Ignorance is not bliss
June 5, 2008
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Paul Irish
SPECIAL TO THE STAR
Don't be an ostrich!
You know who you are. Are you the guy who hides his head in the sand refusing medical tests or examinations because he's scared he may be sick?
As ridiculous as it sounds, there are a lot of those frightened birds out there.
Colin Graham, 74, admits he had a touch of the ostrich in him.
But he still had enough sense to listen to his doctors – and he's glad he did.
In early 2005, Graham's family doctor felt an irregularity in his prostate gland while performing a digital rectal exam.
He sent Graham to Sunnybrook's Odette Cancer Centre for a PSA test, which proved normal.
But because of other factors – Graham's age and the facts that cancer runs in his family and his prostate gland was irregular – Sunnybrook doctors determined he had a high risk of having prostate cancer.
A biopsy proved them right, and the prostate was removed.
"I didn't feel the slightest bit sick ... I didn't know I had it," Graham says. "Men should take full advantage of anything that will help them detect the cancer. My PSA was normal, but look what happened."
Dr. Robert Nam, a urological oncologist at Sunnybrook, was able to detect Graham's prostate cancer thanks to a nomogram, which classified him as a high-risk patient even though his PSA levels were normal.
A nomogram is a statistical model that determines the threat of cancers or disease based on known risk factors.
Sunnybrook's model – called the Prostate Cancer Risk Calculator – takes just minutes to determine the level of risk, based on age, family history, ethnicity, urinary symptoms, PSA, free/total PSA ratio and rectal exam results.
It's the first nomogram to use all known risk factors for prostate cancer, and has already proven to be more reliable than conventional cancer screening.
Nam says a PSA test may not detect smaller cancers, but once other markers are taken into account, the nomogram can identify patients at a high enough risk to warrant a biopsy. Although he says the PSA number will always be important, it is more useful when used in context with as much information about the patient as possible.
To see how the nomogram works, go to the website at prostaterisk.ca and click on the link to the risk calculator. However, it is best used in consultation with a family doctor.
Sunnybrook researchers based the nomogram on 3,108 Canadian men (all of whom had abnormal PSA values or rectal exam results), along with another group of 408 volunteers with normal PSAs.
All of the men underwent prostate biopsies.
Of the main group, 42 per cent were diagnosed with prostate cancer.
Of the 408 with normal PSAs, 24 per cent were diagnosed with prostate cancer.
Further evaluation of the nomogram is underway, through a multi-institutional cross-Canada study group of another 5,000 men.
"In addition to helping men avoid unnecessary biopsies, the risk calculator better detects prostate cancer at an earlier, more curable, stage," Nam says.
"And it helps identify high-risk patients who may need to make immediate dietary and lifestyle changes and need repeat biopsies."
Toronto Star