Prostate cancer screening leaves patients in conundrum

Daniel Peck/Daniel Peck Photography - When Jim Cassell’s PSA spiked, prostate surgery loomed, but NIH offered an alternative.

The U.S. Preventive Services Task Force asked the wrong question and, as a result, came up with the wrong answer when it recommended against routine PSA screening of men for prostate cancer. If you stop PSA screening, we will lose the gains we have made in reducing prostate cancer mortality from over 30,000 to less than 20,000 men a year. The task force objected to the price men pay for that reduction: the biopsy of almost a million men and treatment of over 200,000, some of whom require no treatment at all.

The real question is who should be biopsied and who should be treated. We currently go directly from increased or increasing PSA to biopsy. The results don’t tell us the extent of the disease, only that a nest of abnormal cancer cells is present. The MRI may help us select only those patients with significant lesions for biopsy and spare the rest. The other option, much more invasive, is annual biopsy with all its inherent risks.

Prostate cancer is one of the leading causes of death in men. We need better ways to diagnose patients who require treatment. But burying our heads in the sand is not an option.

Barry Aron, MD, Urological Consultants, PA, Rockville

In August 2011, I was diagnosed with prostate cancer and faced the same troubling questions about how to treat it. My wife and I read all the suggested books. We went to all the best institutions: Johns Hopkins, Sloan-Kettering and others. I empathize with anyone who has faced this complex and important decision.

The one thing we found out quickly is that there are no easy answers. All treatments have significant and profound side effects. Watchful waiting and other surveillance programs are an option as well, and while there are no side effects to these options, there is a possible devastating consequence: that one prostate cancer cell escapes the prostate capsule and enters your system. Then your treatment options are far more limited.

Your article highlights the value of advanced MRI imaging in determining the extent of prostate cancer. This troubled me: The MRI technique has improved over the years, but as far as I know, there are not enough data to suggest that MRI imaging is as accurate for all types of prostate cancers as an ultrasound probe. Interpretations of the data can vary, not to mention the equipment used in the testing.

The most telling and perhaps saddest point in this article is when the author talks about her relief about having avoided an “unnecessary treatment.” Unfortunately, it will be some time before she will know that to be so.

Anthony Head, Herndon

Paws for retirement

I enjoyed “Retirement puts an end to job stress, but it can be tough on other aspects of your health” [Feb. 26]. The story doesn’t mention one antidote to depression among retirees: pets, especially dogs, as first you adopt or rescue them, and that makes you feel good. Second, you walk them daily, and that gives you exercise. Third, you meet other dog owners and acquire a whole new set of friends. You are also never lonely. And lastly, forget the Prozac, as it is hard to be depressed with a dog licking your face!

Phebe Brown, Alexandria

Listen to the heart

As a registered nurse with more than 30 years of experience, I was disgusted with the turn of events for Ian Liu [“It started in his back,” Medical Mysteries, Feb. 19]. I am glad that he received the treatment he desperately needed. I sincerely hope his upcoming procedure is successful.

Your story highlights the lapses in medical training. A heart murmur that is end-stage and destroying the heart leading to imminent heart failure is not a new onset. It should have been picked up much earlier, by proper technique, in my opinion.

It takes at least one full minute if not up to three minutes to listen to the heart properly. When is the last time you had someone actually spend the time to listen? Think about it. They put the stethoscope on your chest and back for maybe four seconds, you take a deep breath, then four more seconds here and there — poor technique and totally ineffective.

Ann Conlin, Ellicott City

Meditation’s benefits

Regarding “A mindful alternative for PTSD treatment” [Feb. 19]: I have been meditating for over 15 years. The effectiveness of meditation can be demonstrated by the following test: Take your blood pressure before and after a 15-minute meditation. Your blood pressure will be down at least 20 points after meditation.

Bill Pierangeli, Silver Spring

 
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