Tag Archives: Cancer

Join the debate: Should old men be screened for prostate cancer?

Posted on by
2

Joe Biden’s office reported last week that he has been diagnosed with prostate cancer that has metastasized to his bones. They’ve also reported that he went the previous 11 years without a PSA test to screen for it.

At this point, his treatment options are limited. It’s impossible to cure metastasized prostate cancer. Hormone treatment can slow the cancer, but such treatment has side effects – it’s essentially reversible chemical castration, which reduces testosterone to about 5-10% of normal or less.

We’ll never know how much, if at all, Biden’s cancer is related to his cognitive impairments that are now widely acknowledged.  

As for his failure to get PSA tests for 11 years, his office and his media allies point out that some (but not most) medical authorities recommend against PSA tests for men over a certain age, typically something like 70 or 75.

In my opinion, that cutoff, even if adopted, should not apply to a person tasked with Joe Biden’s responsibilities, but that’s a different column. This column is about using such a cutoff for ordinary men.

Here are some of the pros and cons of skipping PSA tests for ordinary old men. Join the debate in the comments section below if you wish.

Cons for the PSA test in old men:

*Prostate cancer usually grows slowly. It’s a fact that more men die with prostate cancer than of it. The expected life span of a 75-year-old American man according to the actuarial tables is about 12 years. The expected life span of that man newly diagnosed with prostate cancer, if not treated, is not much shorter. It’s about 8 years, though the quality of the last few of those years is very poor.

*Given that prostate cancer is usually slow-growing, some cases are overtreated. The man winds up with the trouble of treatment, but no lengthening of his life span, because he dies anyway of something else. If the PSA test is not given to a man, and so the cancer is not discovered, then we can be assured that he will not be overtreated for it.  

*Treating prostate cancer costs taxpayers. The usual treatment is a prostatectomy or radiation therapy or sometimes both. In the case of men over 70, these costs are borne mainly by the Medicare system. It’s reasonable to assume that treating a man with prostate cancer costs somewhere between several tens of thousands of dollars up to a hundred thousand dollars or more.

*The PSA test sometimes produces a “false positive.” That is, a man will have an elevated PSA level suggestive of prostate cancer when, in fact, he does not have the cancer. This will lead to further testing to disprove the cancer. That testing would not have been necessary if the PSA test had not been given.

Pros for the PSA test:

*The PSA test itself costs hardly anything. The retail cost of a PSA test at LabCorp is $69. Medicare gets it for less.

*The PSA test is easy. It’s just one more little vial of blood filled from the same blood draw as the rest of an ordinary blood panel at a man’s annual physical.

*False positives are easily addressed. It is sometimes said that the occasional false positives of a PSA test result in “unnecessary treatment” but that’s not true. What it results in is further investigation in the form of non-invasive imaging and perhaps a tissue biopsy. The imaging is painless, though the biopsy is less so.

*Some prostate cancers kill quickly. The quick-killing ones, once discovered, can be distinguished from the slow-growing ones by ongoing monitoring. If warranted, they can be treated. If Joe Biden had received PSA tests as part of his ordinary annual medical exams, his rapidly advancing cancer would have been detected and would have been treated. Such treatment probably would have saved him from the cancer.

*Overtreatment in a minority of cases does not justify ignorance and non-treatment in the majority of cases. The solution to the problem of overtreatment of slow-growing cancers is not to stay ignorant of all cancers; it’s to avoid overtreating the slow-growing ones.

*Prostate cancer does kill. While it is true that the majority of men survive prostate cancer, it remains the number two cancer killer among American men (second only to lung cancer) simply because it’s very wide spread. It’s true that death by prostate cancer is usually slow but, to me, that makes it all the worse.

My personal opinion is that we should give the PSA test to old men, but use common sense in treating the cancers that are found. A slow-growing prostate cancer in a 78-year-old man with numerous co-morbidities and a life expectancy three years is a different story from a fast-growing prostate cancer in an otherwise healthy 73-year-old man with a life expectancy of 15 years.

Feel free to weigh in with your thoughts.

The Bidens must have known about his cancer for years

Posted on by
3

First, my sympathies for the Biden family. I’ve been there.

Now, here’s my puzzlement. Prostate cancer is notoriously slow-growing. Although prostate cancer is the second-leading cause of cancer deaths among men (second to only lung cancer), that’s not because it’s so deadly, but because it’s so common. It’s a fact that more men die with prostate cancer than of it.

Of those who die, the typical mechanism of death is by the cancer cells metastasizing to other organs and/or to the bones. It takes years for that to happen – typically something like 5-10 years even without treatment, and even longer with treatment.

Even after the metastasizing occurs, death is usually half a dozen years away or more. After all, the cancer cells are still slow-growing prostate cancer cells, even though they’re now in a new home in another organ or in the bones.

The usual treatment for prostate cancer is to remove the prostate gland, a walnut-sized gland “down there” whose main function is to provide the ejaculate that is the vehicle for sperm cells produced in the testicles. After a prostatectomy, a man can still have an orgasm, and it’s a much tidier affair. The surgery is usually done with what’s often called a “robot” but, in reality, is a human-operated arthroscopic system that utilizes fine motor controls and a viewing system.  

An alternative treatment that is often elected is radiation treatment. The prostate is irradiated five times a week for about six weeks. In one of nature’s happy coincidences, prostate cancer cells are more vulnerable to radiation than normal cells. The intended result is for the prostate cancer cells to die (or, more accurately, be sufficiently damaged that they cannot reproduce) while the other cells survive.

In practice, the radiation damages other cells to some extent, which sometimes inconveniences the patient with regard to, for example, urinary and sexual functions.

Neither approach is thought to directly impact a man’s cognitive function. But it should be mentioned that prostate cancer is a disease of older men. Radiation five times a week for six weeks has an effect on older men, even when the radiation is all below the waist. And being under anesthetic for four hours for a prostatectomy is not trivial trauma for a 75-year-old man.

Both treatments are effective, but recurrences are common. A prostatectomy tends to leave at least a few viable cancer cells behind in the prostate “bed” from which the prostate gland is removed. Radiation treatment, too, is known not to kill all the prostate cancer cells. The hope is that it kills enough of them that the man dies of something else before the remaining ones regroup and reproduce.

If the cancer has spread beyond the prostate – i.e., it has metastasized – then all bets are off. Neither a prostatectomy nor radiation treatment are directed toward anything other than the prostate gland.

The announcement from the Bidens is that he has “an aggressive form” of prostate cancer which has metastasized to his bones. The particular bones are not specified, but the hips and pelvis are the most likely. Nor is it specified to what extent the bone metastasis has taken place.

In advanced stages, metastasizing will spread to many bones. The common symptom is worsening bone pain, a deep, achy, persistent and ultimately agonizing sensation.  

Prostate cancer is usually detected long before any symptoms are noticeable. A routine blood test, which is part of every older man’s annual physical, measures a compound called “prostate specific antigen” or PSA.

Elevated levels of PSA suggest, but do not prove, prostate cancer. The doctor typically orders up further tests to confirm the suspicions. The ultimate confirming test is a biopsy.

Here’s my puzzlement. How is it that Biden’s first inkling that he has prostate cancer is when it has metastasized to his bones, given that metastasizing takes years and he presumably has been getting PSA tests at least annually?

My guess is that the Bidens have known of his cancer for a long time. It’s quite possible – nay, it’s likely – that he has undergone radiation treatment for it. (Prostatectomy treatment appears out of the question, because reports are that a nodule was discovered on his prostate; so it’s still there.)

The radiation treatment appears to have ultimately failed, as it not infrequently does. When the cancer became detectable again, it would have produced elevated PSA levels. By the time it was metastasizing, those levels would be very high.

Again, this does not happen in a matter of weeks or months, but years. It’s inconceivable that the Bidens were unaware of this cancer last November.

Hezbollah just received hormone therapy

Posted on by
4

One of the treatments for cancer is often hormone therapy. Men with prostate cancer sometimes get what might be called anti-hormone therapy.

Prostate cancer cells need testosterone. Take away the testosterone, and they mostly stop growing and stop multiplying. This is accomplished with drugs that eliminate testosterone. It’s usually not permanent.

This treatment is not without side effects. Testosterone aids in numerous male functions, especially muscular strength and emotional aggressiveness. It’s the main reason that “women” who are really modified men who have gone through male puberty have a big advantage in women’s sports.

Testosterone is manufactured in the testicles. Hence the expression “He’s got real balls” to describe male machismo.

Which brings us to the Mideast. There’s a cancer in the Mideast. It’s been there for centuries, but lately it has grown more virulent and malignant.

This cancerous terrorism came to Israel again last year, this time starting south of Israel, in Gaza under the regime there called Hamas. They invaded Israel and butchered the residents. They beheaded babies, raped women, and took hostages back to Gaza to torture, kill and display their mutilated remains in public and on the internet. The world has not seen such an exhibition of barbarous cruelty in generations. 

The terrorism sympathizers in Gaza cheered. So did the ones at Columbia and Harvard.

Israel is now surgically removing the Hamas terrorism from Gaza, but in the meantime a strain called Hezbollah has metastasized north of Israel. This Hezbollah strain rains missiles and bombs down on Israeli cities and towns. Lately, it has launched missiles targeting Tel Aviv a hundred miles away.

These bombs and missiles have no military objective. They are directed at civilians for the purpose of killing, maiming and terrifying them.

Hezbollah is officially a terrorist organization according to the U.S. State Department. Its stated aim is to destroy Israel, completely. And by any means necessary, as they say in the fever swamps of American college leftism.

Hezbollah receives about $700 million a year from other terrorists who own and operate the nation of Iran a thousand miles to the east, beyond Iraq.

The nation of Iran is Persian by ethnicity, not Arab. They have no natural interest in Israel or the Palestinian problem far to the west. 

Their interest is in simply hating on the Jews.

That hatred has little historical basis. It appears to be simply a gimmick. It’s designed to be a point for the people to rally round in support of the ruling theocrats who oppress women, toss gays off buildings, and commit other atrocities, all while keeping their people entrapped in the 11th century.

Iranian Jew-hatred thus has the purpose and methods of a giant pogrom. The Jews are a scapegoat for a failed regime, much as they were in post-WWI Germany and countless other times in history.

This nation of Iran that funds Hezbollah terrorism is the same nation of Iran to which Barack Obama’s outgoing administration delivered wooden pallets of about $1,700,000,000 in Euros and Swiss francs (the cash was in foreign currency in order to get around U.S. sanctions passed by Congress).

Obama assured us that Iran had assured him that none of this nearly-two billion dollars of cash would be used to fund terrorism. As if we’re all gullible enough not to know that cash is fungible.

Hezbollah has used its billions from America via Iran to construct a massive terrorism machine, directed mainly at Israel. It’s the biggest non-governmental military in the history of the world.

Israel has had to resort to hormone therapy to battle this cancer. Here’s the treatment protocol.

Hezbollah is apparently chock full of individuals capable of being infiltrated. The Israelis did so. They learned that Hezbollah was in the process of purchasing new smart phones and pagers. Israel intercepted the shipments, and either modified or replaced the phones and pagers with ones that were tricked out.

To explode. Israel then placed calls to the phones and pagers to detonate the implanted explosives. All at once.

People typically keep their phones and pagers in their front pocket. In men, that places them in proximity to the above-mentioned organ of the male body that produces testosterone. Most of the terrorists were not killed, but only injured. This was by design or by accident, but I suspect by design. The Israelis are not prone to accidents.

The end result is that the terrorists are now money-rich with Iranian funding but testosterone-poor with Israeli hormone therapy.

These much-reduced testosterone levels will probably cause the terrorists to be less aggressive in the future. (And their bosses may find it difficult to recruit replacements.)

But cancer is resilient. More treatment will likely be necessary.

N.B. No offense is meant to cancer patients. I’ve been one myself, though never a recipient of hormone therapy.

But Cancer Doesn’t Have Me

Posted on by
2

“I have cancer,” was the title of my column last winter. It’s cancer of the prostate gland, an obscure, walnut-size gland in the male anatomy.

Prostate cancer is about as common as breast cancer. It’s a leading cancer killer among American men, second only to lung cancer.

It kills by spreading, typically to the bones, liver and lungs. Bones ache and break, the liver shuts down, and the lungs fill with fluid and blood.

If caught sufficiently early, however, the cancerous gland can be surgically removed in a five-hour operation. The anesthetized patient is strapped into an operating table 45 degrees upside down so that gravity pulls his guts away from the prostate gland deep in his lower abdomen. Half a dozen incisions are made across his middle. With the help of a computerized robot, the surgeon dodges intestines, nerves and blood vessels to access, cut free and extract the scoundrel.

The surgery often results in side effects such as incontinence and sexual dysfunction. An alternative treatment is to kill the gland with a radiation regimen, but that tends to produce the same side effects.

Another approach is to just carefully monitor the cancer. The growth of prostate cancer is usually (but not always) slow. Patients often live for years or even decades.

They call this “watch and wait.” What they’re watching and waiting for is to see if the cancer is spreading quickly enough to kill the man before something else does anyway.

Watch and wait didn’t fit my cancer profile. It was already Continue reading →