Calvin Cohen of Johns Island is enjoying retirement without prostate cancer, a disease that killed his father nearly 20 years ago.
Just a month after Johns Island resident Calvin Cohen set his retirement from working as a lineman for Berkeley Electric Cooperative for more than 38 years, he found out he had prostate cancer.
For years, at the recommendation of his urologist, Cohen had been taking PSA blood tests yearly since his father died from the disease in December 1993. The PSA test, often given to men starting at age 50, detects a protein called prostate-specific antigen and can identify the presence of cancerous cells in the prostate.
Cohen?s test results began to spike in the fall of 2010, and a subsequent biopsy revealed he had cancer. Like many prostate cancer patients, he chose to have it removed. After all, his family history also included a brother and cousin who chose surgery and survived, as well as another cousin who detected the disease too late and died.
?I said let?s go on and take it out. I can?t see walking around with it in me, so I got it done,? says Cohen, who is now 61 and enjoying days of fishing, seeing family and ?piddling around.?
The PSA controversy
In October, the U.S. Preventive Services Task Force recommended that healthy men should no longer be routinely screened for prostate cancer using the PSA and that the test did not save lives. Furthermore, the PSA could lead to ?aggressive treatments? that leave men impotent, incontinent or both.
The report was based on findings of several clinical trials, including the Prostate, Lung, Colorectal and Ovarian cancer screening trial, which studied nearly 77,000 men ages 55 to 74.
The study?s author, Dr. Gerald Andriole, said, ?Despite additional follow-up, there is no demonstrable mortality benefit for the men who had PSA testing compared to the usual care group.?
The news raised the ire of many urologists and oncologists, who are worried that a possible de-emphasis on the PSA may reverse progress in catching and curing prostate cancer.
Flawed studies?
Among them was local urologist Dr. William Carter III of the Roper-based Lowcountry Urology Clinics, who called two of the studies the task force?s recommendation was based on flawed for several reasons.
Carter says the studies failed to take into account that some who were part of the non-PSA study group had prior PSA tests performed on them nor that the PSA already had helped the medical community find and cure a large number of patients in the mid-1990s.
?Since PSA?s been introduced, there?s been a 40 percent plummet in the mortality rate of prostate cancer,? says Carter. ?That didn?t occur because people are eating a better diet. It didn?t occur because the incidence of prostate cancer went down. It went up. So in a period of time where prostate cancer incidence went up, mortality went down. Something has to account for that. There?s nothing else it could be (other than the PSA).?
Carter added that other flaws in studies included that neither reached their targets of 10 years of data and the task force failed to note that African-Americans or patients with a family history of prostate cancer, such as Cohen, have an increased risk of developing prostate cancer.
?That was, in my perspective, a big goof,? says Carter, noting that prostate cancer remains the most common nonskin cancer in men in the U.S.
Leaving cancer alone
Like many, Carter also acknowledges that ?active surveillance,? formerly known as ?watchful waiting,? is an alternative to biopsies and surgery for some patients, particularly older patients who have PSA scores that have leveled off.
Part of the problem with the issue, according to Medical University of South Carolina urologist Dr. Stephen Savage, is that not all prostate cancers are the same and some don?t need treatment. That, in and of itself, is hard for some patients to fathom.
Savage says he sees some validity in the task force?s recommendation, but that it failed in suggesting that the test not remain a tool in fighting prostate cancer.
?It?s important to bring the issues to light … and to be aware of the risks of diagnosing a clinically insignificant prostate cancer,? says Savage, noting the risks of incontinence and impotence from having surgeries.
He added, ?The way the system is set up, the practitioner (the doctor) is not rewarded for taking time to explain this. … The person (doctor) who treats it gets paid to treat it.?
Peace of mind
Prostate cancer has touched the life of one of Charleston?s most beloved residents, former College of Charleston basketball coach John Kresse.
Former College of Charleston basketball coach John Kresse, who had prostate surgery nearly four years ago, still passes along his knowledge to students, including this ?Techniques and Strategies of Coaching? class.
Kresse, now 68, started having regular PSA tests in his mid-40s. When he was 63, his test results went ?sky high? and he had biopsies. He had the choice between watchful waiting or having surgery.
?I chose to remove the prostate gland, to make sure the cancer was not going to come back,? says Kresse, who still teaches at the college. ?When the biopsy showed the cancer, I decided to take the most certain avenue to get rid of the cancer, which it did successfully.?
He?s a believer in the PSA, but realizes that physicians and patients have to weigh the risks of biopsies and surgeries.
?Some say the PSA is overused and unnecessary, but for me, I had been monitored for many years by examination and the PSA provided a measurement and a peace of mind that was very important to me.?
Today?s guidelines
The current recommendations for the use of prostate-specific antigen blood tests are as follows:
The first PSA should be conducted at age 40.
If the PSA is less than 0.6, rescreen at age 45. If the PSA is greater than .6, repeat the PSA in a year.
At age 50, PSA screening should be conducted annually.
Patients should be informed about the benefits and risks of PSA screening.
Dr. William Carter III, Lowcountry Urology Clinics
Reach David Quick at 937-5516.
Source: http://www.postandcourier.com/news/2012/feb/06/experts-debate-prostate-cancer-test/
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