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Survivor guilt (?)

Prostate Cancer | Last Active: 21 hours ago | Replies (45)

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While screening can sometimes catch the very aggressive kind in time, I've read that it can often develop and metastasise in the year between annual screenings. It's almost a different disease: my oncologist told me it represents about 1 in 20 prostate cancer cases, and most typically appears in people of African or Caribbean ancestry (which I'm not).

In my case, there was was nothing visible in my prostate. They were trying to figure out where the metastasis on my spine had come from, and CT and MRI showed a perfectly-normal prostate with no signs of tumours and normal volume. After the tumour biopsy showed prostatic origin, they gave me a DRE, and the urologist thought -- just, maybe, not sure -- he *might* have felt a tiny nodule, but he didn't sound too confident.

In my case, that sucker just escaped the prostate almost as soon as it was born and made a beeline for my spine. That's what I mean by two different diseases ­— with the really aggressive kind, you might not have the luxury of years, or even months, to catch it early. And just coincidentally, for a week I was sharing a hospital room with an army vet (also not of African or Caribbean ancestry) who'd had the same experience: he was getting annual PSA screenings, and his prostate cancer just appeared out of nowhere and almost instantly metastasised.

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Replies to "While screening can sometimes catch the very aggressive kind in time, I've read that it can..."

Fortunately, the cases where “… it can often develop and metastasize in the year between annual screenings…” are so rare that it wouldn’t even make the evening news.

That’s also the reason why when PSA is being tested, both the % Free PSA and the PSA Doubling Time should also be tracked. Those additional datapoints may give an indication that something more serious might be lurking unseen that the PSA test might be missing. Also, these days there’s a PSE test that can be used that is more sensitive than the standard PSA test.

As for the DRE, these days many centers are moving away from that. The data show that if an irregular prostate is felt, that 50% of the time it’s benign; and of the 50% that were cancerous, 95% of the time an MRI would’ve picked that up anyway. (So, the value of DREs is being questioned these days, especially since many men are skipping PSA tests just to avoid getting a DRE.) If an elevated PSA is found, and other possibilities are ruled out, then go straight to the mpMRI,

How old were you when you were initially diagnosed with prostate cancer?

Yup…you had bad luck all right - and a type of cancer that moves so fast it’s practically impossible to catch early.
A friend had inherited a form of colon cancer genetic in origin. After her mother died in her 50’s from it, her GI doc performed colonoscopies every two years.
She was clean for 14 years until a stomach ache brought her to the ER - just months after her last negative c-scope.
Tests revealed metastatic colon cancer to the liver and biopsy confirmed the same type of cancer that killed her mother. Her GI doc reviewed her last colonoscopy, looking at internal photos of various areas he had covered; nothing showed.
She lasted about 2 yrs but succumbed to the disease anyway, regardless of her hyper vigilance, and athletic, organic lifestyle …dumb, rotten luck.