Science Ain't So Bad

TRYING TO GET THE PROSTATE TEST RIGHT

A USELESS TEST?

If you’ve been reading the newspaper lately, you probably know to skip the PSA test. Pretty much a scam, right? You risk impotence and incontinence. And for what? You die when you die and your tombstone won’t say “Saved by PSA”.

As usual. There are two (or more) sides to the story.

Dr. Edward Messing (University Of Rochester Medical Center) took a look at the country’s largest cancer registry and he compared data for the period before PSA testing was introduced and after it was introduced. The work was published in Cell.  What did he find out? Surprise! He found that the amount of “advanced” cases  – metastatic cancers that were going to spread –  would have tripled had it not been for PSA testing.

So getting your PSA tested is a good thing, right?

Maybe. But this isn’t a very accurate test. What if it leads you to get an unecessary needle biopsy and the biopsy, itself, makes you sick? What if you wind up with urinary incontinence or impotence from the biopsy? Or what if the biopsy is positive and you get surgery and you swoon in the operating amphitheater years before the cancer would have nipped you?

Well, well, well. This is so complicated you probably wonder what MISTER Scienceaintsobad thinks. I ain’t givin’ no medical advice, but I will tell you what I would do if my own PSA score were to jump.

I would be very calm.

Why? Because, as I say, the tests are usually wrong. And, also, as I said, this cancer is a tortoise. At least, it usually is. So I would probably figure on being around to blog another day.

Your blog’s so b-o-r-i-n-g, most of us readers’ll go out and celebrate when you bloody slip the mortal coil, MISTER ScienceIsSoPredictable! – ReaderOfYourBlog993. 

Hey WATCH it, ReaderOfYourBlog993!

Well what to do with the knowledge from the test? If you’re just going to ignore it, why waste time and money? Why do the test in the first place?

Precisely the argument of the US Preventative Services Task Force.

Here’s the thing. (Gotta stop saying that.) Why not act intelligently on this information? Instead of calling  up the biopsy guy, why not look at  other noninvasive tests that could be used to narrow down the possibilites? Here’s one worth considering. Here’s another.   And, yes, this test not only gives accurate information about the presence of prostate cancer, it also gives an indication of how advanced it is which, after all, is the key. With that information, you know when to act and when to roll the dice on outliving the cancer.

Just one thing. None of these tests is available. They are still “raw science”. They might not make it to the clinic. Ever.

Am just playing with you? Would MISTER ScienceAintSoBad do that? Course not. I do have something with a bit more immediacy here. This study, using currently available drugs,  takes the sloppy PSA test and sharpens it up. It’s the brainchild of  Dr. Steven A. Kaplan and his colleagues at  the NewYork-Presbyterian Hospital/Weill Cornell Medical Center  (published in the Journal of Urology) . They looked at men who keep getting abnormal PSA tests followed by normal biopsies. For these patients, this would happen over and over. Frustrating!

Since the standard PSA test has trouble telling the difference between an inflamed prostate (which is benign if you don’t mind peeing constantly) and cancer,  they tried using certain drugs – drugs that are currently available –  to  shrink the prostate. THEN they did the PSA test.

Good idea.

After shrinking the prostate, the tests were , in fact,  more accurate. Fewer patients had to undergo a needle biopsy with its risks and more advanced cancers were identified. No. This “drug plus PSA test” approach isn’t standard follow-up to a positive PSA test. Not yet.  More thought has to go into how it might be applied to the general population. And, of course, cost/benefit considerations are important when you make a simple test more complex. But all these tests show that we don’t have to be trapped by our current thinking on the PSA test.

The Task Force raised good questions but the panel members need to get out more. Science can offer a broader range of options than just the plain vanilla PSA test.

Science. It ain’t so bad. Right?

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Image credits: That’s actually Margaret Field in The Man From Planet X which you may have caught back in 1951. He isn’t really checking for a prostate, even though it sure looks that way. The alien is trying to kidnap her and take her back to X where they have a huge shortage of librarians.  
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.

STELLATE CELL ACTIVATION (Hey! I needed a picture.)

Oncology: Pancreatic Cancer. Head/Neck Cancer

What’s your favorite cancer?

I bet it isn’t pancreatic cancer.

The request queue for cancer’s pretty short. But the least popular members of this rather unpopular group of diseases may be things like the oral cancers (head and neck), pancreatic, and lung cancer. Course I haven’t taken a survey, and I bet there’re plenty of others that aren’t big favorites either. But if you DO have the bad luck to have a tumor, you want it to be at an early stage and easy to get at.

The pancreas, when it goes bad, doesn’t send off early warnings and it isn’t easy to get at. Aesthetics aside, things would probably work out much better with the pancreas if it were located on your ear. Signs of disease would be easier to spot early and snipping off the bad thing would be an outpatient procedure.

CANCER BOMBLETS

Well Mark Howard (University of Kent, School of Bioscience) hasn’t figured out a way to rotate your pancreas to your ear but he seems to be onto something equally (some would say more) exciting than a pancreas hanging off of your right ear:  cancer bullets.

Dr. Howard’s “thing” is the shape of certain amino acids (peptides). He was able to figure out how to optimize their ability to lock onto (bind with) cancer cells. Hook the amino acids to the right drugs, and you have a delivery system,  a “cancer bullet”.

DOES IT WORK?

You WOULD ask!

MISTER ScienceAintSoBad’s beat is science and Mark Howard is, in every sense, a scientist. But this is early in the process. It’s a remarkable accomplishment and he gets himself a ScienceAintSoBadRating of 10 which, while not a Nobel Prize, isn’t pigeon crap, either.  But that doesn’t mean this’ll permanently eradicate cancers. And, if it does, it remains to be seen if it will work for everyone. Those studies haven’t been done yet.

ScienceAintSoBadFingers are crossed.

And The Cut-It-Out-Of-Myself Kit?

BIOMEDICAL RESEARCH: Do-It-Yourself Medicine

TEST YOURSELF FOR CANCER?

My dad was SO proud that he was one of the first to drive an automobile. But, you know what? He got to drive a car his entire adult life. The cars got better and better. But he never had to learn how to drive a rocket ship.

It never even came up.

Now we have ALL this new STUFF comin’ at us.  More and more every day. And that stuff engenders even more stuff. Digital devices make it easier to design even more digital devices and nano systems.. well, that’s THIS story.

What do you know about micro/nanoelectromechanical systems?

Me neither.

But a professor at the University of Missouri has an NSF grant to develop an “Instant” cancer detector, taking advantage of the special properties of exquisitely sensitive “M/NEMS” based sensors (which MISTER ScienceAintSoBad hopes to tell you ALL about. As soon as he figures it out, himself.)

Dr. Jae Kwon believes this technology will lead to home based test kits that people can use to figure out whether they have certain diseases like breast or prostate cancer.

Which brings me back to my original point about runaway technology and the way it shapes our daily lives: I’m gonna test myself for cancer? What do I do then? Go to the Doc and explain that I have Glioma and what are “we” gonna do about it? It’s taken a while, but I’ve gotten used to pumping my own gas. Will I mind diagnosing my own cancer?

At least we should have time to get used to this one. It doesn’t sound imminent.

ScienceAin’tSoBadRating = 5 .

Smarter Folks Doesn't Smokes

SUBSTANCE ABUSE: Smoker Brain.

What’s science GOOD for, you may ask?

I dunno, I may answer.

But maybe it could serve to humiliate people  who are already miserable and make them feel worse.

A (smug and self satisfied?) study led by Dr. Mark Weiser (Sheba Medical Center) concludes that the higher your IQ, the less likely you are to smoke.

MISTER ScienceAintSoBad appreciates the underlying reality here. This is a painful piece of science but – yeah – indulging in self destructive behavior probably ISN’T gonna correlate with the biggest, bestest brains. But should research dollars be used to rub it in?

To be fair, a better understanding of the factors that lead a person to smoke may help researchers understand how to effectively combat it. So we’ll give the benefit of the doubt to Weiser and assume his motives were pure.

ScienceAintSoBadRating = 6 for a well intentioned study that we would like to see replicated somewhere else before conceding the point.

And, no, MISTER ScienceAintSoBad isn’t and never did smoke cigarettes or the like and is not being defensive.

Just nice.

For a change.

Was this necessary?

Orthopedic Surgery: Knee.

Have you ever heard the term “Anterior Cruciate Ligament?”

I sure hope not.

It’s one part of the most complicated thing in the world – probably the most complicated thing in the whole UNIVERSE – the knee. And when the ACL gets ripped, it really HURTS!

Normally, it doesn’t get much better on its own – especially a major tear. Which means you get to make a visit to MISTER Orthopedic Surgeon.

Whee!

Surgical repair of the ACL is a common procedure and, with a little cooperation on your part and a bit of luck, it usually works pretty well. But it’ll cost you in the long run since your chances of arthritis later in life bump up significantly.

The interesting thing about all this is WHY the thing doesn’t get better on its own. Some parts of our body (luckily) do. Other parts don’t.

So that’s the question for our time. What’s it take to get the things that DON’T heal to change their ways?

Dr. Martha Murray (Children’s Hospital, Boston) has been puzzling out this very thing with respect to the Anterior Cruciate Ligament.

No big announcements. Just slogging through the science. But, so far, she has figured out that fibrin – the stuff that makes blood clot and which plays a role in repair of other tissues (including bones) – doesn’t seem to last long enough at the injury site – an important clue which may lead to techniques for enhancing the fibrin around the ligament.

Anyway, this is just a report on a work in progress but one that is so representative of the many efforts throughout medicine to learn how to teach the body to heal in new ways.

ScienceAintSoBadRating = 5 . Still early days.

RadiationTherapy: A Life Worth Living

Cancer.

It seems so somebody-else-but-not-me.

And yet.. you’re the one in the back-flapper gown.

Crappy, expensive, uncomfortable, inconvenient, and, potentially deadly, cancer is just a THING now. It CAN take you down but, mostly, it’s a bunch of medicine that you’re not gonna like; you’ll still get to see your grandkids.

At least I hope so.

The five year survival rate shows that the  Odds are now with you for most cancers.

This jibes with my own experience. MISTER ScienceAintSoBad knows several people – quite a few, actually – who have had cancer. One of them succumbed (too early) at ninety. The others? All here. All fine.

My sister’s husband, R – a fine dad and an unbelievable grandad – had a nasty oral cancer.

Things looked bad.

But R went to Israel and took advantage of some experimental stuff.

I don’t want to minimize it. It was rough.

But the cancer’s long gone and R’s doing great.

His taste buds and salivary glands, however, are good and fried. He REMEMBERS what it’s like to enjoy food.

That’s about it.

It’s a side-effect of the radiation.

So.

Getting rid of cancer’s good. Reducing collateral damage is better.

New, more refined techniques, such as IMRT , which splits the high energy beam into hundreds of much smaller beams for finer control, and the Gamma Knife. which can even adjust to movements such as respiration or a beating heart are aimed at reducing the side effects of cancer survivors.

The newest weapons are a recognition that quality of life matters.