Prostrate over the Prostate
Dolors & Sense
by Sanford Rose
KISSIMMEE Florida—(Weekly Hubris)—3/5/12—Yeah, it’s scary.
The gland keeps getting bigger, from a walnut to perhaps a lemon.
What weighed 20 to 30 grams can get to upward of 50, and maybe even 100 grams.
The first stage is dubbed benign prostatic hyperplasia. By age 80, close to 90 percent of men have it.
It is annoying—e.g., polyuria and nocturia.
Especially the latter. Awakened at night with the urge, men can lose delta-wave sleep. That’s the best kind of rest. If men had 30 minutes more of delta-wave sleep each night, life would be a lot more fulfilling.
But BPH is not dangerous to life; it is, after all, benign. It doesn’t metastasize. And it is controllable pharmaceutically.
Remember, however, that every pill contains a touch of poison. So, if you can avoid pills, do so.
BPH can boost the PSA score. Prostatic specific antigen is the standard test for cancer of the prostate (together with the inevitable digital rectal exam).
It is a lousy test—very sensitive; not very specific. It produces a lot of false positives and false negatives.
The oft-mentioned rule is that if the test shows fewer than 4 nanograms of the antigen per milliliter of your blood, you don’t have cancer.
Not true. More likely, if you have fewer nanos, you’re reasonably safe but still have a 15 percent probability of being cancerous.
And since some 15 percent of prostate cancers become life threatening, that gives you about a 2.3 percent chance of expiring from the disease, which is, all things considered, also pretty good.
What counts is not necessarily the level of the antigen, but the velocity of change. If you have a score of 2.5, but 2 last year and 1.5 the year before that, worry more than if the score has remained a level 4 for all three years.
Say you have an outsize PSA and a suspicious digital exam. You’re sent for a biopsy.
The pathologist says you have cancer.
Is he right?
Here’s the disturbing truth, as publicized by Gilbert Welch.
Whether you are told you have or have not cancer depends on who your pathologist is.
Seven expert pathologists were shown 25 specimens. On about half these specimens, the experts could not agree on whether there was cancer. The votes were six yes to one no on three specimens, five to two on another, four to three on still another, three to four on two others, two to five on one, and one to six on three more.
Either these experts had different standards of what constitutes cancer or, more prosaically, even the experts make lots of mistakes when analyzing prostate tissue.
How to avoid being bowled over by prostate excrescences and frightening test results?
There are no ways of avoiding the former, but, yes, exercise diminishes the prospect of receiving the latter.
Add prostate cancer cells to the blood of both sedentary and well-exercised folks: the cells will grow much less rapidly in the blood of the exercised than they will in the blood of the idle.
But you knew that. Right?
Sanford Rose
Sanford Rose, of New Jersey and Florida, served as Associate Editor of Fortune Magazine from 1968 till 1972; Vice President of Chase Manhattan Bank in 1972; Senior Editor of Fortune between 1972 and 1979; and Associate Editor, Financial Editor and Senior Columnist of American Banker newspaper between 1979 and 1991. From 1991 till 2001, Rose worked as a consultant in the banking industry and a professional ghost writer in the field of finance. He has also taught as an adjunct professor of banking at Columbia University and an adjunct instructor of economics at New York University. He states that he left gainful employment in 2001 to concentrate on gain-less investing. (A lifelong photo-phobe, Rose also claims that the head shot accompanying his Weekly Hubris columns is not his own, but belongs, instead, to a skilled woodworker residing in South Carolina.)