Okay let’s do this! With all the news about Joe Biden, it’s a good opportunity to discuss the number one (after skin cancer) cause of cancer in men (overall one in eight) and second leading cause of cancer death in men (behind lung cancer). Armed with this knowledge you would wonder why screenings are stopped (too young). If you have read Zeke Emmanuel’s post in The Atlantic in 2014 (!) when he said, “Why I hope to die at 75“, (he was 55) you will understand how the creator of Obama care and oncologist from Penn crafted this concept. He doubled down recently Jan 10, 2025, at his age of 65. “Once I have lived to 75, my approach to my health care will completely change”. Look, I don’t care what he does for himself and his family, but when you influence policy and payments and screenings, as an oncologist, there is responsibility beyond your own viewpoint. Does his concept translate to everyone including children who are near the end of their lives? It there no eagerness to live the best as long as you can? Should we remove all the outstanding immuno-therapies extending life now in prostate, breast, pancreas and even brain cancers?
So, when Medicare, to cut costs, recommended stopping these great screening tools, we (other) Docs were up in arms. Stop prostate psa at 70, stop colonoscopies unless you are at risk, only do mammograms every other year then stop between 70-80. These are great tests to find disease early and treatable. If you wait to treat, it’s even more expensive since people don’t go from avoiding screening directly to hospice.
Radiation Oncologists and Urologists take the lead on treatment for prostate cancer, and primary care for screening, so careful what pundits you listen to. You may have a low psa that when it dramatically increases, pushes the need to do a workup, but you have to actually test and pull the head out of the sand. Gleason score 8,9,10 are so aggressive and cancer isn’t linear (from low to high grade) some do present (less than 7 % )with metastatic disease at diagnosis.
Years ago they started something called “observation”- low psa, low grade cancer probably not lethal, won’t need treatment, patient will die from something else. However that changed and now we call it “active surveillance”, since just observing didn’t work out, we recheck psa’s, we re- biopsy and in those expected to live another 5-10 years, we treat.
In oncology we often believe that advanced cancer means it has been there for awhile— not so with high grade tumors of any kind, they grow and spread rapidly, especially if the patient’s immune system is compromised.
Now you know how someone didn’t get a psa since 2014. Travesty isn’t for Joe Biden. He chooses his own care. My concern is for you and your families. If there is a family history, check younger than 50. Otherwise get yearly psa’s and don’t use a cut off of age (sorry Zeke). If your doc believes you have some longevity, you deserve all screening tests. One out of 2-3 of us will have cancer by the time we are 80. Best to find it while treatable, unless other health issues are overpowering. Also, note that African American men frequently present younger and with more aggressive disease.
At least we are talking about it, but no one is stating the true evolution of this need to cut Medicare costs . It was like “Yay screening tools!!” Then it was” Oops can’t treat everyone for everything all the time”. So it didn’t happen in a vacuum. If you are under surveillance, stay on top of it. Symptoms are rare unless it is advanced. Bone is the most common for prostate as it attracts cancer for metastasis, followed by lymph nodes. For these cases we can radiate them while a patient is on hormone therapy (pills and shots). There are new I.V. radionuclides we use for bones and PSMA treatments for all metastatic prostate disease. New immuno-therapies are now under investigation for even resistant cases. People do survive and for years. Refuse to accept the pat on the head, “Oh you don’t need this anymore” for your own health maintenance. You have been paying for insurance and into Medicare your whole life. Less is never more in cancer care. Always be your own advocate.
PS: Can you tell my hair is on fire??!