Prostate Cancer Warning

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PSA2020
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Prostate Cancer Warning

Post by PSA2020 »

I would like to post a warning for every male pilot
regarding the lack of education on prostate cancer.

For years, I would regularly have a doctor do a digital examination and find nothing.
First, if a doctor wants to do this examination like the above, run to another educated doctor.

A digital examination, is totally useless at early stage detection.
No matter what age, ,you need to ask your FAMILY Doctor, not your aviation examiner
for a requisition for a blood test at least every six months for TESTOSTERONE and PSA

You need to keep a record over as long a time period as possible of what these scores are.
When you PSA rises above 2 you need to be aware that once you hit 4 something may be happening.

I had to get a blood test done and the PSA came back at 9. My Aviation examiner said don't worry about it.
My family doctor at my insistence sent me to a Urologist who ordered a RATIO TEST
The Ratio Test is a far more refined or a test that provides a much higher order of reliability to the
relatively Unreliable PSA test.

The RATIO test came back at a LOW number which is a HIGH RISK interpreted as indicating a 30% risk of possible
early stage Prostate Cancer.

Again, this is not reliable.
The Urologist had an attitude problem, a lack of ability to give real advice or information,
what I got was pathetic information.

I then when to another Urologist and got slightly better information and more advice,
but incorrect WRONG misleading information that is well, technically correct but
factually misleading. I call it an attitude of contempt.

I was given a requisition for a Biopsy by yet another Urologist and was not told
of any further options other than "a biopsy" NOR was I told what a Biopsy comprised of
as it is not what most people think it is.

At the appointment for the Biopsy the Urologist gave me more badly required information
that should have been given to me by a string of medical professionals but all failed.

I was told, that an MRI will see what a Biopsy might miss so therefore do the MRI and if it showed
NO Cancer than I would have proof that I don't have prostate cancer and would not require that "Biopsy"

Its worth mentioning that its now NINE months into this farce of prostate care in this province but
it does not make a lot of difference which province you are in.


Now, while waiting for the MRI, I did a lot of training that reduces my testosterone radically
something that many doctors are not familiar with.
I saw my family doctor and ordered a fresh PSA and Testosterone test ever two weeks
and it went from 9 down to 5 bottoming towards the 5.

My family doctor told me that it was impossible to have prostate cancer with a Decreasing PSA score.

The MRI showed some cancer , it also showed a lot of enlargement so
then the biopsy was done. First they Plug 5 holes in the suspected area
and 12 more holes in areas that showed no Cancer.
While they do this they monitor what they are doing on an UltraSound screen
that is of escalating generations of resolution. The latest is 34mhz which is very high
by standards over the last 10 years.

This is called "A FUSION" biopsy, meaning, it "fuses" two images, the MRI and the UltraSound.

The BIOPSY came back as positive , and at a high level
so that triggered a CT Scan and Bone scan to look for other cancer
but this came back negative.

Then, and only then was I told of the options men have.
1. Get the prostate removed
2. Get internal radiation seeds that stay in place for life but decay in radiation
3. External Radiation with testosterone blocking medication.

Cancer is fed by Testosterone, reduce that and the cancer can reduce or disappear.
4. The testosterone blocking medication is 3 stages
(a) Pills identical to chemical castration , these kick start the reduction
(b) After 2 weeks, you get an injection that lasts 6 months and then another 6 months later.

5. After a month of testosterone reduction you get 6 weeks of daily radiation.

AVIATION MEDICALS
I would appreciate any feedback from those who have access to the manuals and policy.

As I understand it, most countries allow medicals while on hormone treatment.
A long as the cancer has not spread outside the prostate you can still fly.
Medicals will require a letter to the above and
A PSA report showing that the PSA is within expected levels.

External Radiation, appears to be treated differently varying from able to fly
to not able to fly while having radiation.

There are new procedures coming out.
In addition to above internal radiation, long term may not be suitable for many people
WARNING, Do not hold your bladder extensively as this causes Calcification of your prostate
and that can prevent internal radiation treatment.

Fast Acting Internal Radiation puts highly radioactive beads in your prostate for
a few minutes for several treatments. relatively invasive but very effective.

That's my short tutorial on Prostate Cancer.
Bottom line is, the finger up the bottom means diddly squat.

Risk Factors
My Urologist said quote "prostate cancer is of epidemic proportions among the RC Priesthood
That is, it can be sexually transmitted.
You can inherit factors from your father and or your mother.
Environment is a cause
as is severe stresses in life especially separation and
not being able to have a relationship with your children etc.

If your father or male line relatives had prostate cancer
then you are at high risk.

I'd suggest you keep an accurate record of your PSA and Testosterone
and get to learn how and why it fluctuates and with decades of tests behind
you to give you a baseline, then you will know what is unusual.

Symptoms.
Men are NOT told the primary symptom is
"Blood in your sperm" or a "change in colour of your sperm"

Doctors can and do laugh at these symptoms and say its perfectly
normal. It also can be the very first symptom of a deadly disease.

PMs welcome.
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7ECA
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Re: Prostate Cancer Warning

Post by 7ECA »

No one seems to tell guys, that when you turn forty things start to fall apart - and you need to start going to the doctor regardless of how you feel. At the very least, you should go to the doctor once a year for an annual checkup. Problem is, too many guys ignore minor symptoms which may incrementally increase in severity, until it is too late. Prostate cancer is very treatable, if caught early - but, too many guys ignore things until it's metastatic, and then you're often SOL.

And then at 50, you get to have a colonoscopy - unless you're at higher risk of colorectal cancer, and then it's 40 as well.
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AirFrame
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Re: Prostate Cancer Warning

Post by AirFrame »

PSA2020 wrote:
Tue Feb 04, 2020 5:03 pm
Then, and only then was I told of the options men have.
1. Get the prostate removed
2. Get internal radiation seeds that stay in place for life but decay in radiation
3. External Radiation with testosterone blocking medication.

Cancer is fed by Testosterone, reduce that and the cancer can reduce or disappear.
4. The testosterone blocking medication is 3 stages
(a) Pills identical to chemical castration , these kick start the reduction
(b) After 2 weeks, you get an injection that lasts 6 months and then another 6 months later.

5. After a month of testosterone reduction you get 6 weeks of daily radiation.
Why not #1 as a solution, ie. Remove the prostate?

Also interested in aviation medical related effects as I have a father and uncle who both had prostate cancer and my mother died from ovarian cancer that led to lymph node cancer. Father had prostate removed and still flies.
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7ECA
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Re: Prostate Cancer Warning

Post by 7ECA »

From what I've heard, option #1; a radical prostatectomy is a surgical procedure that can carry numerous risks to quality of life - because of where the organ is located, things like urinary incontinence, ED, etc. Of course, depending on the severity of the cancer it may be the best option for survival.

The #2/#3 options are usually used in cases in which one has prostate cancer, but of a less advanced stage thus allowing less "radical" methods to be used.
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PSA2020
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Re: Prostate Cancer Warning

Post by PSA2020 »

AirFrame,
I do not wish to become infertile so therefore potential fathers
like myself, would prefer not to have their prostate removed.

Your risk factors include primarily if your father and brothers and or your grandfather
were known to have prostate cancer. Reality check is many men die of other causes when
they unknowingly also have prostate cancer.

A risk factor can also be your mother's genes, you could inherit one from her that by itself or with your father's history
increase your risk fact.

Environmental is what you are exposed to internally , externally and psychologically such as stress,
diet, exercise and sleep.

No one has yet replied to the Aviation Medical requirements while having treatment other than removal.
Treatment has multiple phases and options.
Removal is one option that is straight forward but if you still have testicles you still produce
testosterone and if you have cancer anywhere else, that testosterone is the primary feeder of that cancer.
By way of info, removal of the prostate can be accompanied by removal of testicles however the
testosterone blocking medication is another more normal option, if it can be called that.


I would like to hear from anyone who knows what the TC approach is.
I believe (correct me if I'm wrong)
that providing the cancer is identified as local to the prostate,
has not spread and is unlikely to spread then its acceptable.

That testosterone blocking medication and injections do not stop a Class 1 medical
That External Radiation is acceptable

That full reports are required.

The FAA by comparison want Disc copies of the MRI, CT scan, Bone Scan
and proof that the PSA level has dropped as expected.

I'm expecting (without any knowledge) just common sense, that
TC will require PSA blood levels for all future medicals.

I would appreciate a PM from anyone who has been through the
testosterone blockers with injections and external radiation.



AirFrame wrote:
Wed Feb 05, 2020 7:42 am
PSA2020 wrote:
Tue Feb 04, 2020 5:03 pm
Then, and only then was I told of the options men have.
1. Get the prostate removed
2. Get internal radiation seeds that stay in place for life but decay in radiation
3. External Radiation with testosterone blocking medication.

Cancer is fed by Testosterone, reduce that and the cancer can reduce or disappear.
4. The testosterone blocking medication is 3 stages
(a) Pills identical to chemical castration , these kick start the reduction
(b) After 2 weeks, you get an injection that lasts 6 months and then another 6 months later.

5. After a month of testosterone reduction you get 6 weeks of daily radiation.
Why not #1 as a solution, ie. Remove the prostate?

Also interested in aviation medical related effects as I have a father and uncle who both had prostate cancer and my mother died from ovarian cancer that led to lymph node cancer. Father had prostate removed and still flies.
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montado
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Re: Prostate Cancer Warning

Post by montado »

I find doctors in Canada can be terrible at times.

I took my daughter in once for a foot injury and literally the doctor says “I see this all the time, it’s a sprain”

And I’m thinking to myself no shit. A sprain is a blanket term that applies to many injuries. And you see this all the time eh? I’m a pilot, I see clouds all the time. Thank Doc.

He pretty much wanted to refuse further investigation. We needed up doing an xray. I got my brother involved because he was a little more familiar with these injuries and sports medicine types things as he is an athlete. The Doc was not picking up on some things basically missing some key points because of my daughters age. Brother says based on the injury the base action was probably stem cell to repair the ligaments.


So I’m no doctor, and I also want to trust healthcare professionals. I don’t want to walk in and be a google know it all. But for @#$! sakes Canadian doctors will flat out @#$! you over because they are simply lazy. They don’t give a shit man, the tax payers paid them upfront... it’s basically like a shit contractor the stiffs you if you pay in advance.
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AirFrame
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Re: Prostate Cancer Warning

Post by AirFrame »

PSA2020 wrote:
Wed Feb 05, 2020 5:00 pm
I do not wish to become infertile so therefore potential fathers
like myself, would prefer not to have their prostate removed.
Fair enough. I thought most men would only develop (or maybe only detect) prostate cancer over 40 anyway, and as you cross 40 the likelihood of starting a family drops off rather rapidly, especially if you and your partner are about the same age.
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Re: Prostate Cancer Warning

Post by Beefitarian »

I'm going to speak out and say every man would prefer not to have their prostate removed. I am fairly confident that is never a recreational procedure.

At any rate, I suspect you will just need to find out what TC will ask for and how they will treat you. It seems like every case is different.

The people who treated my eye were surprised at how difficult TC was. They told me they have treated several pilots but dealt directly with the company. The company would send forms and the doctor would fill them out and return. Since I am only a lowly private pilot there was no company. The Transport Canada representative told me they have no forms.

I'm a bit dumb so I assumed they were fine with what the ophthalmologist sent them. Then being a bit suspicious I called before going flying. Surprise, my medical was still pulled. I guess they assumed I had quit flying or died or something, they never said his report was insufficient until I specifically asked.

I finally got my Cat 3 back but only after chasing around a bit, TC would not explain what they wanted or even speak to the ophthalmologist. The person at TC just kept saying, "The ophthalmologist needs to submit his report." I kept asking, "What do you need in the report?" Eventually they got whatever they wanted. No fun.

I sincerely hope you get everything fixed up and TC makes it easy. Occasionally it happens.
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Castorero
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Re: Prostate Cancer Warning

Post by Castorero »

PSA2020
I sympathize with your predicament and hope that you will make a good recovery.
Given that it was diagnosed early and from the sounds of it you must be well on the other side of 50, if you had digital exams "for years", you will be fine and will live to die of old age.

As we all know men are sensitive creatures who don't like going to the doctor at the best of times, and Pilots, well we are a Sub species for sure...

And please don't take what I about to say on this topic in a negative way or personally, but rather in a broad public health umbrella way...

A couple of comments made here are flat out wrong and bad advice.

Let me just concentrate on the statement that prostate digital exams are useless.

Nothing could be further than the truth.

A digital exam has been and still is the most cost effective tool in detecting most prostate tumors long before metastasis.

The most useless test for screening has been the PSA test. Just ask all the men that underwent negative biopsy surgery because of persistently elevated PSA.

On the other hand PSA is a useful monitoring tool, post treatment.

On a personal and individual basis, there are many better options in screening for early prostate cancer just as there are for early detection of a lot of other conditions.

Screening falls into the basket of public health just like immunizations. It is a concept that farmers relate to best because it is Herd health, not individual health.

The farmer can afford to loose a calf or two as a result of of his treatment , or lack of.
You see where this is going.

I agree with you that there are better ways, but the cost to the public health budget is balanced with calculated results.
I dont think that you are going to see screening for prostate cancer every six months anytime soon, unless you are willing to pay for it personally, and you are not going to have a routine MRI for anything, anytime soon.

That is the reality of Public Health.

And that also is a reality that works against individual health.

The people that have the means, go to the Mayo Clinic for that type of comprehensive type of care.
It is Very costly. And the effective results, are usually no better than our public system in Canada.

I commend you for being your own health advocate and shopping around until you got the answers that you were looking for.

Until cheaper and more cost effective methods are available, a digital rectal exam can and will save your life. ("If you don't put your finger in it, you will put your foot in it." Lawrence Sullivan, Master Urologist)

The other thing that will save your life, as a man, is to have a wife/partner

They will nag you to go for your regular check ups.

If your GP or CAME doesn't do a rectal exam on you, Insist on it, with a smile :D

Castorero
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Schooner69A
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Re: Prostate Cancer Warning

Post by Schooner69A »

"The most useless test for screening has been the PSA test. Just ask all the men that underwent negative biopsy surgery because of persistently elevated PSA."

That's bullshit and just not true. Do not be spread false information that may kill some one.

Consider the PSA test like you would the oil pressure warning light on your car; it could be complete loss of pressure or it could be a faulty gauge. In either, you're going to check it out.

So, too, with the PSA test. Yes, FFS, there are false positives, but you then go on to check it out.


My prostate cancer was picked up as a result of regular annual PSA tests. In mid-2004, one of those test showed that my reading had gone from about 4.5 to about 5.5. My GP indicated that, normally, the latter reading would not be of much concern except for the time frame in which it had increased.

A digital examination revealed nothing.

However, a subsequent 'plucking' of ten samples from the prostate gland revealed cancer.

I underwent radiation therapy and for fourteen years was basically cancer-free with PSA readings below one (1).

Then, a little over a year ago, a PSA level of 2.5 appeared. A PET scan was done.

The cancer is back.

This past month, another PSA reading; it's doubled.

However, at my age, "Watch and Wait" is the course of action. Hormone therapy if required.



All of which to say that PSA tests play a vital role in the maintenance of your health. Were it not for that simple test, my cancer may have gone undetected until it was too late.


If YOU wait until the cancer can be detected by the gloved finger, you may have waited too long...

Don't come pissin' and moanin' to me if that's the case...
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Re: Prostate Cancer Warning

Post by Castorero »

Schooner,

It is hard to know how much to throw into a first response, but in this case the point I was making, if it did not come across clear enough, is that the digital exam should not be discounted as valueless.
It should be the very first exam done, period.
THEN, order the PSA and anything else that may be appropriate.

The problem has been the development of a trend in the last 20 years, with GPs relying ONLY on the PSA for screening. with no rectal exam.

This is problematic, and of late guidance has gone out to remedy it.

Without a rectal exam, an elevated PSA only tells you that it is elevated and not much else.
I certainly am not saying that one should not order a PSA test, but that it should be done in conjunction with the physical exam.

Prostate cancer is not the only malady that will raise the PSA and the digital exam will help in the differential diagnosis.
If the PSA IS elevated, and or is trending upwards, of course it needs to be resolved as to cause, and may require referral to the urologist.

As I have said before The PSA is great for monitoring post treatment, not so good and not too SPECIFIC in pointing to Cancer alone.
Too many false positives leading to too many negative biopsies. However, it is what we have and we use it.
That a better biochemical screening test is needed, there is no doubt.

But, not doing a rectal exam during an annual physical is, in my not so humble opinion, tantamount to negligence.

The takeaway from this is that early and recurrent screening from age 45-50 is the key, and, do both PSA and rectal exam. Insist on it.
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Last edited by Castorero on Sat Feb 15, 2020 12:21 pm, edited 3 times in total.

7ECA
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Re: Prostate Cancer Warning

Post by 7ECA »

I would argue that while one could certainly do both, the digital exam as well as the PSA blood test, one or the other should suffice. The problem, as it were, with the digital exam alone is as mentioned; that it often fails to diagnose an issue until the prostate has grown significantly - a stage at which the cancer (if it is indeed cancer) has often gone beyond the prostate and is now a metastatic issue. Cancers, in general, are both more treatable and survivable if caught early and prior to metastasis.

The PSA is a valuable tool, when used appropriately - that is, as a measure of a trend. A single test result will say little, but multiple tests show what is occurring.
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Schooner69A
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Re: Prostate Cancer Warning

Post by Schooner69A »

Casterero; I reiterate: digital failed; the PSA picked it up.

I too agree that there's nothing wrong with the digital examination; however, I would use the PSA for initial warning; digital exam to confirm; if it is negative but still high PSA, go for prostate sampling.

J
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Re: Prostate Cancer Warning

Post by Castorero »

Schooner,

I am glad we are having this discussion because it sheds light on a very important subject.
I agree with everything you have said and let me clarify the fact that I am not advocating digital exam alone for the screening of prostate cancer.
You have to do both. You cannot do one without the other.

Aside from the fulminant cases that occur at a younger age, forties, early fifties.
prostatic tumors by and large grow very slowly and are contained within the gland for quite some time before they seed out, and usually they CAN be felt as a small nodule or irregularity.

Yes, do the PSA for a baseline and to be complete, but a nodule likely means cancer and leads to biopsy, But not all nodules are cancer either, and not all elevated PSAs mean that there is cancer in the prostate, or that a normal PSA means that you do not have cancer.
Or, that a palpable nodule in the prostate, means that it has already spread beyond the gland by the time you are able to feel it.

It takes a fair amount of practice to get good at knowing what you are feeling with your finger.
If your doctor doesn't do this regularly, she/he will never be any good at it, and so they stop doing it.
It is not called the Practice of Medicine for nothing


The reason I am so adamant about including the digital exam as part of the screening is that the rectum may well be hiding a number of other unpleasant surprises which may be picked up by this simple exam, such as tumors, polyps, piles, to name a few.

And , most importantly, it may pick up a prostate tumor in a man with a normal PSA.

Those of you that had a colonoscopy may or may not remember the Surgeon doing a rectal exam before inserting the scope, and I will bet dollars to doughnuts that his finger lingered over the prostate as well as checking the surrounding cavity.

What got me excited was PSA2020 's blanket statement that the digital exam is of no value. It is in fact of great value if you do it, and it is of zero value if your doctor is too lazy to bother and simply orders the PSA and tells you that you have now been screened, when in fact you have not.
Unfortunately this is the new normal from what I hear.

PSA is not a specific test, more of a scatter gun approach but it is all we've got for cheap non invasive screening.

The value of a good thorough history, followed by a physical exam cannot be overstated, sadly a lot of MDs all too often rely on ordering a slew of tests instead of putting hands on the body and in places where the sun don't shine.

I would not let my MD get away with that sort of half assed work and would be heading for the door if it persisted.

I am happy to carry on talking about this topic if you wish because the more we know, the better we can look after ourselves, as PSA2020 pointed out so well.
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Re: Prostate Cancer Warning

Post by WeatherMaster »

Schooner check your PM
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