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Brothers and prostate cancer

By Dennis Webster

A friend came to see me about two years ago. I had the opportunity to discuss prostate cancer risk assessment with him briefly some time before this encounter, but was not certain he fully understood what I was talking about. We decided that the proof of the pudding would be in the eating. His Total PSA blood test result (one item in the risk assessment formula) was found to be1.9ng/ml (generally considered a “normal” PSA level).
What usually happens when you have a Total PSA result of 1.9ng/ml? You would be been sent away by your doctor, reassured (falsely) you were not at risk for the deadly type of prostate cancer.
Fortunately for my friend, a Prostate Cancer Risk Assessment (unlike just having at Total PSA test) showed that he was at high risk for the lethal form of prostate cancer. This is because the formula includes other information linked to prostate cancer like how old you are, your ethnic background, whether you have a family history of prostate cancer, your “free to total PSA ratio”, an IPSS score and the results of a DRE (digital rectal examination). Interestingly, my friend did not have a DRE at the time of his risk assessment. His result looked like this:
Many men today are looking for ways to better manage their health. With cancer on the rise in Trinidad and Tobago as well as the increasing number of people dealing with high blood pressure and diabetes, it is difficult sometimes knowing where to start and there are different opinions on what that starting point should be.
For men, I recommend speaking with their doctors about including a prostate cancer risk assessment to their general health assessment. I personally like the Sunnybrook Hospital, Prostate Risk Calculator. Why?

1. It has been tested and retested among well respected research and teaching hospitals and has proven its effectiveness in finding the deadly forms of prostate cancer.
2. It considers more information when determining your risk, not just your Total PSA result.
3. Every creed and race finds an equal place. Yes, you bring your own information to the same formula. The formula gives you a result that you then discuss with your doctor. After that discussion, you both will decide on whether:

1. To keep an eye on things and repeat the assessment (usually in 6mths to 1 year).
OR
2. You should have a prostate biopsy to make sure you do not have deadly prostate cancer.

My friend’s result (35.2 per cent risk for Gleason 7) prompted a referral to a urologist at which time a DRE was performed and a suspicious spot on his prostate was felt.
Long story short, he was diagnosed with prostate cancer after having 12 samples of prostate tissue tested. Fortunately only a Gleason six was diagnosed (early stage cancer). One option when managing this type of cancer is just keeping an eye on things and in consultation with his oncologist, a decision was made to repeat his Total PSA blood test in one year.
I received an email later from my friend stating his brother had also been diagnosed with prostate cancer, and it was a more aggressive type.
One year later, my friend’s Total PSA increased slightly. A repeat biopsy showed his cancer had increased in amount and aggressiveness. He has decided on radiation treatment, having already received an earlier opinion regarding surgery. His brother will have surgery. I hope to share their journey with you in the coming weeks.

For more information on Prostate Cancer Risk Assessment, send a blank e-mail to myrisk@brachy4u.ca
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