Prostate, Ovarian Cancer Screening: When to Test? Not So Clear

Reader Comments
Back to article

A very good article, altho I can appreciate the preference of the main subject of ovarian cancer by the female reporter. However, for s person who ran a PSA score for 10 years of about 4, and then saw it run up to over 4 in less than 6 months, and after a positive digital exam, got a biopsy with a Gleason score of 6. Chose the Johns Hopkins Hospital's Brady Urology Clinic's Radical Prostectomy with nerve sparing procedures, and had the prostate removed 10 years ago this Fall without any need for chemo or radiation. After surgery, PSA fell to level less than 0.01, and has remained at the same level for the past 9 years. With the advent of robotic surgery, my 6 inch abdominal incision, which caused me significant pain and lengthened recovery, has been reduced to a 2" parallel (no abdominal muscle cutting) incision, with recoveries of less than 2 weeks(as compared to my 12 week recovery). I agree with the commenter regarding do not dance with the cancer--get rid of it and live a reasonably active life!

Dan Henderson of MD 10:29PM March 18, 2009

i have had ovarian cancer twice, just finished my 2nd chemo, i would have rather had a ca125 5 years eariler and know sooner rather than wait until it was to late. i would think a false positive is better than waiting and if more doctors would do that test then we would not have as many deaths as we do. i can remember breast cancer and mamograms years ago were thought unnecessay and now look how many lives it saves. we need to do something to help women now and not later. by the way most people know what the color pink means and the month of october, how about teal and the month of september??

Katherine Hobson: I'm glad you're doing well with treatment against this horrible disease. The problem with ovarian cancer is that it is quite rare -- far more rare than prostate or breast cancer. If we screened everyone, it would result in many, many women having unnecessary surgery (far more women would be cut open unnecessarily than would be saved by the test). It's possible that the net benefits of lives saved in terms of screening would not outweigh the negatives in terms of the bottom line: do people who are screened live longer than those who are not? Studies are still looking into this, so there's no answer yet. In terms of awareness, I think much more attention should be paid by docs and patients to these symptoms, which can signal early disease. If you have the symptoms listed in the article and they are new and persist for two or three weeks, talk to your doctor and specifically mention ovarian cancer. If he/she tells you that's not likely, ask why. Far too many women have early symptoms yet aren't taken seriously. Be your own advocate.

bj martin of MD 8:31PM March 18, 2009

My mother died of ovarian cancer and I do believe that only a small number of ovarian cancers are hereditary. But we have recently been encouraged by a blood test for proteins that may be a great indicator. The cost estimate for the test that I have seen is $100-200 and the accuracy is 94%. We who have a reason for raised awareness should be asking our physicians about this test. I believe that the initial studies were done in
Europe. This is the first really promising indicator that I have seen in all the years that I have been following research.

Katherine Hobson: You may be referring to a test called OvaSure, which was briefly on the market last year until its manufacturer withdrew it after a warning by the FDA. The problem with it, and many tests, is that even though it have a very low false positive rate, ovarian cancer is rare enough so that most of the women who test positive will not actually have cancer. And unlike prostate cancer or breast cancer, the invasive procedure used to follow up is actual surgery, not just a biopsy, and that carries risks.

Contessabelle of SC 8:06PM March 18, 2009

According to recent information, the HE4 combined with the CA125 improves the efficacy of the CA125 alone. To add to the complications of understanding ovarian cancer is the theory that there are two distinct presentations: early stage vs advanced stage. If the latter theory holds true, than early diagnostic as we presently know them will not be successful. The HE4 test was approved for use along with the CA125 in Europe and I believe just recently received FDA approval in the U.S.

Sandi Pniauskas 6:41PM March 18, 2009

Was under doctor’s care for up and down PSA numbers...10 needle biopsy showed NOTHING...Two years later numbers actually lower, but still up and down and under 10
Read in a book that there was such a thing as a 20 needle biopsy test*(would pierce more areas) and that is where they found the agressive cancer!!!!!No symptoms just the numbers jumping up and down. Always go where they have the state of the art equipment. Also no one mentions the PSA FREE test...something showed up there abnormal..Why didn't they do that PSA FREE two years ago? Prostate removed, incontinence , and 38 treatments of radiaiton I had a 9 gleason score. Don't mess around. Remove the cancer... don't dance around it. My doctor sent me a letter stating that he would no longer treat me since I choose to travel to the Cleveland Clinic for more advance testing. Too bad they can't work together. It is all about the money. Advanced testing could make a diffrence for a longer life.

J. Simmons of OH 6:12PM March 18, 2009

CA-125 screening in the low risk/general population was shown to be ineffective and fraught with false positives when the first multi center trial was completed late '80s early '90s. It is a NON specific test that interacts with numerous benign conditions. Screening in the general population resulted in hundreds, as in HUNDREDs of needless interventions-read surgery-in women without the disease. (The argument that if you happen to be the one in the 600 or so who actually had the disease is facile at best, and disingenuous at worst). The argument is Not to tell patients that we are just waitng for Stage 3 to act, it is taking a responsible stand that says I am not going to subject you to a test that lacks the sensitivity and specificity with which to make reasonable treament decisions. Does it make me feel better not to have a good screening test. Absolutely not. Should I give my patients a false sense of security by giving them a test with a sensitivity of 3%(CA-125)? I think not. CA -125 is not a good or reasonable screen. To posture that it is does not serve our patient population, it is tougher to take an honest stand sometimes than to order a useless test and pose like a hero in our pt's eyes.

Pat O'Brien of MD 4:58PM March 18, 2009

We all want to live forever, but we wantonly squander our life each and everyday i.e. we frequently take life for granted and do not live life to the full.So for the weaker sex, off with our breasts and uterus and ovaries by prophylactic surgery maybe someone's choice. But there is a little problem, how can you prevent brain tumours or Alhzeimer's disease. Have a good day, every day!

han 4:43PM March 18, 2009

I am very concerned that we have not progressed further with better testing methods and that we, as patients, must ASK for the very blood test which might aid in early detection of ovarian cancer. I am fearful as well, because I have some of the symptoms and the first specialist I was referred to didn't even perform an ultrasound, even though I had a CT scan showing a large mass "obscuring" my left ovary and left me with the impression I just had ibroids, made no recommendations and gave me pamphlets to read!

F G Franklin of OH 4:32PM March 18, 2009

After reading the above article and being a physician, I could not agree more with the comments posted by Diana Strinati Bauer of PA. Waiting until the ovarian or prostate cancer is symptomatic is irresponsible if there is a safe, reasonable screening approach with good sensitivity and fairly high specificity. Early intervention is key. Prognosis is grim in the later stages.
Early diagnosis leads to early, less (often minimally) invasive and less drastic treatment options.
Screening makes sense!!!

Marc Guerrier M.D. of FL 4:32PM March 18, 2009

We are talking about the principle of "first do no harm." Does anyone remember how politics screwed up science when it came to estrogen replacement? How many women died of heart attacks and cancer because of shrill sexual politics instead of objective scientific inquiry?

CGTodoroff of MI 4:24PM March 18, 2009