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Posted by: Greg Lance-Watkins

DoB: 26-Jan-1946
Chepstow, NP16 7LR, Monmouthshire, United Kingdoms.

tel: 01594 - 528 337

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com

All ideas and info. provided here are to be discussed with your medical professionals. I am NOT Medically trained. I have merely had this vile disease since 1998 - always use your Common Sense and seek expert medical advice.
YOU MAY FIND THE LINKS in text and in the Right Sidebar of Help.
I can NOT vouch for any external site that I may direct readers to & therefore can NOT accept any legal responsibility - this is a personal blog of that which I believe only.
I do NOT believe there are magical cures hidden from us by our medical professionals though there are without doubt cases that seem cured as if by magic. Medical knowledge of this disease is very rudimentary and research frequently profligate but pointless!
However - sticking goji berries in your ear on a moonless night or similar WILL NOT HELP - Nor will the price paid for quackery be it here OR Mexico, Brazil or China!
There are many health care professionals trying their very best with great care and compassion but perfection is a little way off!
Be Minded:
I have cancer - cancer does not have me!

"Cowards die many times before their deaths; The valiant never taste of death but once.
Of all the wonders that I yet have heard, it seems to me most strange that men should fear;
Seeing that death, a necessary end, will come when it will come". - (Julius Caesar - Act II, Scene II).

Friday, 9 December 2011

Dr. LESTER & MY FIRST full CONSULTATION WITH results!

09-Dec-2011 - Dr. LESTER & MY FIRST full CONSULTATION WITH results!
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Hi,

well it was CT Scan on Wednesday and true to form Velindre does us proud by avoiding a long period of 'Super Scanziety' and it is straight in to see Jason Lester my oncology consultant who has planned and orchestrated my treatment since my cancer moved up a grade from the care of 'urology' specialists at The Royal Gwent in Newport.

It became obvious a year ago that I was moving up a pay grade!

My op on New Years Eve showed that I was in trouble! Then eventually the NHS managed to get their act together and organise a CT Scan - due to the utter incompetence of NHS Wales the scan I should have had in January eventually delivered a result in April! This delay due to NHS Wales mismanagement see CLICK HERE - the outright theft of NHS money to fund NHS Wales vanity projects is a disgrace! How many people have died so that Welsh politicians could rebrand to suit their politics!!!!!!!!!!

I met Jason Lester in April and from his comments it was clear that my prognosis was NOT good and my life expectancy ran to just a couple of months!

My thanks to Dr. Lester and all those caring people on his team and lets not forget the front line staff at the Gwent who have provided the treatment and care that has kept me alive for the last 13 years of cancer!

Dr. Lester's clinic was running spot on and at 14:00hrs. my 'Super Scanziety' ended with an early Christmas present!

My Flexi at the Gwent had been really good with no signs of tumour and even scar tissue was hard to find but surprisingly the CT Scan was also excellent - No sign of any additional tumours with at least a 50% shrinkage of the original tumours in the abdomen and lymph system - thatn is not to say the cancer is gone but it is probably clear with the original tumours either dormant or just scar tissue.

So now with the cancer seemingly gone it is now a watching brief for the future.

I can but hope that after 13 years under cancer's sword of Damaclese with both short and long term scares!
there will at last be a period of respite!

My thanks to all who have done so much to help and encourage me, support and help during these 13 rather difficult years - Thank you but let us not forget the many who have not been so fortunate and on that note please spend a moment thinking of those you have known, cared for or loved who lost their private war with cancer during those 13 years - not least in my life have been John, my Father, Jean, my Father's younger brother Alan, Peter, Dave and so very many more!

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I Have Been Fighting Cancer since 1997 & I'M STILL HERE!

I Have Cancer, Cancer Does NOT Have Me

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar.

You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins

tel: 01594 - 528 337

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com
TWITTER: Greg_LW
Health/Cancer Blog: http://GregLW.blogspot.com

Wednesday, 7 December 2011

CT Scan - The FIRST since Chemo & Radiation!

07-Dec-2011 - CT Scan - The FIRST since Chemo & Radiation!
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Hi,

This was my first full CT Scan since the joys of Chemo & Radio Therapy earlier in the year!

Scans come with their own mix of anticipation and dread! I dubbed it 'Scanziety' some 12 or 13 years ago when I first started down this cancer route!

Of course you want the scan but naturally one fears bad news and there is a constant feeling that perhaps ignorance is bliss - though to be honest I find underastanding EXACTLY where I stand and the depth of the ordure gives me an understanding of just how grim is the battle ahead at this stage and thus I 'feel' I have a greater ability to deal with it!

Although I was due at 14:30hrs. at Velindre for my appointment I arrived at 13:35hrs. as I thought I might be down for 'bloods' as well and hoped to do that first as there is quite a bit going on at home. Seems they don't want my blood this time! So I sauntered around to Radiology to check in before going for a coffee in the canteen.

Good news 'can I do you now sir?' and I was in and changed into one of those idiotic gowns in minutes - drink another pint of water quick stab to put a cannella in and then a top up of iodine to improve disclosure on the scan.

10 minutes later and I'm free to go and it isn't quite 14:00hrs!

Now for 'Super Scanziety as we wait for the results on Friday!

Fingers crossed!

Please Be Sure To

Tweet My Blogs

To Spread The Facts World Wide To Give Others HOPE

I Have Been Fighting Cancer since 1997 & I'M STILL HERE!

I Have Cancer, Cancer Does NOT Have Me

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

. If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar.

You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way. .

Posted by: Greg Lance-Watkins

tel: 01594 - 528 337

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com
TWITTER: Greg_LW
Health/Cancer Blog: http://GregLW.blogspot.com

Friday, 18 November 2011

AVASTIN withdrawn by FDA in Breast Cancer Treatment

AVASTIN withdrawn by FDA in Breast Cancer Treatment
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Breaking News Alert
The New York Times
Friday, November 18, 2011 -- 10:46 AM EST
-----

F.D.A. Revokes Approval of Avastin as Breast Cancer Drug

The Food and Drug Administration announced Friday that it was revoking its approval of the drug Avastin for breast cancer after concluding that it “has not been shown to be safe and effective for that use.”

Avastin, made by the pharmaceutical company Roche, will remain an approved treatment for certain types of colon, lung, kidney and brain cancer, the F.D.A. commissioner, Margaret A. Hamburg, announced.

Some women who say the drug has been keeping them alive had pleaded desperately for the approval to be retained.

Read More:
http://www.nytimes.com/?emc=na

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To Spread The Facts World Wide To Give Others HOPE

I Have Been Fighting Cancer since 1997 & I'M STILL HERE!

I Have Cancer, Cancer Does NOT Have Me

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

Posted by: Greg Lance-Watkins

tel: 01594 - 528 337

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com
TWITTER: Greg_LW
Health/Cancer Blog: http://GregLW.blogspot.com

Tuesday, 8 November 2011

NEVER Ignore SYMPTOMS They are an early warning system!

NEVER Ignore SYMPTOMS They are an early warning system!
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'GP missed cancer 8 times'

Tragic ... Nikki Sams

EMMA MORTON
Health Editor

Published: 19 Oct 2009

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A DOCTOR failed to spot a woman's cervical cancer EIGHT TIMES and dismissed her symptoms as "nothing serious", a GMC hearing heard today.

Tragic Nikki Sams, 26, died after the cancer spread into her lungs, spine and neck despite repeated complaints to her doctor of irregular bleeding and abdominal pain.
Dr Navin Shankar, 59, ignored her request for hospital checks and never performed an internal examination at his surgery in Luton, Beds.
The blunder only emerged when Nikki was transferred to another GP practice after Dr Shankar was suspended for a separate case of serious misconduct involving a nine-day-old baby.

Dr Shankar ... arrives at hearing
Her new doctor immediately recommended a smear test which revealed abnormal cells, and further examinations at Luton and Dunstable hospital found a tumour on her cervix.
She had a hysterectomy the following week and began radiotherapy, chemotherapy treatment but died a year later.
The General Medical Council (GMC) upheld a number of complaints against Dr Shankar relating to misconduct in Nikki's case at a hearing last week.
Devastated father Michael Sams, 54, who gave up his job at Luton airport to care for his daughter, said a "catalogue of unforgivable errors" cost Nikki her life.
He said: "Nikki was so brave, she never complained or said 'Why me?' but she died unnecessarily.
"It is unbelievable that in this day and age a girl can go to her doctor so many times complaining about all these symptoms and be sent away and told not to worry."
Michael told how Nikki went through "the worst pain of her life" as she underwent treatment at the Mount Vernon Hospital Cancer Centre in Northwood, Middlesex.
After six months she was given the all-clear and returned to work but during hospital treatment following a car accident it was discovered that her cancer had returned.
A series of x-rays showed the disease had spread into her spine, neck and lungs and Nikki was given six months to two years to live.
She died at home a month after being diagnosed with secondary cancer in August 2007.
Dr Navin Shankar had treated the advertising saleswoman from Luton, Beds., between 1999 and 2005 at the Wigmore Lane Health Centre.
He appeared before the General Medical Council (GMC) last week to assess his fitness to practice and determine whether sanctions should be taken against him.

Complaints

The case has been adjourned for a performance assessment to be carried out but the GMC has already "proven" a number of the complaints against the doctor.
The GMC found she had made direct requests to Dr Shankar and a number of other unrecorded complaints about inter-menstrual bleeding in the same period.
But he failed to keep adequate records of her symptoms.
Nikki even made a request for referral to Luton & Dunstable Hospital, but at no stage did Dr Shankar perform an abdominal or internal examination or send her to hospital.
Mr Sams added: "The hysterectomy was such a blow for Nikki because she was so young and desperately wanted a family, but that was just the start of the nightmare.
"I never told her she was terminal because I didn't want to give up hope or frighten her - but it was a terrible burden to carry. I spent most of my time away from her in tears.
"I brought up Nikki as a single parent and we were so close, we were more like friends than father and daughter.

In September 2005 the GMC found Dr Shankar guilty of serious professional misconduct after he dismissed the case of a baby with a blocked artery and then forged his notes on the examination.
Nine-day-old Daniel Miller, whose leg had turned dark blue, had a life threatening blood clot and his toes were becoming gangrenous, but Dr Shankar had said his nappy was too tight.
He was suspended for six months, and after a failed appeal in March 2007 received a further nine month ban.
However, in January 2008 the GMC allowed him to return to unrestricted practice.
The GMC panel ruled that cancer victim Nikki Sams had complained to GP Dr Navin Shankar eight times before she was diagnosed with cancer.
Dr Shankar received repeated complaints of inter-menstrual bleeding, post-coital bleeding and abdominal and back pain between 30 November 1999 and 12 July 2004.
But he did not refer Nikki to hospital for further investigation despite her asking for this, or perform an abdominal or internal examination himself.
Dr Shankar, who qualified from Patna Medical College in India in 1971, has practised in Luton, Beds., for over 30 years.
His case had been adjourned while a performance assessment is be carried out to determine his fitness to practise.
The hearing will reconvene at a date to be fixed to determine whether sanctions should be taken against him.
If his fitness to practise is deemed to be impaired, Dr Shankar could receive a warning, have conditions placed on his registration, be suspended or struck off.

To view the original article CLICK HERE
.

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I Have Been Fighting Cancer since 1997 & I'M STILL HERE!

I Have Cancer, Cancer Does NOT Have Me

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar.

You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help. . YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins

tel: 01594 - 528 337

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com
TWITTER: Greg_LW
Health/Cancer Blog: http://GregLW.blogspot.com

Monday, 31 October 2011

& My Flexi Result!

& My Flexi Result!
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Hi,

so today, as ever with some trepidation it was off to The Royal Gwent for a Flexible Cystoscopy - this time was in the urology center where they have larger and clearer HD VDU screens.

The increased high definition showed up many of the scars from previous resections and clearly showed the resection of New Year's Eve, once the position of the ureter stump was found (stump of course as mine was removed when I had my left kidney removed in 2001).

The site of that resection, which had started out as a T3, was looking very healthy and similar to the surrounding wall of the bladder, which was very reassuring.

To enlarge the pic. double click it

I'm not sure who was most surprised at just how clear my bladder was so scarring not withstanding it was an all clear.

I do have a feeling that if I entered the middle lobe of my prostate in a competition it might just win at least a placing that size! However as yet it is no serious problem and with all the future flexis the opportunity is there to check it every 6 months or so.

Then a visit to the urology unit where I have now been a patiet for 13 years!!!! Many changes of staff as a number of the original staff have now retired but the genuine interest and humour of those who have watched my progress and helped to keep me alive is a huge encouragement when you consider around 6,500 people a year are diagnosed with Kidney Cancer with a morbidity rate of around 5,000+ within the 5 years that classify as cured if you can last past the 5 years!

Bladder Cancer is also more prevalent than many believe with over 10,000 diagnosed a year in Britain:

Standardised (AS) Incidence Rates per 100,000 Population, UK, 2008

		England	Wales	Scotland	Northern Ireland	United Kingdom
Male	Cases	6,322	432	487	149	7,390
	Crude Rate	25.0	29.6	19.5	17.1	24.5
	AS Rate	19.1	20.3	14.8	15.6	18.8
	AS Rate - 95% LCL*	18.7	18.4	13.5	13.1	18.3
	AS Rate - 95% UCL*	19.6	22.2	16.2	18.1	19.2
Female	Cases	2,469	152	265	59	2,945
	Crude Rate	9.4	9.9	9.9	6.5	9.4
	AS Rate	5.6	5.6	5.7	4.6	5.6
	AS Rate - 95% LCL*	5.4	4.7	5.0	3.4	5.4
	AS Rate - 95% UCL*	5.8	6.5	6.3	5.8	5.8
Persons	Cases	8,791	584	752	208	10,335
	Crude Rate	17.1	19.5	14.5	11.7	16.8
	AS Rate	11.6	12.1	9.6	9.3	11.4
	AS Rate - 95% LCL*	11.4	11.1	8.9	8.1	11.2
	AS Rate - 95% UCL*	11.8	13.1	10.3	10.6	11.6

.
The Morbidity Rate is not as encouraging as one might wish!

The number of bladder cancer deaths and mortality rates for the constituent countries in the UK are shown.

So I guess on this alone my survival is unusual and then considering the TCC Tumours in the abdomen and the cancerous Lymph Node(s) the stats have been against me with chemo and Radio Therapy - I have been incredibly fortunate!

Consider Steve Povey who I knew of and had spoken to a couple of times - at 53 he was diagnosed with lung cancer in August and died last weekend CLICK HERE

I also note that Robin Page, a friend of mine with prostate cancer who you may know from his days on 'One Man & His Dog', his oncologist who is in her 40s ignored a pain in her lower back and is now facing serious spread opf cancer which is now being treated but with a poor prognosis I understand.

We all know all too many who are facing the challenges of cancer and I hope they will find they have the good fortune I have had and the team that has supported my fight against this pernicious collection of diseases!

Good Luck - At the moment I seem to be clear and long may it last :-)

ANYONE wanting help or a chat - an amateur view from someone who has been there, got the TShirt and been subject of the video do feel free to contact me if you feel I might be able to informally help!
.

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I Have Been Fighting Cancer since 1997 & I'M STILL HERE!

I Have Cancer, Cancer Does NOT Have Me

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar. You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way. .

Posted by: Greg Lance-Watkins

tel: 01291 - 62 65 62

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com
TWITTER: Greg_LW
Health/Cancer Blog: http://GregLW.blogspot.com

Friday, 28 October 2011

& My Blood Results Are ;-)

& My Blood Results Are ;-)
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Hi,

Jason Lester said he would contact me immediately if there was any problem with my full set of bloods he had taken on 14-Oct-2011 but it was good to receive confirmation today that my bloods were OK..

So the next step is a Flexi on Monday at the Royal Gwent.

Thanks to all for the huge amount of support for Lee and I
.

Please Be Sure To

Tweet My Blogs

To Spread The Facts World Wide To Give Others HOPE

I Have Been Fighting Cancer since 1997 & I'M STILL HERE!

I Have Cancer, Cancer Does NOT Have Me

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar. You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins

tel: 01291 - 62 65 62

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com
TWITTER: Greg_LW
Health/Cancer Blog: http://GregLW.blogspot.com

Friday, 14 October 2011

14-Oct-2011 - appt.: Dr. Lester re.: Treatment Outcomes

14-Oct-2011 - appt.: Dr. Lester re.: Treatment Outcomes

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Hi,

this being the first serious roundup of the outcome of my chemo & radio therapy - neither of which come with much of a track record of certainty - I would be a fool to try to claim I was unconcerned!

I have had a bit of ongoing discomfort which has proved worrying - well worrying for me! A chat with my St. David's Nurse Nairn (Sort of Macmillan Nursing for Monmouthshire and a bit of Wales where they also run charity shops to fund hospice care etc.) Anyway Nairn was right I think, when she said it was most likely to be part of the aftermath of the treatment and if it was more challenging (mets. or tumour growth) by now it would be more vigerous and likely to have more notable symptoms 'take some CoCodomol and see if that helps' - so I didn't bother.

One aspect of the main wound hernia and the absolute lack of stomach muscles of any use is that it has led to standard male patern groin hernia which is not of help! In fact standing still or lifting becomes very uncomfortable and I have definitely been doing too much lifting recently!

Anyway, the day for clinic caught up with me faster than I had expected!

Jason Lester was running almost on time and he was VERY reassuring as he felt I had fared very well and better than he had expected 'without so much as having the good grace to be ill'!

Lester feels there is every reason to be optimistic indicating that had the cancer not been destroyed at this stage there was every reason that I would be expected to be considerably more unwell and even not have made it this far!

Lester wants to seem me again just before Christmas as he intends to keep a close eye for the future - probably an element of astonishment and many might think in masochism!!!

So the plan is a Flexi at The Royal Gwent and a CT scan Velindre before seeing Jason Lester for the next check-up.

One thing that he felt of paerticular value was a meeting with his Radiology Consultant and they studied the MRI scan I had had. There is no doubt that I have degenerative spinal damage but that my spine shows no sign of any cancerous invasion or damage.

A spin off of the MRI scan was, apparently, that it showed up the lymph system and there is no visibl;e evidence of the cancer in the lymph glands and since it was in one of the glands in April there was every possibility of spread.

I guess I got lucky with a great deal of help from Julian Lester and his team at Velindre!!

Yes of course the cancer is likely to return but time is of value!

Especially after 13 years and so many rounds in this challenge - There are a lot of people who need to see a future and 13 years looks like a lifetime when first diagnosed the longer I can set an example the better the LIFEline for all.

So off to have a full set of bloods done before heading home to give Lee the good news.

Please Be Sure To

Tweet My Blogs

To Spread The Facts World Wide To Give Others HOPE

I Have Been Fighting Cancer since 1997 & I'M STILL HERE!

I Have Cancer, Cancer Does NOT Have Me

I just want to say sorry for copping out at times and leaving Lee and friends to cope!

Any help and support YOU can give her will be hugely welcome.

I do make a lousy patient!

.
If YOU want to follow my fight against Cancer from when it started and I first presented with symptoms see The TAB just below the Header of this Blog. called >DIARY of Cancer< just click and it will give you a long list of the main events in chronological order.
.
Thoughts and comments will be in chronological order in the main blog and can be tracked in the >ARCHIVE< in the Right Sidebar. You may find the TABS >MEDICAL LINKS< and also >CANCER LINKS< of help.
.
YOU are welcome to call me if you believe I can help in ANY way.
.

Posted by: Greg Lance-Watkins

tel: 01291 - 62 65 62

of: Greg_L-W@BTconnect.com

on: http://GregLanceWatkins.Blogspot.com
TWITTER: Greg_LW Health/Cancer
Blog: http://GregLW.blogspot.com

Wednesday, 5 October 2011

PROSTATE CANCER - Can Cancer Ever Be Ignored?

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Can Cancer Ever Be Ignored?

By SHANNON BROWNLEE and JEANNE LENZER
Published: October 5, 2011
As chief medical and scientific officer of the American Cancer Society, Otis Webb Brawley — who is also a professor of oncology and epidemiology at Emory University — is the public face of the cancer establishment. He operates in a world of similarly high-achieving, multiple-credentialed, respectable professionals, where insults tend to be delivered, stiletto-style, in scientific language that lay people aren’t meant to understand. So it can be more than a little jarring to hear, for example, James Mohler, chairman of the urology department and associate director of the Roswell Park Cancer Institute in Buffalo, say of his friend: “I have known Otis for over 20 years. He doesn’t come off as being ignorant or stupid, but when it comes to prostate-cancer screening, he must not be as intelligent as he seems.” Or Skip Lockwood, the head of Zero, a prostate-cancer patient advocacy group, charge that Brawley is more concerned about saving men’s sex lives than about saving the men themselves.

David Walter Banks/Luceo
Dr. Otis Brawley has been an outspoken skeptic of routine P.S.A. testing.

Brawley has become the target of these attacks because of his blunt and very public skepticism about the routine use of the prostate-specific antigen, or P.S.A., test to screen men for early prostate cancer. “I’m not against prostate-cancer screening,” Brawley says. “I’m against lying to men. I’m against exaggerating the evidence to get men to get screened. We should tell people what we know, what we don’t know and what we simply believe.”

The P.S.A. test, which was approved by the U.S. Food and Drug Administration in 1986, has become an annual ritual for millions of middle-aged men who assume that finding prostate cancer early will prevent death. By 2008, nearly half of men over 50 reported that they were screened in the previous 12 months. Despite the seeming logic of the P.S.A. test, the evidence that it saves lives is far from conclusive, and Brawley is not the only one questioning it. A growing cadre of doctors, epidemiologists, patients and cancer biologists are rethinking its value. And the most recent studies, while not ending the debate, indicate that routine P.S.A. testing appears not to reduce the number of deaths, and if it does, the benefit is exceedingly modest.

Patients and their doctors are now faced with radically polarized views about the logic of routine testing. On one side are physicians like Mohler, who argue that the test can reduce a man’s chances of dying of prostate cancer, plain and simple. This side of the debate is passionate, backed by the persuasive conviction of men who have survived prostate cancer and well financed by the multibillion-dollar industry that has grown up around the testing and treatment of the disease.

The other camp makes a less emotionally satisfying argument: on balance, scientific studies do not support the claim that screening healthy men saves lives. Screening, Brawley and others argue, can lead healthy men into a cascade of further testing and treatments that end up injuring or even killing them. As Richard Ablin, who discovered a prostate-specific antigen, put it in an Op-Ed in The New York Times, using the P.S.A. test to screen for cancer has been “a public health disaster.”

So what should a man do when his doctor suggests a routine P.S.A. test? The U.S. Preventive Services Task Force, a panel of independent experts that evaluates the latest scientific evidence on preventive tests and treatments, is charged with making recommendations in just such situations. It already recommends against routine screening for men over 75. According to an internal document, in 2009 the task force conducted an in-depth analysis of data and seemed poised to give routine P.S.A. testing a “D” rating — “D” as in don’t do it — for any man of any age. But this was around the time that the task force stated that routine mammography for women ages 40 to 50 was not necessary for every woman.

That recommendation caused a public uproar, and Ned Calonge, the task-force chairman at the time, sent the P.S.A. recommendation back for review. One year later, in November 2010, just before midterm elections, the task force was again set to review its recommendation when Calonge canceled the meeting. He says that word leaked out that if the November meeting was held, it could jeopardize the task force’s financing. Kenneth Lin, the researcher who led the review, quit his job in protest, and now, nearly two years after its initial finding, it remains uncertain when the task force will release its rating for P.S.A. screening.

Cancer screening is a growing field; existing tests are becoming more sensitive, and new tests are constantly developed. We now have CT scanning for lung cancer, and there is also a blood test marketed by Johnson & Johnson known as a “liquid biopsy,” which searches for stray cancer cells in the bloodstream. More testing inevitably brings more treatment, because the urge to correct every cellular anomaly, no matter how small or potentially harmless, is practically irresistible. But if there is one lesson from the P.S.A. test, it is that more information and intervention do not always lead to less suffering.

The popularity of the P.S.A. test as the main weapon against prostate cancer is due in large measure to the earnest and passionate advocacy of William Catalona, a urologist from Northwestern University Feinberg School of Medicine. During his residency training at Johns Hopkins Hospital in the mid-1970s, Catalona set up a clinic for late-stage prostate-cancer patients. Back then, the only tool for finding prostate cancer was a digital rectal exam — actually feeling the prostate through the rectal wall. By the time many tumors could be detected, the cancer was already advanced, and removing the prostate surgically did not offer a reliable cure.

Catalona grew close to many of the men he treated, as well as to their families. “Prostate cancer is a terrible death,” he said. “They developed bone fractures, they had a lot of pain, they lost weight. They required heavy doses of narcotics.”

Catalona wanted to catch these cancers early, when they might be curable. He noticed that men with more advanced cancers at the time of surgery tended to have the highest P.S.A. levels. Could there be a bright line, a “safe” level of P.S.A. that could distinguish healthy men from those with prostate cancer? After reviewing his own patient records, he decided the cutoff level should be 4 nanograms of P.S.A. per milliliter of blood. He followed up with a study of 1,653 patients. The results, published in 1991 in The New England Journal of Medicine, showed that P.S.A. testing could detect prostate cancer several years earlier than a digital rectal exam.

The test quickly gained powerful support: Gerald Murphy, who held the position at the American Cancer Society now held by Brawley, pushed the society to endorse the test. In 1996, Gen. H. Norman Schwarzkopf, a prostate-cancer survivor, appeared on the cover of Time magazine over the statement “There’s a simple blood test everyone should know about.”

By then, doctors were using the test for routine screening. “P.S.A. testing was so easy,” says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute (full disclosure: one author of this article is an instructor at Dartmouth). Doctors were predisposed to use the test for several reasons. First and foremost, there was the perception that early detection could save lives. It was also easy to administer. “It was a blood test,” Welch says. “You didn’t need equipment. . . . You didn’t need to put any scopes up any part of the body. Heck, you didn’t even need to ask the patient if he wanted it; you could just check off the box on a list of tests, like cholesterol, when you did a blood draw.” Today it’s common for doctors to order the P.S.A. test and patients to take it without talking about what it might really mean.

At one time, Otis Brawley, too, assumed that routine screening was the best medical practice. Sitting in his living room in an Atlanta suburb, Brawley recounted his transformation from believer to skeptic.

In 1988, after medical school at the University of Chicago, Brawley landed a prestigious fellowship at the National Cancer Institute in Bethesda, Md. There he came under the tutelage of Barnett Kramer, an oncologist and epidemiologist who went on to become the associate director of the institute’s early detection and community oncology program. Kramer walked Brawley through a short history of screening, beginning with the Pap smear, which has been an unqualified success, significantly cutting cervical-cancer deaths.

But other cancer screening tests had not worked out so well. For example, researchers at the Mayo Lung Project conducted a study between 1971 and 1983 to determine whether frequent chest X-rays could help reduce deaths from lung cancer. Chest X-rays detected lots of suspicious spots and shadows on the lungs and probably led to some cures of early lung cancers, but the study ultimately found no difference in death rates between the patients who were screened and those who were not.

Kramer suggested one probable explanation: diagnosing the spots picked up by X-ray often requires surgery, which carries a small but definite risk. Brawley knew that many spots seen on X-rays are simply old scars or minor abnormalities commonly seen in healthy people. With so many innocent blips detected, complications from lung biopsies and other invasive tests, along with treatment complications, could kill enough patients to negate any benefit from early detection.

Prostate cancer is the second-leading cause of cancer death among men, after lung cancer. In 2009, it was diagnosed in approximately 192,000 men. A small number of tumors are very aggressive, but the majority of prostate tumors are not likely to cause death. They grow very slowly, and only a fraction break out of the prostate, seed new tumors in other parts of the body and kill the patient. The current thinking is that about 30 percent of men in their 40s have prostate cancer, 40 percent of men in their 50s and so on, right up to 70 percent of men in their 80s. Yet only 3 percent of all men die from the disease. In other words, far more men die with prostate cancer than from it, and only a tiny fraction of prostate cancers ever cause symptoms, much less death.

But here is the tricky part: Unless there are symptoms or a finding on a physical exam, doctors generally cannot accurately predict which cancers are destined to be indolent, to sit around for years growing slowly, if at all, and those that will ultimately prove lethal.

In his discussions with Kramer, Brawley saw that these two pieces of information — the fact that a certain number of prostate cancers will never cause harm, and that doctors can’t reliably predict which cancers will be dangerous — had powerful and potentially devastating consequences for men. The first implication was that using the P.S.A. test to screen men who had no symptoms would uncover a huge reservoir of indolent cancers. Most of those cancers that men previously died with — and not from — would now theoretically be detectable. And once detected, the majority of those cancers would be treated.

The most frequent treatment then, as it is now, was the surgical removal of the entire prostate gland. The prostate sits at the base of the penis, wrapped around the urethra, which is the tube that carries urine and semen out of the penis. Trying to separate gland from urethra is a difficult job, and even the best of surgeons can damage the urethra or the bundle of nerves that initiate erections. About half of men who undergo radiation or surgery will have permanent side effects like impotence and incontinence. Up to 1 in 200 men die within 30 days from complications related to the surgery.

“You didn’t have to be brilliant to see that history was repeating itself,” Brawley says. “Doctors were just substituting a blood test for chest X-rays.”

Tim Glynn, a self-described country lawyer from Setauket, N.Y., was 47 in 1997 when he went to his primary-care doctor, troubled by a vague feeling of being down. After his physical exam, Glynn was sent to have his blood drawn. Along with thyroid and cholesterol levels, the doctor ordered a P.S.A. test. A week later, Glynn returned to hear the results. His P.S.A. was elevated. He was told to get a biopsy as soon as possible.
After the biopsy, he walked into a bar in the middle of the afternoon and ordered a martini. A few weeks later, Glynn’s urologist told him the biopsy showed prostate cancer and recommended that he have his prostate removed immediately. Glynn chose to do some homework first.

One of Glynn’s clients happened to be Richard Ablin, the scientist. Ablin told him that not all prostate cancers are alike, and that he could wait; if he developed symptoms, or if his P.S.A. shot up, he could always opt to be treated at that time. (Some doctors recommend “active surveillance,” in which the patient is periodically given P.S.A. testing and biopsies, rather than immediate treatment.) Glynn chose to hold off on surgery.

Kerri Glynn, Tim’s wife of now 39 years, was terrified by her husband’s decision. “I felt as if an ax had fallen,” she says. In her mind it was better to be safe than sorry, and safe meant being treated immediately. “She was a wreck,” Glynn says. “She was scared witless.”

His colleagues were also worried about his decision to forgo treatment. “My business partner was clearly very anxious, and my assistant asked if she should look for a new job,” Glynn recalls. “And there was the fear that if this became public knowledge, there would be clients who wouldn’t want to deal with us because they wouldn’t want to engage a lawyer who was going to be dead the next day. When you see the people around you falling apart, you sort of have to get treated for them, so you can go back to a normal life.”

For many people, not being treated after a diagnosis of cancer is psychologically unbearable. Our view of cancer, says Barnett Kramer, is still shaped by the fact that until relatively recently, cancers were only discovered when they were causing symptoms. Before current treatments were available, such cancers were often fatal. We can now screen for cancers long before they become symptomatic, but it’s still very difficult to imagine that they can safely be left untreated. Brawley says, “I have had patients say, ‘Damn it, I’m an American — you can’t tell me I have cancer and we’re going to watch — you have to treat it.’ ”

Glynn had the surgery. Fourteen years later, he still takes drugs for impotence. It would be more than a year following surgery before he had the energy to play a set of tennis again. “The toll that this took on energy and physicality was like being aged five years,” he says.

One way to look at Glynn’s story is as a success. His cancer was removed. His impotence is being managed. But Glynn sees it differently, and so do many other men who have been treated for prostate cancer. Darryl Mitteldorf is the executive director of Malecare, a cancer-patient support group. He says it is not uncommon for men to regret their decision to be tested and treated for prostate cancer. “We have men come in very upset, week after week, telling us what they’re not telling their doctors,” he says. One-third of men who are given a P.S.A. test were never asked if they wanted it. Of men who are asked, more than half say their doctor failed to mention possible side effects that result from treatment.

Brawley tells the story of a patient who had surgery and then underwent radiation, which left him with severe damage to both his rectum and ureter. “He had every side effect known to man,” Brawley says. “He had a bag for urine, a bag for stool, he was a terrible mess, in and out of the hospital with infections.” The man died six years after his surgery, from an overwhelming infection. Yet cancer statistics would list such a man as a success story, Brawley says, “because he survived past the five-year mark.” Would an untreated prostate cancer have killed him within six years, too? There is simply no way to know.

Many doctors suggest that African-American men and those with a family history should be tested as early as age 40, because they are at increased risk of dying of prostate cancer. But Brawley, who is African-American and has declined P.S.A. screening himself, says this recommendation is based on conjecture, and even for men at higher risk, the test may cause more harm than good. Until the proper studies are done, he asserts, “We just don’t know.”

The dueling narratives of P.S.A. testing boil down to the way each side frames the potential for harm from the disease compared with the collateral damage from the test and subsequent treatment. Mohler says, “P.S.A., when used intelligently to detect prostate cancer early in men after proper education . . . performs pretty well; it actually performs better than a mammogram.” P.S.A. advocates are concerned that statistics play down the value of each life saved. Some also argue that the statistics will validate their view as men are followed beyond 14 years. More important, they worry that if men reject screening, malignant cancers will go undiagnosed.

David Newman, a director of clinical research at Mount Sinai School of Medicine in Manhattan, looks at it differently and offers a metaphor to illustrate the conundrum posed by P.S.A. screening.

“Imagine you are one of 100 men in a room,” he says. “Seventeen of you will be diagnosed with prostate cancer, and three are destined to die from it. But nobody knows which ones.” Now imagine there is a man wearing a white coat on the other side of the door. In his hand are 17 pills, one of which will save the life of one of the men with prostate cancer. “You’d probably want to invite him into the room to deliver the pill, wouldn’t you?” Newman says.

Statistics for the effects of P.S.A. testing are often represented this way — only in terms of possible benefit. But Newman says that to completely convey the P.S.A. screening story, you have to extend the metaphor. After handing out the pills, the man in the white coat randomly shoots one of the 17 men dead. Then he shoots 10 more in the groin, leaving them impotent or incontinent.

Newman pauses. “Now would you open that door?” He argues that the only way to measure any screening test or treatment accurately is to examine overall mortality. That means researchers must look not just at the number of deaths from the disease but also at the number of deaths caused by treatment.

Many experts agree with Newman, and two large studies of P.S.A. screening, published in The New England Journal of Medicine in 2009, came to the same conclusion: There was no difference between the screened and unscreened groups in overall deaths. One trial, conducted in the United States, showed no reduction in prostate-cancer deaths over a period of up to 10 years when men 55 and older were screened. The other, which was carried out in several European countries, showed that screening reduced mortality from prostate cancer by 20 percent, yet the overall number of deaths in each group was the same. Newman gives one possible reason for this: the benefit of early diagnosis could be offset by complications from diagnostic tests and subsequent treatment.

Each study has been criticized for design and execution issues that might have skewed the results, but the failure to reduce overall mortality reported in the European study is probably no fluke, Newman says. An analysis of six studies of screening involving nearly 400,000 men, published last year in the British medical journal BMJ, found no significant difference in overall mortality when screened men were compared with controls. Philipp Dahm, a professor of urology at the University of Florida College of Medicine and lead investigator for the analysis, says the study shows that P.S.A. screening “does not have a clinically important impact” on overall mortality. Or as Kramer, an author of the U.S. study, crisply puts it, “Men may be trading one cause of death for another.”

For Brawley, the greatest tragedy of P.S.A. screening is that it has been a distraction from making greater progress in reducing deaths with the one clear helpful thing: distinguishing between the prostate tumors that really need to come out and those that are better left alone. Instead, new types of P.S.A. screening are being promoted. “We live in a time when our failure to define questions properly has delayed our progress and harmed health,” he says. “We keep pursuing son of, son of P.S.A.”

As it stands, each man must decide for himself how he wants to play the odds. “Let’s put this in perspective,” says Welch, whose most recent book is “Overdiagnosed: Making People Sick in the Pursuit of Health.” “The European trial says 50 men have to be treated for a cancer that was never going to bother them to reduce one death. Fifty men. That’s huge. To me, prostate screening feels like an incredibly bad deal.”

Other men, Welch acknowledges, may arrive at a different conclusion, and he is careful to avoid pushing his own patients in one direction or the other. The answer is ultimately personal, he says, and while studies of groups of people can feel unhelpful if you could be the one in the group with cancer, that is all we have to go on.

The solution, in Welch’s view, and in that of a growing number of physicians, including Brawley, is to make sure men fully grasp the downstream decisions they may face as a result of screening — the risk of knowing too much. Studies have found that when men are given balanced information about both the cons and pros of P.S.A. testing, they are less likely to opt for screening than men who were merely offered the test. Given this, Brawley asks, how can it be ethical for a doctor not to inform men of the risks — or to fail to even tell a man that the test has been ordered? “If a man understands the risks and benefits and does not want to be screened, that decision should be supported,” he says. “But just saying that gets you in trouble.”

Shannon Brownlee (brownlee@newamerica.net) is acting director of the New America Foundation Health Policy Program and an instructor at Dartmouth Institute for Health Policy and Clinical Practice.
Jeanne Lenzer (jeanne.lenzer@gmail.com) is a freelance journalist and a frequent contributor to the British medical journal BMJ.
Editor: Vera Titunik (v.titunik-MagGroup@nytimes.com)

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