Tell me more.

Commercial Competition, beloved of classical economist, is carried to its logical bellicose conclusion in the American West. Businessman and landowners hire armies of gunmen to shoot down their rivals.

Businessman Lawrence Murphy of Lincoln, New Mexico, resented cattleman John Chisum challenging the cozy control of prices Murphy’s “House” managed with the Sante Fe dealers and officials.

When Murphy sold The House to ambitious merchants James Doland and James Riley, Who tightened its monopolistic price fixing. Chisum put up a strong challenge, aided by lawyer Alexander McSween, and English rancher John Tunstall. Tunstall privately hoped to take advantage of the cutthroat competition and secure monopoly powers in New Mexico himself.

But Doland and Riley persuaded a corrupt sheriff to issue a warrant for Tunstall’s arrest,and the posse that went after him caught him on foot and gunned him down when he was unarmed.

Tunstall’s ranch-hands, already physically threatened by Sheriff Brady and other House roughnecks, feel that they are in a fight to the death for survival.

They are led by a 19-year-old tearaway named William “Billy the Kid” Bonney, who has killed at least one man in a private quarrel. The ferocious “Kid” promises to make Lincoln County’s strife as memorable as the conflict of York and Lancaster.

That is why I have gone back to my old Razor non-smart phone model.

David

First one says, “Windy, isn’t it?”

Second one says, “No, it’s Thursday!”

Third one says, “So am I. Let’s go get a beer…”

A conversation with a male friend inspired me to conduct a review of the latest information on prostate cancer screenings — because men still are getting conflicting information.

This time around, yet another study is raising questions on the usefulness of the popular PSA test… and, as my friend said to me in frustration, what else is there for a guy who’s worried about getting prostate cancer to do?

His angst is understandable — his 52-year-old brother has been undergoing rigorous treatment for prostate cancer that was identified by a high PSA reading in a recent exam. This is not a guy who wants to hear that the test is unreliable so he shouldn’t bother getting it.

I took my friend’s question to Sheldon Marks, MD, associate professor of surgery at the University of Arizona College of Medicine and author of the book Prostate & Cancer: A Family Guide to Diagnosis, Treatment, and Survival. I asked Dr. Marks to explain what men need to know — here’s his guidance…

FACTS FIRST

Prostate cancer is nothing to be trifled with. According to the most recent data, about 32,000 men die of it each year in the US alone. The average age men die at is 80, and 32,000 deaths is quite large enough in my view. It’s understandable, then, why men want any test that can give them an edge.

“PSA” stands for prostate-specific antigen, a protein made by the cells of the prostate gland. PSA tests measure the level of PSA in the blood — a level of no higher than 2.5 nanograms per milliliter of blood is now considered “normal.”

A higher level can be a warning sign of cancer, most especially if the level is rising rapidly (known as “velocity”).

The rap against having regular PSA tests is that numerous studies have demonstrated that the results aren’t all that reliable because there are many false-positives.

For instance, inflammation anywhere in the pelvis can cause an elevation in PSA, as can such everyday activities as riding a bicycle and indeed any “rectal/anal trauma” (though, Dr. Marks told me, hemorrhoids don’t cause this problem).

A high reading from causes other than prostate cancer can, and often does, lead to unnecessary biopsies. Not only does this create a lot of anxiety that may turn out to be unfounded, but the biopsies also have some risks (such as bleeding and infection), though typically not severe.

BACK-AND-FORTH FINDINGS

So now let’s take a look at the back-and-forth research findings. PSA tests became standard for men over age 50 starting in the 1990s, but a 2004 study cast doubt on the old benchmark of 4.0, showing that biopsies often detected cancer in men with a lower level of 2.5.

Dr. Marks told me that most experts continue to believe that tens of thousands of lives are saved every year by PSA testing — yet a 2009 study published in The New England Journal of Medicine showed that no fewer men were dying from prostate cancer with regular PSA screenings than without them.

Then last year, a major study published in BMJ (formerly British Medical Journal) concluded that PSA levels are highly accurate predictors of prostate cancer risk in men at age 60… and now, to add further complication, a study published in the February 24, 2011, issue of the Journal of the National Cancer Institute has said that a rapid increase in PSA levels, which had been thought to be an indicator of cancer, really isn’t a reliable indicator.

WHAT’S A MAN TO DO?

Be aware of your risk level. Men who are African-American and men with a family history (prostate cancer in a father, grandfather, uncle or brother) should consider themselves at high risk and should begin PSA testing at age 40 and then at the intervals their doctors recommend. Dr. Marks tests his low-risk patients at ages 45, 48 and 50, and then annually.

Calling himself a “firm believer in the power of the PSA as a useful tool,” Dr. Marks told me that it’s important to understand that while an elevated PSA does not necessarily mean cancer, it does usually mean something is not right and that further urologic evaluation is appropriate.

“Cancer is just one possibility—it could be enlarged prostate, a prostate infection or bladder infection,” he said, noting that the problem with the PSA test is that not all doctors understand its proper use and how to appropriately interpret the number.

Dr. Marks told me that over his career he has seen significant progress in reducing the number of young men who die from prostate cancer.

“It’s directly attributable to PSA testing and early detection and treatment,” he said, adding that “just last week I saw a patient diagnosed 15 years ago with a very aggressive killer prostate cancer, and he looked great and was still happy, and alive!

To me, the fact that some men have anxiety or stress with a biopsy is far outweighed by the dramatic benefits of saving such men’s lives. There is nothing more sad than to see a man die too young from a preventable or treatable cancer.”

Source(s):

Sheldon Marks, MD, clinical associate professor of surgery, University of Arizona, clinical lecturer, department of radiation oncology, University of Arizona College of Medicine, Tucson.

He is author of Prostate & Cancer: A Family Guide to Diagnosis, Treatment, and Survival, Fourth edition (DaCapo).