Biden Suffering From Aggressive Prostate Cancer

[unicorn]

13 hours ago, Moses said:

...So, I can reassure you: if somebody telling you what PSA screening is bad for people below 60 yo - kick him into face: he has maybe political, maybe financial reasons to tell that, but for sure his reasons aren't laying in medical sphere.

It's highly infantile, or insane, to believe that your personal (probably incorrect) feelings about the harms and benefits from screening in your individual case somehow invalidate decades of scientific study and known facts. The data are what they are, and not subject to "opinion":

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening#fullrecommendationstart

"...Adequate evidence from randomized clinical trials (RCTs) shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened.^3, 4 Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened.³ Current results from screening trials show no reductions in all-cause mortality from screening...".

These facts don't change because of rhetoric. They are what they are. "Challenging" them can only be done with newer studies, perhaps reflecting newer technology (of course, these guidelines are reviewed every few years, or as new data come out). Saying they're invalid because of feelings from a personal experience makes about as much sense as statements from people who say "My niece received an MMR at 13 months, and was diagnosed with autism at 15 months. Therefore the MMR vaccine causes autism." It's ignorant and childish to make such statements, as well as hostile to science.

 

 

[unicorn]

13 hours ago, Riobard said:

Right, the arbitrary recommended age cut-off for discretionary PSA screening is 70 ...

Well, it's not arbitrary. It's what the data show. There is a difference between "I" recommendations (insufficient evidence), and "D" recommendations, which mean there IS adequate evidence, and the evidence shows that the action (i.e. screening) is harmful. 

This is different from the recommendations for Colon Cancer screening, which is more nuanced as we get older. The problem with prostate cancer screening is that ALL men will get prostate cancer if they get old enough, and only a small percentage of those who get prostate cancer will ever be affected by it. Autopsy studies on men who died for other reasons in the US show that essentially one's age pretty much equals the percent probability of finding prostate cancer on autopsy (in other words, most men 70+ have prostate cancer but won't be affected by it). While most prostate cancers regress spontaneously and/or do nothing, most colon cancers really do need to come out, and the data strongly suggest colon cancer screening is highly effective. When to stop colon cancer screening (unlike prostate cancer screening) depends more on the patient's health:

 

 

[Riobard]

58 minutes ago, unicorn said:

Well, it's not arbitrary. It's what the data show. There is a difference between "I" recommendations (insufficient evidence), and "D" recommendations, which mean there IS adequate evidence, and the evidence shows that the action (i.e. screening) is harmful. 

This is different from the recommendations for Colon Cancer screening, which is more nuanced as we get older. The problem with prostate cancer screening is that ALL men will get prostate cancer if they get old enough, and only a small percentage of those who get prostate cancer will ever be affected by it. Autopsy studies on men who died for other reasons in the US show that essentially one's age pretty much equals the percent probability of finding prostate cancer on autopsy (in other words, most men 70+ have prostate cancer but won't be affected by it). While most prostate cancers regress spontaneously and/or do nothing, most colon cancers really do need to come out, and the data strongly suggest colon cancer screening is highly effective. When to stop colon cancer screening (unlike prostate cancer screening) depends more on the patient's health:

 

 

For Kryst sake, man, do you need to be so selectively contrarian and pompously oriented to shaming attempts when you add potentially interesting and illuminating content that would go down better with a spoonful of sugar? Why would a truly bright and informed person almost consistently require a salvo accompanying their input?

Surely the average reader could pick up that I haven’t objected to the age 70 cutoff and that what I mean by arbitrary is not the randomly whimsical connotation but rather the meaning that is based on choice and discretion, as patient self-determination in shared decision-making is a constant running theme through the related literature and 70 could be considered more an inappropriately rigidly delineated threshold at which screening is not recommended if general life and health preservation benefit were to be established as, say, 15 years as opposed to 10 years past the cutoff, given that even 2nd standard deviation bounds around the average age of male mortality nevertheless bins millions of men whose ancient life status nevertheless has objective value?

Who is to say that zero sum is exactly one decade? A person being arbitrary.

[Riobard]

6 hours ago, Moses said:

Long post from above shortly:

If you are above 40 yo and below 60-65 yo, and your doctor tells you what you don't need PSA screening - it is right time to change your doctor.

Well interestingly one critique made regarding the Canadian guidelines, in fact by clinicians that opine that the age-based recommendations should be more flexible, is that they are too narrowly constructed, overly weighted by clinical evidence review, and in fact miss the boat on person-specific variables that should temper the assertion of screening non-value as well as overlook financial cost considerations that should constrain flexibility in guidance due to burden on resources. While deficiencies in approach to recommendations exist, I don’t think that one can satisfactorily argue that bureaucratic influence is a major determinant of the health protection guidance for PSA screening.  

[Moses]

1 hour ago, unicorn said:

These facts don't change because of rhetoric.

In this case, the "rhetoric" is quite simple: the doctor doesn't care about you - the doctor cares about "protocols".

Do you lose anything if you insist on a PSA test? You don't lose anything. What do you lose if the doctor misses your cancer and it metastasizes? You lose your life.

So it's simple: if the doctor tells you that you don't need a PSA test - change your doctor.

[Moses]

By the way: you even don't need to go to doctor for fast check - home tests are in pharmacies over counter, and cost mostly below $10 even in US and EU. I masked brand because there are a lot of such tests in pharmacies.

 

They are very easy in use: 

 

If result is positive, you should make one more test in 3 months (don't worry, prostate cancer is very slow, you have time)

 

If you got positive twice, then you should talk about it with your doctor.

And remember: positive test means you have high level of prostate specific antigen and that doesn't mean you have cancer, it just means you have problem with prostate and should check it.

[Riobard]

6 minutes ago, Moses said:

In this case, the "rhetoric" is quite simple: the doctor doesn't care about you - the doctor cares about "protocols".

Do you lose anything if you insist on a PSA test? You don't lose anything. What do you lose if the doctor misses your cancer and it metastasizes? You lose your life.

So it's simple: if the doctor tells you that you don't need a PSA test - change your doctor.

Unless you subsequently lose your prostate gland based on an educated guess, however reasonable seeming at the time, in which the exigency would ultimately have been disputable. 

[Moses]

13 minutes ago, Riobard said:

Unless you subsequently lose your prostate gland based on an educated guess, however reasonable seeming at the time, in which the exigency would ultimately have been disputable. 

during the pathological examination of my prostate, which was removed, it was discovered that there was 1 millimeter left before the tumor migrated beyond the prostate capsule, as soon as the cancer had gone beyond the capsule and started to settle in the lymph nodes and bones, I would have had about 5 years to live... so I don't regret anything: I lost the ability to ejaculate and retained all other functions - hardon and orgasm

P.S. there is a bonus from the operation: orgasm without ejaculation is approximately 1.5-2 times longer and often stronger, because the body tries to push out sperm that is not there and does it quite diligently

[unicorn]

27 minutes ago, Moses said:

...So it's simple: if the doctor tells you that you don't need a PSA test - change your doctor.

Well, what cannot be disputed is that no one needs a PSA test. However, professional guidelines dictate that the test not be offered without fully informing patients of the test's risks and.potential benefits. If the patient consents to the test, it should be an informed decision. When patients asked me about the test, I would inform them both verbally and in writing what the risks and potential benefits of the test were. Once informed, a majority declined, but some decided to go ahead. A more accurate statement would be that if the physician offers the test without fully informing you of both the risks and the potential benefits, change your doctor. As the professional guidelines state: 

"Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening."
 

[Moses]

7 minutes ago, unicorn said:

many men will experience potential harms of screening

So, tell me please what is "potential harm" of blood test? 

[Riobard]

5 minutes ago, Moses said:

during the pathological examination of my prostate, which was removed, it was discovered that there was 1 millimeter left before the tumor migrated beyond the prostate capsule, as soon as the cancer had gone beyond the capsule and started to settle in the lymph nodes and bones, I would have had about 5 years to live... so I don't regret anything: I lost the ability to ejaculate and retained all other functions - hardon and orgasm

That’s good. The correct guess was made and would then seem to have been an incontrovertible judgement, as if overdiagnosis with deleterious effects were outside the realm of possibility. If your situation were to be the norm the guidance would evolve differently. 

So I’ll chime in with my recent experience of a near collision with biopsy needles. I went to a different MRI program that yielded a higher PI-RADS score and the urologist pushed biopsy. However, the report text included apparently humanly impossible anomalies that may have been typos, yet dismissed by the urologist, that prompted me to pony up much more cash for a confirmatory MRI in the clinic with which I had been previously consistently engaged, in which new results were consistent with lower scores within the same program over time. Averted biopsy conundrum, and PSA in spite of increasing age has been lower than the past 10 years median value. 

Parenthetically, why I wouldn’t do a home PSA kit but rather pursue standard venipuncture with the same unique lab result delineation for temporal comparative tracking if possible to use the same resource. 

Works both ways. 

[unicorn]

23 minutes ago, Moses said:

...

 

...

A PSA test is not a "yes/no" test. It is a numerical value. The reference range depends on one's age, and even one's country of origin:

https://pmc.ncbi.nlm.nih.gov/articles/PMC8099648/#:~:text=According to the findings of,9.01 ng%2FmL for the

In general, a PSA between 4 and 10 should be followed up by a free PSA determination (higher levels of free PSA lower the concern for cancer), and levels over 10 should usually involve some further evaluation (ultrasound, MRI, or biopsy). Home tests have little role, and I can't think of who would want to have one done. If you don't have health care coverage, such as insurance, which will pay for a real, laboratory PSA test, you have far bigger things to worry about. 

[vinapu]

end of world is near, I side with Moses

[Moses]

15 minutes ago, unicorn said:

A PSA test is not a "yes/no" test. It is a numerical value. The reference range depends on one's age, and even one's country of origin:

To whom you explain it? Since I went over that myself, maybe I even know more than you about prostate and prostate cancer. If you will read my advises above, you will find, what my suggestion is: to take home test for yes/no (we are talking about high PSA level) twice within half of year and only if both are positive to go to doctor and ask for blood test with precise level of PSA measuring.

For 90% of males "over 50 yo" even first step "yes/no" will be enough for to stop to worry for next 12 months. And I underline, what it is not "a cancer test" it is just signaling test.

[unicorn]

28 minutes ago, Moses said:

So, tell me please what is "potential harm" of blood test? 

Why don't you read the multiple references?

Obviously, it's not the blood test itself, but rather acting on the information without understanding the consequences, like a lot of dumb-asses do. Even if only a biopsy is done, 1% of prostate biopsies involve complications which require hospitalization, and that's just for the biopsy. When prostates are removed for harmless cancers (and yes, most prostate cancers are harmless), morbidity and mortality increases. Not that difficult a concept to understand. 

First read up on the subject. Then you won't sound like an ignoramus when you try to discuss the subject. And maybe you'll actually learn something, instead of simply being a know-it-all who tries to pretend he's knowledgeable about something in which he's ignorant. You have no medical background, no public health background, yet have the arrogance to claim to know better that the world's best experts on the subject, who've actually read the data and know what they're talking about. Your extreme arrogance is only matched by your extreme ignorance of the subject.

[Moses]

1 minute ago, unicorn said:

Obviously, it's not the blood test itself

Ok. So blood test is harmless. Right?

Then why you will not tell to your patient to make blood test in case, for example he complains for frequent urination at night?

In my country everything starts from PSA test. Normally, bound PSA makes up approximately 65–70% of total PSA, and free PSA is about 30–35%. However, in prostate cancer, the ratio of fractions usually changes: the percentage of free PSA in relation to total PSA decreases and is usually less than 10%. So, here if number is lower than 15% twice within 3 months, you'll be asked to visit urologist in clinic. Then they will make ultrasonic examination. In case they will think about possibility of cancer, then they will ask for MRI with contrast. And only if your PSA still abnormal, if ultrasonic and MRI will show tumor, only then they will talk about biopsy.

And everything before biopsy is harmless (ok, contrast at time of MRI isn't that healthy, but risk is very low).

So why do not check all men? What is the harm of blood test?

[unicorn]

8 minutes ago, Moses said:

...

Then why you will not tell to your patient to make blood test in case, for example he complains for frequent urination at night?

...

Obviously, if someone is having obstructive urinary symptoms, an exam and a (numerical) PSA test would be strongly recommended. This is not the same as screening. By definition, screening is testing someone with no symptoms. And free PSA is usually up to about 25%, not 30-35%. I cannot explain something to someone who refuses to educate himself on the subject.

 

[Moses]

3 minutes ago, unicorn said:

Obviously, if someone is having obstructive urinary symptoms, an exam and a (numerical) PSA test would be strongly recommended. This is not the same as screening. By definition, screening is testing someone with no symptoms. And free PSA is usually 25% or less. I cannot explain something to someone who refuses to educate himself on the subject.

I'll put it in human terms: "Why should we detect prostate cancer at stage 1 or 2? Let's bring the patient to stage 3-4 and then start treating him - at this stage, patients pay more and are more willing to do so."

[Riobard]

1 hour ago, Riobard said:

Well interestingly one critique made regarding the Canadian guidelines, in fact by clinicians that opine that the age-based recommendations should be more flexible, is that they are too narrowly constructed, overly weighted by clinical evidence review, and in fact miss the boat on person-specific variables that should temper the assertion of screening non-value as well as overlook financial cost considerations that should constrain flexibility in guidance due to burden on resources. While deficiencies in approach to recommendations exist, I don’t think that one can satisfactorily argue that bureaucratic influence is a major determinant of the health protection guidance for PSA screening.  

Edit: as well as missing the boat by overlooking financial …

[Riobard]

I just read the 15-year results of the huge UK cluster randomized PSA surveillance study. I believe that many guidance entities have been holding out for how it might influence recommendations. I would think that it strengthens the grade of evidentiary reliability for the Canadian guidelines for age 50-69 (no benefit outside of shared decision-making) and explains why that health protection entity has not revised its position relative to having been published several years ago, in spite of reasonable-seeming critiques that have not yet integrated the implications of the aforementioned UK PSA CAP research. 

https://jamanetwork.com/journals/jama/fullarticle/2817322

[unicorn]

2 hours ago, vinapu said:

end of world is near, I side with Moses

Fortunately, science is not a popularity contest. Facts win out. 😉

That being said, if you haven't watched it, you might want to check out the movie Idiocracy. It looks as though we're heading that way. Under RFK Jr.'s direction, Florida just became the 2nd state to remove fluoride from its water. Let's celebrate science denial!

 

 

[Riobard]

3 hours ago, vinapu said:

end of world is near, I side with Moses

Tough call, though. Mythical vs Biblical. 

[PeterRS]

10 hours ago, unicorn said:

These facts don't change because of rhetoric. They are what they are.

This is so typical of @unicorn's aggressive and total misunderstood response in the thread about the Japanese farmer holding out against expansion at Narita airport in order to keep his farm. He quotes one study and assumes it is the only valid one. And there he is wrong. There are six doctors in my family. Every  one disagrees with @unicorn's dogmatic and aggressive responses.

[vinapu]

8 hours ago, unicorn said:

Fortunately, science is not a popularity contest. Facts win out. 

 

facts are undeniable but their interpretation may change, yes,  due to more scientific research. Valid and proven theory today , in , say 10 years may become obsolete due to new discoveries

 

[PeterRS]

14 hours ago, unicorn said:

Fortunately, science is not a popularity contest. Facts win out

Facts win out, but only if it has been proven that the medical profession have proved that the facts themselves are either accurate or are not disputed by other recognised and reliable sources. Your fact is, frankly, not universally agreed. Besides, in your post of 15 hours ago you quote a "fact" that is now 7 years old. Other more recent studies do not necessarily agree with that fact!

What is fact is that prostate cancer is the second leading type of cancer in the USA. It's also spreading more raidly in Asia than many in the medical profession would have expected a few decades ago. Worldwide there are roughly 1.4 million new cases per year. According to much more recent 2025 reports The Lancet Commission on Prostate Cancer (and you have to agree that The Lancet is a leading, responsible medical journal), states the number is expected to increase to 2.9 million cases by 2040.

Prostate cancer is the second most common cancer in males after skin cancer. About 1 in 8 men will be diagnosed with prostate cancer during their lifetime.

Globally, there are roughly 1.4 million new prostate cancer cases yearly, but according to The Lancet Commission on Prostate Cancer, that number is expected to more than double to 2.9 million cases in 2040.

With cases surging, what strategies can be adopted to address the 1 in 6 males who actively choose to avoid screening?

“A big component of this is education and the need for the population to understand the risk that prostate cancer poses.”

Although screening recommendations for prostate cancer are narrow compared to some other forms of cancer, males at average risk should consider one at age 50, and those with higher risk might consider screening as young as 40.

https://www.healthline.com/health-news/avoiding-prostate-screenings-raises-death-risk?utm_source=ReadNext#1-in-8-men-will-be-diagnosed-with-prostate-cancer

And your facts are not borne out by those by the most recent American Cancer Society guidelines. This states that discussions about screening should commence -

• Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years
• Age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
• Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age)

After this discussion, men who want to be screened should get the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening. (See Screening Tests for Prostate Cancer.)

https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html