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Howard Wolinsky's avatar

Thanks, Jim.

Personally, I didn't worry about that first PSA.

I thought I was made from Teflon because up to then nothing serious had impacted my health.

I thought it would be a nothing.

Again, personaly, it has been a nothing they call "cancer"--more of a label that changed my self-identification and insurance status than a health threat,

I was lucky.But stilll had consequences,

Howard

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Howard Wolinsky's avatar

My pal Peter Swenson, a Yale historian, has had his struggles with the trifecta--PSA, mpRI and BPH. He complains: "An arrogant Yale uro dismissed the idea of an MRI, but I insisted. He wanted to do a biopsy lickety-split."

So far Peter has avoided a biopsy.

He is author of "Disorder: A History of Reform, Reaction, and Money in American Medicine." (My exposes on the AMA are cited in there.)

He reminded me of a urologist's sneak attack of doing an unauthorized PSA.

Here's what he said :

"Hi Howard,

I probably told you this before. I told my PCP not to order the PSA test. I got a result nevertheless, a little over 4. He blamed the lab and wasn't very apologetic. Maybe looked a bit sheepish. He didn't take the blame. Didn't explain anything except said now we should watch it periodically and if it rose at a certain rate, then do something. It rose to about 10 and then back to 7 and fluctuates.

I've dragged my heels all the way. Avoided biopsies, insisted on MRIs. Two found the same tiny equivocal lesion. "Incidentaloma"? They also found a very large prostate, now 109 ccs. Hence no doubt the PSA results. Glad I insisted on MRIs.

I think doctors should have pamphlets to give patients explaining the risks of screening with PSA tests. Tell them to go home and have a think, read more, etc. The AUA, AAFP, and ASCO should produce them instead of just issue guidelines about talking. Maybe their members need to read them. Maybe definitely. That's my 2c worth.

Thanks for what you're writing. I read a lot of it. It has given me backbone to resist going down the slippery slope.

Peter

CM Saden Professor

Department of Political Science

Yale University

https://campuspress.yale.edu/peterswenson/

He adds:"A tiny few may be saved from death by cancer but more killed by stress, depression, suicide, sepsis, etc. And then there's what I would call "demi-death" (to coin a word?) --the purgatory of fear, incontinence and impotence. https://www.youtube.com/watch?v=gK-GWJjA0pc

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