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This is great progress. Important to note this is not an average effect across all cancers. Some cancers still have terrible outcomes eg pancreatic cancer, GBM

• kodah 4y ago
  Prostate cancer is one that men should be especially familiar with. My dad was diagnosed years ago after his PCP ignored escalating PSA levels. Although he's a "survivor" of Stage 4 his life is a shell of what it was, and has expressed a number of times he wishes he was dead. When I spoke to the oncologist after his diagnosis I remember this adage specifically: "If you did an autopsy on every man that dies over 40, you'd find the beginnings of prostate cancer in all of them. It's a question of when, not if." I say this to highlight three things: - Physicians routinely ignore things they shouldn't. Be your own advocate and research the things your doctor tells you, especially the things they believe are just worth watching. - There is little to no awareness in the public over prostate cancer. - Surviving isn't always a good metric. In my dad's case, surviving was a promise for a slow and miserable death.
  • omniglottal 4y ago
    Knowing something must be checked, while your primary refuses to check it, what is one's recourse in the US?
    • nequo 4y ago
      I've never met a doctor who refused to check something if I asked for it. If yours does, can you switch?
    • dylan604 4y ago
      Typically, for HMOs, it's getting your doctor to recommend a specialist.
    • mythhouse 4y ago
      you mean the cases where a layman thinks he knows more than a trained professional ?
    • runnerup 4y ago
      https://www.privatemdlabs.com/lab_tests.php?view=all https://www.privatemdlabs.com/lab_tests.php?view=all https://www.discountedlabs.com/choose-a-test https://www.discountedlabs.com/choose-a-test Or use your insurance's telemedicine portal to get a random doctor on the line and get them to order the tests. For many people this will be out of reach but for those earning a comfortable salary, you can pay out of pocket for X-ray, CT, MRI, etc and they're "only" like $500-2,000.
      • JeanPierreK 4y ago
        Thanks for the mention runnerup. Indeed we are the easiest place to get your levels checked in-depth, hassle free. I'm the ceo over at https://www.PrivateMdLabs.com https://www.PrivateMdLabs.com, plz email me to j@privatemdlabs dot com so I can give you a token of appreciation and discount for your next tests.
  • grandiego 4y ago
    > Be your own advocate and research the things your doctor tells you I share your concern but I think there is no definitive advise about how to prevent these horrible outcomes (besides the usual "do regular exercise", "lower sugar consumption", "avoid stress", etc.) Did you find anything more concrete?
    • zamadatix 4y ago
      Generally it's about catching issues early as possible not necessarily preventing the issue from occurring. If you wait until you're experiencing impacting systems before getting things like this checked your likelihood of having the same quantity of quality adjusted years of life is much lower.
    • Gatsky 4y ago
      There are not really any lifestyle interventions with good quality evidence for preventing cancer. This is my list: Definitely worth doing: - Don't smoke anything that burns or chew tobacco. - Depending on your age and sexual experience, get the HPV vaccine. - Investigate your family history of cancer. If there are multiple people on one side of the family getting cancer (particularly breast + ovarian + pancreatic, or colon + gastric) then consider getting genetic testing/discuss with a doctor. - If you have certain ethnicity, just get a genetic test, pay for it if you have to (Mainly for Ashkenazim) - Avoid consuming herbs/plants which contain aristocholic acid. Probably worth doing: - Reduce red meat consumption (observational data and plausible mechanism) - Reduce or eliminate alcohol (observational data and plausible mechanism) - Eat highly processed meats rarely (charcuterie etc) - Make sure to get sufficient fruit and vegetables and fibre. This may offset the risk of red meat consumption. - Take vitamin D, particularly if your levels are low or you live far from the equator. Don't take intermittent megadoses, take some every day. This seems less useful if you are overweight. - If you are female, then have children and breast feed if possible. Longer durations of breastfeeding are more effective. Having more children is also more effective. (One may balk at this, but there is a lot of supportive data about long term breast cancer risk) - Exercise. There is only (a ton of) observational data, but exercise is so universally beneficial. Going from nothing to a bit of exercise has a bigger impact than going from a bit of exercise to a lot. Most people over do it. Do cardio and resistance training. Try to do something every day. - Avoid supplements designed to have antioxidant properties (based on data suggesting harm from controlled trials, and no clear benefits). Maybe: - Move closer to the equator. - Avoid obesity (note this is complicated... obesity itself may not be the problem. Obesity is protective for some cancers, and this varies by age). - Get checked for Hepatitis B and C, particularly if you have risk factors or were born/grew up in an endemic country. - If you get chronic reflux or heartburn, consider pushing for your doctor to investigate further (usually a gastroscope) and do an H pylori test. This is particularly if you were born/grew up somewhere with a higher chance of exposure. If you have it, take the eradication therapy. - Try to maintain metabolic health. This is highly personal and hard to give general advice around. Eg. South east asian/Subcontinental people can be metabolically ill despite not being overweight. Investigations here could vary from checking for insulin resistance (eg HOMA-IR calculation from a blood test), gettinga DEXA scan to look for visceral fat, or in the extreme case continuous glucose monitoring to look for foods which really spike your blood glucose. The interventions are exercise, sleeping well, and potentially avoiding foods which spike your sugar (or scheduling exercise after eating such foods). Soon we will have a better idea if certain personalised dietary interventions may be beneficial.
  • jghn 4y ago
    You're misinterpreting the "when not if" adage. For prostate cancer it's generally used as an example of how there are cancers you die of and cancers you die with. Many prostate cancers are so nonaggressive that men will die with them and never know they were there. And that's the problem. If you did a test and saw something & then immediately eradicated that prostate cancer, what if it was going to be one of the ones that wouldn't have caused you real harm during your natural life? In that case the likelihood of the treatment causing more damage to you than the cancer itself is high. And predicting which are which is improving but still imperfect.
    • deleted 4y ago
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  • dunbr 4y ago
    I work in this field and directly am involved with the treatment of prostate cancers. What you describe is not standard of care, and I’d hesitate to say that everyone should be so alarmed of getting prostate or any cancer. It’s unfortunate that your father’s PCP wasn’t aware of such warning signs, and I’m sorry for your loss. However, We’ve seen this before with prostate and breast cancer where early and often screening leads to not only false positives but undue stress on patients. Furthermore, catching a nonaggressive prostate cancer 2-5 years early may lead to the same outcomes as catching it when certain things like PSA are detected to be increasing. But you may drastically affect one’s quality of life. It can at times be a difficult balance. We see more and more elderly patients being treated because they are living longer. For many though, “waitful watching” or “active surveillance” is the correct clinical decision and always is up to the patient. Finally, while prostate cancer isn’t as publicized as breast cancer (we’re trying!). It is a well known cancer and there is awareness of it.
    • deleted 4y ago
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    • remote_phone 4y ago
      What is your opinion on the Grail blood test?
  • mythhouse 4y ago
    > PCP ignored escalating PSA levels. He was ordering psa tests but just ignoring the velocity ? I had similar discussion on HN last week https://news.ycombinator.com/item?id=34251569 https://news.ycombinator.com/item?id=34251569
• nerdponx 4y ago
  Isn't pancreatic cancer in particular usually very far advanced before it's detected?
  • juve1996 4y ago
    In general the worst cancers are the ones that are difficult to detect early enough before they metastasize. As the article says, this death rate has dropped mostly because of preventative care and early screening.
  • Broken_Hippo 4y ago
    Yes, unless you get lucky. They find spots on the pancreas by accident all the time. It is incredibly common. I know, I have one: I got an abdominal CT scan while getting something unrelated checked. Some of these go on to be cancer, and sometimes they know it is precancerous. The cyst I have wasn't immediately precancerous. Now I get regular MRIs to check on it. Since I have no symptoms, there is really nothing else to do. That lack of symptoms, though, is a real issue. If you have a little bit of cancer and no symptoms and you don't find it accidentally, it is going to be much, much harder to detect early.
    • nerdponx 4y ago
      If it's so deadly and widely asymptomatic until it's way too late, why don't we screen for it? Or is that problem, that we don't have a good screening test other than expensive and time consuming MRI?
      • Broken_Hippo 4y ago
        Screening isn't really helpful because it isn't good enough. We find all of these lesions, but the vast majority don't result in anything that needs treated nor do they appear to have symptoms. They are just there. So right now, we just watch them. I'm guessing if we knew how common they were, could better tell between normal and cancerous, or heck, even knew why they were so common, we could do better. But we just aren't there yet. And unfortunately, this is the case for a number or screenings - and is a downside of some routine screenings. I keep hoping that once we understand a variety of cancer better, this will improve. FWIW, mine was found on a CT scan and all the monitoring was on an MRI - and both expensive (thankfully the out of pocket costs for healthcare here are low) and uncomfortable for some folks.