5 ms·

First time it really hits home how large the risk is. 1/6 is a rather large risk.

foepys 4y ago
It's more likely that you die with prostate cancer than because of prostate cancer. Yes, cancer is never good but for most men prostate cancer develops late and is usually growing very slowly and doesn't spread.
- thaumasiotes 4y ago
  In medical school, one of my mother's classes had an exercise one day which took this form: Here are a bunch of slides of prostate samples. Find the cancerous one. This led to the teacher getting so many questions about whether the slide someone was currently looking at was the cancerous one that he was forced to interrupt the class to make this more general announcement: There's a bit of cancer in everyone's prostate. Find the slide with obvious cancer.
  - copperx 4y ago
    Surely the slides were of men of an advanced age, right? Otherwise that statement is false.
    - thaumasiotes 4y ago
      Why do you think that?
      - copperx 4y ago
        I don't believe every person of every age has observable cancer that can be seen on a slide.
        thaumasiotes 4y ago
        You're probably correct as to babies. But the prostate gland is extremely cancerous and my assumption would be that that tendency begins at either birth or puberty. The exponential function spends the entire infinite length of the negative x-axis rising from 0 to 1; think about the growth of cancer in your prostate gland that way. I would not expect a man in his late 20s to fall into the category "men of an advanced age". But I would be unsurprised to learn that there was visible protocancer in a sample of his prostate.
    - Dalewyn 4y ago
      I'm not a doctor, but my understanding has been that we all have cancer cells at any given point in time. Consider how many cells inside you are undergoing cell division; errors in cell division are where cancer cells come from. The question is whether your body sees and kills the cancer cells; most of the time it does, which is why most of us can live pleasantly for most of our lives despite errors cropping up silently. What we term cancer are the cancer cells that slipped past our body's defences, growing into masses that cause no end of grief. To put it in computer terms, it's like error correction in HDDs and SSDs and ethernet connections. Errors are inevitably going to occur while data is in transit, but they are of no concern so long as error correction and other such mechanisms can correct and recover. The errors do become a concern when they start slipping past such mechanisms, however.
      - zkirill 4y ago
        This is my understanding as well and my favorite protein, p53 [1], is responsible for hunting down cancerous cells. From what I remember reading in Robins Basic Pathology, it takes many steps for a cell to evolve into cancer and our body has ways to reduce the probability at each step. The most fascinating topic to me is how someone's lifestyle and environment affect their body's natural cancer defence mechanisms. We can do many things to stack the odds in our favour, but sometimes the odds are still not in our favour. Should we strive to minimize the chance by adjusting our lifestyle and changing the environment, or strive for some kind of balance? [1] https://en.m.wikipedia.org/wiki/P53 https://en.m.wikipedia.org/wiki/P53
        Dalewyn 4y ago
        >Should we strive to minimize the chance by adjusting our lifestyle and changing the environment, or strive for some kind of balance? That is as much a philosophical question as it is biological, and one where the answer will vary by who is asked. Personally, I will say this: If you're miserable while endeavouring to prevent cancer (or any other disease), that's putting the cart before the horse. The goal is, presumably after all, to live happily.
        pfdietz 4y ago
- barrenko 4y ago
  Yess, it's something along the lines that as a man - if you live long enough you'll get prostate cancer.
- canucker2016 4y ago
  "watchful waiting" is the phrase used. see https://www.telegraph.co.uk/news/2023/03/12/prostate-cancer-patients-survive-just-long-watchful-waiting/ https://www.telegraph.co.uk/news/2023/03/12/prostate-cancer-... The above link mentions "one in eight men" will be affected by prostate cancer. If you have the deadly fast-growing type of prostate cancer, it'll be evident soon enough.
  - nickd2001 4y ago
    Someone I knew had the slow-growing case for quite some time. Then, it abruptly without warning turned into the aggressive form and killed him. Makes it very difficult to know what to expect. I guess frequent checks are necessary, because once its evident, you're already in a world of trouble...
- melling 4y ago
  Currently, but as lifespans increase… https://www.marketwatch.com/story/good-news-and-bad-news-kids-born-today-will-probably-live-to-be-older-than-100-and-theyll-need-to-pay-for-it-2019-06-14 https://www.marketwatch.com/story/good-news-and-bad-news-kid...
- wisty 4y ago
  The stats are still pretty bad. Prostate cancer kills more people than breast cancer (though it's usually men in their 80s, so the QALYS is not as bad). A prostate cancer diagnosis is not terrible (since it's so damn common) and aggressive treatment and overly-aggressive screening might be a bad idea in most cases (since it's often best to not worry too much - over-treatment and even over-testing has its costs) but there's certainly a need for better treatment in cases where it does get bad (which is a very sizable number of older men). Doctors don't try to do the test on every man over 55 without a good reason.
  - e40 4y ago
    But, curiously, they stop testing at 70 (or was it 72?). That's what my urologist told me last year when I had my exam. Ever since my father had prostate cancer, I've had a yearly PSA and exam by a urologist (thinking that a urologist will be better at detecting tumors than a GP/PCP).
    - haldujai 4y ago
      There is weak evidence to support testing over 70 due to increasing risks of biopsy/treatment and no evidence to support improved overall mortality. Some guidelines suggest that it's reasonable to continue in patients with >10-15 year life expectancy if the patient desires, but there is no strong recommendation or evidence to support this recommendation or screening in this age group. Some guidelines actually have a strong recommendation to stop screening men with < 15 year life expectancy. Even less evidence for a DRE. PSA by a GP is sufficient if you desire screening.
      - e40 4y ago
        > Even less evidence for a DRE. PSA by a GP is sufficient if you desire screening. I believe my father's prostate cancer was found via DRE and not PSA. That is, PSA was in the normal range. That is what made me get a DRE from a urologist once a year (since then).
        4y ago
lm28469 4y ago
The lifetime cancer risk is ~50% (all cancers) Most of them are caused by lifestyle/environment: https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=2515569_11095_2008_9661_Fig1_HTML.jpg https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/t... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/
- Alex3917 4y ago
  How credible is this paper? I see it's highly cited, but I also see that it claims that fungi are cancer causing but not also cancer preventing, which seems questionable.
  - lm28469 4y ago
    Feel free to read other studies/sources: https://en.wikipedia.org/wiki/Causes_of_cancer https://en.wikipedia.org/wiki/Causes_of_cancer cites other papers with similar stats, there are also many sub articles listed > Over one third of cancer deaths worldwide (and about 75–80% in the United States) are potentially avoidable by reducing exposure to known factors. > Common environmental factors that contribute to cancer death include exposure to different chemical and physical agents (tobacco use accounts for 25–30% of cancer deaths), environmental pollutants, diet and obesity (30–35%), infections (15–20%), and radiation (both ionizing and non-ionizing, up to 10%). > less than 0.3% of the population are carriers of a cancer-related genetic mutation and these make up less than 3–10% of all cancer cases.

It's more likely that you die with prostate cancer than because of prostate cancer. Yes, cancer is never good but for most men prostate cancer develops late and is usually growing very slowly and doesn't spread.

thaumasiotes 4y ago
In medical school, one of my mother's classes had an exercise one day which took this form: Here are a bunch of slides of prostate samples. Find the cancerous one. This led to the teacher getting so many questions about whether the slide someone was currently looking at was the cancerous one that he was forced to interrupt the class to make this more general announcement: There's a bit of cancer in everyone's prostate. Find the slide with obvious cancer.
- copperx 4y ago
  Surely the slides were of men of an advanced age, right? Otherwise that statement is false.
  - thaumasiotes 4y ago
    Why do you think that?
    - copperx 4y ago
      I don't believe every person of every age has observable cancer that can be seen on a slide.
      - thaumasiotes 4y ago
        You're probably correct as to babies. But the prostate gland is extremely cancerous and my assumption would be that that tendency begins at either birth or puberty. The exponential function spends the entire infinite length of the negative x-axis rising from 0 to 1; think about the growth of cancer in your prostate gland that way. I would not expect a man in his late 20s to fall into the category "men of an advanced age". But I would be unsurprised to learn that there was visible protocancer in a sample of his prostate.
  - Dalewyn 4y ago
    I'm not a doctor, but my understanding has been that we all have cancer cells at any given point in time. Consider how many cells inside you are undergoing cell division; errors in cell division are where cancer cells come from. The question is whether your body sees and kills the cancer cells; most of the time it does, which is why most of us can live pleasantly for most of our lives despite errors cropping up silently. What we term cancer are the cancer cells that slipped past our body's defences, growing into masses that cause no end of grief. To put it in computer terms, it's like error correction in HDDs and SSDs and ethernet connections. Errors are inevitably going to occur while data is in transit, but they are of no concern so long as error correction and other such mechanisms can correct and recover. The errors do become a concern when they start slipping past such mechanisms, however.
    - zkirill 4y ago
      This is my understanding as well and my favorite protein, p53 [1], is responsible for hunting down cancerous cells. From what I remember reading in Robins Basic Pathology, it takes many steps for a cell to evolve into cancer and our body has ways to reduce the probability at each step. The most fascinating topic to me is how someone's lifestyle and environment affect their body's natural cancer defence mechanisms. We can do many things to stack the odds in our favour, but sometimes the odds are still not in our favour. Should we strive to minimize the chance by adjusting our lifestyle and changing the environment, or strive for some kind of balance? [1] https://en.m.wikipedia.org/wiki/P53 https://en.m.wikipedia.org/wiki/P53
      - Dalewyn 4y ago
        >Should we strive to minimize the chance by adjusting our lifestyle and changing the environment, or strive for some kind of balance? That is as much a philosophical question as it is biological, and one where the answer will vary by who is asked. Personally, I will say this: If you're miserable while endeavouring to prevent cancer (or any other disease), that's putting the cart before the horse. The goal is, presumably after all, to live happily.
      - pfdietz 4y ago
barrenko 4y ago
Yess, it's something along the lines that as a man - if you live long enough you'll get prostate cancer.
canucker2016 4y ago
"watchful waiting" is the phrase used. see https://www.telegraph.co.uk/news/2023/03/12/prostate-cancer-patients-survive-just-long-watchful-waiting/ https://www.telegraph.co.uk/news/2023/03/12/prostate-cancer-... The above link mentions "one in eight men" will be affected by prostate cancer. If you have the deadly fast-growing type of prostate cancer, it'll be evident soon enough.
- nickd2001 4y ago
  Someone I knew had the slow-growing case for quite some time. Then, it abruptly without warning turned into the aggressive form and killed him. Makes it very difficult to know what to expect. I guess frequent checks are necessary, because once its evident, you're already in a world of trouble...
melling 4y ago
Currently, but as lifespans increase… https://www.marketwatch.com/story/good-news-and-bad-news-kids-born-today-will-probably-live-to-be-older-than-100-and-theyll-need-to-pay-for-it-2019-06-14 https://www.marketwatch.com/story/good-news-and-bad-news-kid...
wisty 4y ago
The stats are still pretty bad. Prostate cancer kills more people than breast cancer (though it's usually men in their 80s, so the QALYS is not as bad). A prostate cancer diagnosis is not terrible (since it's so damn common) and aggressive treatment and overly-aggressive screening might be a bad idea in most cases (since it's often best to not worry too much - over-treatment and even over-testing has its costs) but there's certainly a need for better treatment in cases where it does get bad (which is a very sizable number of older men). Doctors don't try to do the test on every man over 55 without a good reason.
- e40 4y ago
  But, curiously, they stop testing at 70 (or was it 72?). That's what my urologist told me last year when I had my exam. Ever since my father had prostate cancer, I've had a yearly PSA and exam by a urologist (thinking that a urologist will be better at detecting tumors than a GP/PCP).
  - haldujai 4y ago
    There is weak evidence to support testing over 70 due to increasing risks of biopsy/treatment and no evidence to support improved overall mortality. Some guidelines suggest that it's reasonable to continue in patients with >10-15 year life expectancy if the patient desires, but there is no strong recommendation or evidence to support this recommendation or screening in this age group. Some guidelines actually have a strong recommendation to stop screening men with < 15 year life expectancy. Even less evidence for a DRE. PSA by a GP is sufficient if you desire screening.
    - e40 4y ago
      > Even less evidence for a DRE. PSA by a GP is sufficient if you desire screening. I believe my father's prostate cancer was found via DRE and not PSA. That is, PSA was in the normal range. That is what made me get a DRE from a urologist once a year (since then).
      - 4y ago

lm28469 4y ago

The lifetime cancer risk is ~50% (all cancers) Most of them are caused by lifestyle/environment: https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=2515569_11095_2008_9661_Fig1_HTML.jpg https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/t... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/

Alex3917 4y ago
How credible is this paper? I see it's highly cited, but I also see that it claims that fungi are cancer causing but not also cancer preventing, which seems questionable.
- lm28469 4y ago
  Feel free to read other studies/sources: https://en.wikipedia.org/wiki/Causes_of_cancer https://en.wikipedia.org/wiki/Causes_of_cancer cites other papers with similar stats, there are also many sub articles listed > Over one third of cancer deaths worldwide (and about 75–80% in the United States) are potentially avoidable by reducing exposure to known factors. > Common environmental factors that contribute to cancer death include exposure to different chemical and physical agents (tobacco use accounts for 25–30% of cancer deaths), environmental pollutants, diet and obesity (30–35%), infections (15–20%), and radiation (both ionizing and non-ionizing, up to 10%). > less than 0.3% of the population are carriers of a cancer-related genetic mutation and these make up less than 3–10% of all cancer cases.