On 05/04/2013 02:11 AM, *.* wrote:
> The discussion I had with my doctor is that I will decline the DRE and
> stick with monitoring my PSA. I read that the most sensitive finger
> can only feel a prostate lump long after it has grown to large.
>
> PSA on the other hand doesn't catch all forms of PCA. I look only at
> the delta from my age of 40. If I see a significant delta change I
> will consider options. So far so good. I hope to live to see more
> definitive tests.
For patients who have already been treated for prostate cancer, I think
that's a reasonable idea. I (who have already been treated) also
decline DRE's. Studies of thousands of post-treatment PCa patients have
shown that there is almost never a lump in the prostate region for these
patients without a prior rise in PSA.
For pre-treatment patients, the story may be a little different. As you
point out, there are unusual prostate cancers where the PSA does not
rise above the presumed "normal" point. For these patients, a DRE may
discover the cancer before it has spread. If done right, the DRE is an
extremely cheap and minimally invasive (though I admit it doesn't feel
like that) test that can detect a potentially terminal illness before it
becomes terminal.
However, having said that, I'll also say that your "most sensitive
finger" phrase is an important one. I would bet that most general
practice physicians, and unfortunately even some urologists (I went to
one), don't have the skills or the experience or both to recognize a
tumor on a prostate exam. There's not much point having a doctor feel
your prostate if he wouldn't know a tumor when he felt one.
> One game changer is lab on a chip. A 50 cent device capable of looking
> at one or two protein (or other) markers for the cost of drawing a
> drop of blood, lab costs and 50 cents to analyze. These devices remain
> in the experimental stage but hopefully will soon drive down testing
> costs dramatically.
>
> Here is my 2 cents worth on modern health insurance: Despite annual
> physicals none of them ever detected the inguinal hernia I developed,
> the urine flow problem or any other ailment or physical condition I
> developed. Sure listening to my lungs and heart is still a good idea.
> All that palpitation crap is from the 1800's and rarely detects
> anything. Ultrasound is far better and now comes in cheap, handheld
> forms. So why do doctors push for annual exams? They get paid a higher
> fee for them. It is a money maker. Think of all the saved doctor
> visits if we really only saw the doctor when we were sick, except for
> 3-5 year checkups for heart, simple blood tests: CBC, fasting sugar,
> etc. and ultrasound in office with handheld.
>
>
> It is about time to throw away the 1800 crap in favor of science. No
> more paying for "art of medicine" instead of paying for "science of
> medicine." You don't need expensive doctors to listen to your heart,
> order routine blood tests and use a handheld ultrasound unit.
>
> Eventually they will get high Tesla MRI machines to catch prostate
> cancer early on before a finger or PSA can.
>
> Michael H Berkowitz
I agree with all of that. A hundred years from now, our
great-great-grandchildren will have non-invasive instruments in the home
that will diagnose thousands of conditions that today are very hard to
diagnose.
Alan
P.S., As Steve Kramer asked, are you related to Maynard Berkowitz? He
was a very well respected participant in this newsgroup before he died
of PCa.