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Second opinions

August 09, 2008

Re "Stop prostate exams at age 75, panel urges," Aug. 5

It has been said that older men are more likely to die with prostate cancer than from prostate cancer, meaning that most of these tumors grow so slowly that death is more likely to come from another illness, such as heart disease or some other form of cancer.

But life spans vary widely, and one of the experts quoted in the article said that it is difficult to tell if a recently detected tumor is a fast- or slow-growing one. The decision to be tested for the disease is a personal choice, to be made with the advice of one's physician.

It is irresponsible for the federal government to recommend cessation of the PSA test and prostate biopsies at any arbitrary age, be it 70 or 75, because insurers, including Medicare, may start using the guideline to deny these procedures on the basis that they are not "reasonable and necessary," even for a man who may otherwise live to be 105. HMOs may simply refuse to perform them.

Incidentally, I must take issue with the article's contention that prostate biopsies are "painful." I underwent the procedure a few years ago. It was performed on an outpatient basis; I was sedated and felt no pain at all. It took about two hours, after which I returned home and went about my business as usual.

Fred Dean

Los Angeles

This is a good report about a complex problem.

I agree with Dr. Nick Tomasic that no two cancers or two patients are alike.

The patient and his family, however, should be reminded to question their doctors regarding any proposed treatment: Are there other options for me? What if I do not treat this cancer? What is the expected quality of life after the treatment? What are the side effects of the treatment? And always get a second opinion.

Subjecting elderly patients with coexisting morbidities to major surgeries with questionable overall benefits is as unwise as withholding testing and treatment for healthy men with a reasonable life expectancy.

G. K. Roumani MD

San Marino

The writer is a urologist.

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