Numbers don't lie

You will note from my post "Do the math" that I felt getting the first PSA test at 40 is a good idea. Just look at the numbers - it's obvious. Well, it seems that I'm not the only one who thinks you should start PSA testing at 40 - Dr. Catalona thinks so too. Who is Dr. Catalona? Oh, he's just the guy who invented the PSA test!

So, the next time a doctor tells you to wait until 50, point him/her to this article published in 2004 (and then tell them to get caught up with their continuing education).

Here's the relevant quote:

Dr. Catalona recommends that since deaths from prostate cancer begin to occur in men in their 40s, men should begin tracking their PSA levels at age 40 to recognize a sharp rise.

"While I recommend a biopsy with a PSA level of 2.5 (ng per milliliters) or higher, this study shows us that no single value of PSA is as important as the trend," he said. "And the only way you can recognize a trend is if the testing is done early and every year."

H. Lee Moffitt visit

Met with Dr. Pow-Sang at Moffitt yesterday. WOW. I'd never been to Moffitt for anything - this place has their proverbial crap together. The first thing you notice is the (free) valet parking! They also have a (not free) Starbucks inside next to one of the waiting areas.

After we got past the paperwork desk, we did the normal weight/height/bp stuff. My bp was 121/88! That's the lowest it's been in years (133/88 was my previous low)! Next we meet with a woman who wants to use a portion of my prostate tissue for research. We agree. A few minutes pass and Dr. Pow-Sang comes in (a doctor on time?!?!). We chat a few minutes discussing topics I'm already rather familiar with. Surgery vs radiation, blah, blah, blah. On most points he agrees with the first opinion I got from Dr. Baker with two major exceptions:

• A lot of what we hear about the da Vinci process is hype. Yes, you read that correctly - hype. This is coming from a division chief at Moffitt; the guy who trained my first doctor (Baker). Much of what the da Vinci claims is true (less blood loss, improved view of the surgical area, etc), but, not unique to da Vinci. A normal laprascopic procedure (i.e. non da Vinci) performed by an experienced surgeon is as effective and offers no additional risks over the da Vinci procedure. Yes, Pow-Sang does use the da Vinci, but he wanted to make sure I understood it wasn't "magic".
  
  
• We then discussed the upcoming hernia procedure. Long story short, Pow-Sang does not believe it's necessary to have separate hernia/prostate surgeries - he normally does these two procedures at the same time using laparascopic surgery! That means I do not have to have a rather debilitating surgery next week! :) I will have to live with the hernias until the prostate surgery, but I've gotten better at managing the condition and, I consider it a small price to pay to not be down six weeks or so with "open" surgery.
  

Another topic I verified with Pow-Sang was the scheduling of prostate surgery. Waiting until January is just fine. He says since prostate cancer grows so slowly (combined with my early staging) I have between six and twelve months before I have to decide on a course of action. There's no need or benefit to rushing into a decision right this minute.

We wrap things up with Dr. Pow-Sang and meet another research tech who wants a DNA sample from me (Dr. Pow-Sang is doing research on possible genetic markers for prostate cancer). I agree and she scrapes the inside of my cheek. If they do discover something it won't help me, but, it might help my son 20 years from now. Cool...

As things stand now, we're canceling the hernia surgery with Dr. Siegman, and the prostatectomy with Dr. Baker. We'll be making an appointment with Dr. Pow-Sang to do both (with the da Vinci) sometime in January...

The hernia surgery that had been scheduled for next week must have been weighing heavy on my mind. Not long after we got home (noon-ish), I passed out and slept until after 3pm. I never did really wake up and was back in bed around 10 something. However, I feel great this morning! Well rested and no more doctoring for at least three months!!!!

Pre-Op @ Brandon Hospital

Arrived at Brandon Regional Medical Center (BRMC) at 10am for the hernia pre-op. Paperwork, blood work, EKG and chest X-RAY. Except for the receptionist, everyone was really nice and caring. Got home about 12:30pm and promptly crashed for about four hours. Blood work always wipes me out...

Hernia update

Met with a new surgeon yesterday (Dr. Siegman) regarding the hernias. Surgery is currently scheduled for October 16, but I may change that to October 20 later today.

Unfortunately it has to be the traditional "open" type of surgery (i.e. non laparoscopic) because if they used laparosocpic for the hernia repair they can't use the da Vinci gizmo for the prostate removal. That means I'll be off my feet the first week, and a total of four to six weeks to recover.

Since this puts the da Vinci procedure about four weeks out from the hernia surgery, we rescheduled the da Vinci procedure from Nov 17 to Jan 19. Prostate cancer spreads very slowly and there is no risk in putting off the procedure until Jan 19.

I didn't want to be in perpetual recovery for two months, I didn't want to miss Homestead and I didn't want to be gimped up for the holidays. In fact, the urologist (Dr. Baker) thinks it's a good idea - allowing me to heal up from the hernia surgery before he does his thing.

Do the math

Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men. The older you are, the more likely you are to be diagnosed with prostate cancer:

Under 40	1 in 10,000
40 to 59	1 in 38
60 to 69	1 in 15
Life time	1 in 6

While more than 65% of all prostate cancers are diagnosed in men over the age of 65, the 40 to 59 category should be of note to all. Do not wait until you're 50 to get your PSA tested. At a minimum, start at 40.

Pascal's Wager

For some reason I've always been attracted to the mathematical luminaries of our civilization. Blaise Pascal is one such dude. This cat lived in the 1600's and developed theorems that underlie many of todays statistical equations (used in stock markets, quantum theory and everything in between). How cool is that?

Pascal is known for many things, but one that has always fascinated me was his work on "uncertainty". One example of this is known as Pascal's Wager. In brief (and greatly over-simplified), he argues that it's better to believe in God and be wrong, than to not believe in God and be wrong.

Over this past week I've encountered a number of men who don't think they need to worry about their PSA value until later in life (50 is the most common age that this test is first started at). Borrowing from Pascal's Wager, here's a truth table for PSA testing and its possible outcomes:

	Get PSA tested	No testing
You have cancer	It's caught early, you live and enjoy a full normal life	You die
You don't have cancer	No harm, no foul	No harm, no foul

You will notice that age is not included in this table. I do not include it because it has no relevance to the outcome. Neither does race, history or anything else. The issue is quite simple: you have cancer or you don't. Cancer doesn't care how old you are, it doesn't care what color your skin is and it doesn't care who you vote for.

Know your PSA value.