millions of misspent dollars.

Prostate removal is a major operation that leaves about 3 percent or more of men incontinent, and at least half with sexual difficulties that can include impotence.

The problem is that urologists at Stanford and elsewhere have thought mildly elevated blood levels of an enzyme called prostate specific antigen, or PSA, correlated to cancer severity.

Instead, Stamey, who pioneered the use of PSA to diagnose prostate cancer in the 1980s, has concluded that mildly elevated PSA – values between 2 and 10 – are almost always related to normal enlargement of the organ as men age, not cancer.

Almost all men develop prostate cancer if they live long enough.

Eight percent of men in their 20ss, one study found, had the disease; 80 percent in their 70s. But it is often such a slow-growing cancer that it does not significantly elevate PSA and rarely causes problems. Many men never realize they have it.

Prostate cancer kills 226 out of 100,000 U.S. men over the age of 65, an “extraordinarily low death rate,” said the Stanford urologist.

A Hard Choice

What the Stanford team is saying is not without controversy. Medicine, like other sciences, is advanced when bold ideas are put forward to be assessed and either accepted or rejected by the medical community.

What makes Stamey’s bold idea significant is his stature as a leader in the field of prostate cancer treatment and the fact that his findings are based on new observations, not reinterpretations of old findings.

What he and his team think often happens is that a mildly elevated PSA leads to a biopsy to check for cancer. The biopsy is almost always positive because the cancer is so common. That leads to surgery to remove the prostate, even though most of the prostates they studied in the past five years did not warrant removal.

“When we get them out, they’re such small cancers that they would not bother a man who lives to the age of Methuselah,” Stamey said.

But there is no certain way at present to tell which one of those tiny cancers will progress, said Tacoma urologist Dr. William Dean. If doctors wait until it is obvious that the cancer it dangerous, it is usually too late for a cure.

Physicians – and patients – are left with a terrible decision: Perform a serious operation that might not be necessary, or wait and risk the small chance that the cancer will turn deadly.

Mindful of litigation and wanting to prevent the worst, doctors often err on the side of caution.

“These guys are not going to be happy finding they have metastatic disease down the line from watchful waiting,” Dean said. “It’s not a wrong decision to have the operation.”

What is needed is a blood test that relates to the size of the tumor, said Stamey. Three Ph.D. scientists in his lab do little else but search for just such a marker, but so far have found little success.