Prostate Cancer: An Introduction
Prostate cancer is one of the most common cancers among men; the American Cancer Society estimates that approximately one in eight men will be diagnosed with it at some point in their lives.
Prostate cancer is the second leading cause of cancer death in men, after lung cancer. However, most men diagnosed with prostate cancer do not die from the disease.
The five-year survival rate for localized and regional prostate cancer is nearly 100%, thanks to advances in early detection and treatment. Even for men with more advanced disease, treatments such as hormone therapy, radiation, and newer systemic therapies have improved survival outcomes; still, in some cases, prostate cancer can be aggressive and life-threatening.
That said, prostate cancer remains a significant public health concern. The American Cancer Society estimates that approximately 34,000 men in the U.S. died from prostate cancer in 2024. The risk of death increases with more aggressive cancer types, higher Gleason scores, and cancer that has spread to distant organs such as the bones.
In this article we will explore key aspects of prostate cancer, including diagnostic tools such as PSA and the Gleason score, the various treatment options available, and the debate surrounding prostate cancer screening, particularly for men over 70.
Prostate-Specific Antigen (PSA) Test: A Controversial Screening Tool
One of the primary tools used to screen for prostate cancer is the prostate-specific antigen (PSA) blood test. PSA is a protein produced by both normal and cancerous prostate cells, and elevated levels of PSA in the blood can indicate the presence of prostate cancer. However, an elevated PSA level does not always mean cancer is present, as benign conditions like prostatitis (inflammation of the prostate) or benign prostatic hyperplasia (BPH, an enlarged prostate) can also cause high PSA levels.
The PSA test has been at the center of much debate over the past few decades. On the one hand, it has undoubtedly led to earlier detection of prostate cancer, sometimes before any symptoms appear. On the other hand, the PSA test is not a perfect screening tool. It can lead to overdiagnosis and overtreatment of cancers that may never have become clinically significant. Many prostate cancers grow so slowly that they would not have caused harm during a man’s natural lifespan, yet once detected, patients may undergo unnecessary treatments with side effects such as urinary incontinence and erectile dysfunction.
Because of these limitations, the decision to undergo PSA screening should be made after a thorough discussion between the patient and his healthcare provider, considering individual risk factors such as age, family history, and race. Additionally, prostate cancer tends to develop at a younger age in African American men and it is generally recommended that consideration be given to initiate screening beginning around age 45, or even earlier if there’s a strong family history. Additionally, African American men are more likely to be diagnosed with aggressive forms of prostate cancer, leading to poorer outcomes.
In a prior post on medical guidelines, I discussed my personal experience with PSA screening and my diagnosis with prostate cancer.
The Gleason Score: A Key Factor in Diagnosis
Once a prostate cancer diagnosis is confirmed, typically via biopsy, one of the most important prognostic tools is the Gleason score. The Gleason score is a grading system that assesses the aggressiveness of prostate cancer cells under a microscope. Pathologists examine the prostate tissue samples and assign two numbers based on the appearance of the cancer cells. The appearance of cancer cells is evaluated, and each area of abnormal cells is assigned a number on a scale from 1 to 5, with 5 being the most abnormal. (In clinical practice today, grades 1 and 2 are almost never used.) The first number is the most common area, and the second number is the next most common. These two numbers are then added together to give a composite Gleason score between 6 and 10. There is one caveat; not all scores are equal. For example, while 4 + 3 and 3 + 4 both produce a score of 7, the former is more significant because its most common area is of a higher grade.
- A Gleason score of 6 typically indicates low-grade cancer that is less likely to spread and may grow slowly.
- Scores of 7 suggest an intermediate risk, with some potential for more aggressive growth.
- Scores of 8 to 10 represent high-grade cancer that is more likely to grow quickly and spread to other parts of the body.
The Gleason score plays a crucial role in determining treatment options. For instance, low-grade cancers may be candidates for active surveillance, where the patient is closely monitored without immediate treatment. In contrast, high-grade cancers may require more aggressive intervention, such as surgery or radiation therapy. It is also important to recognize that a biopsy may miss an area of high-grade tumor giving an artificially low Gleason score, although with modern use of MRI this is less likely.
Treatment Options
Prostate cancer treatment decisions depend on several factors, including the Gleason score, PSA level, the stage of the cancer (whether it has spread beyond the prostate), the patient’s overall health, and personal preferences.
1. Active Surveillance
Active surveillance is often recommended for men with low-risk prostate cancer, especially those who are older or have other significant health problems. Instead of immediate treatment, the patient is closely monitored with periodic PSA tests, digital rectal exams (DRE), and biopsies to detect any signs of progression. The goal is to avoid over-treatment while keeping a close eye on the cancer in case it becomes more aggressive.
2. Surgery (Radical Prostatectomy)
For men with localized prostate cancer, especially those with higher Gleason scores or younger patients, surgery may be recommended. A radical prostatectomy involves removing the entire prostate gland and some surrounding tissues. While surgery offers the potential for a cure, it comes with risks of side effects such as incontinence and erectile dysfunction, depending on factors such as nerve preservation during the procedure. The newer robotic surgical techniques have fewer side effects than the older open technique.
3. Radiation Therapy
Radiation therapy is another option for treating localized or locally advanced prostate cancer. External beam radiation or brachytherapy (internal radiation) can target the cancerous cells while sparing healthy tissue. Radiation therapy is often used as an alternative to surgery or in combination with other treatments. The side effects are similar to those of surgery, including urinary and sexual dysfunction, though the timing and severity of these side effects may differ.
4. Hormone Therapy (Androgen Deprivation Therapy, or ADT)
Prostate cancer growth is often fueled by androgens, the male hormones such as testosterone. Hormone therapy aims to lower androgen levels or block their effects on prostate cancer cells, which can slow the growth of the cancer. Hormone therapy is typically used in cases where the cancer has spread beyond the prostate or recurred after previous treatment. It may also be used in combination with radiation for high-risk cancers.
5. Chemotherapy and Other Systemic Treatments
For men with advanced prostate cancer that has spread to other parts of the body (metastatic cancer), chemotherapy may be an option. Other newer treatments, such as immunotherapy and targeted therapies, are being developed to improve outcomes for patients with advanced disease.
The Age 70 Screening Debate
One of the most debated topics in prostate cancer screening is when to stop PSA testing. Many organizations, including the U.S. Preventive Services Task Force (USPSTF), recommend that routine PSA screening should generally stop at age 70. The rationale behind this recommendation is that prostate cancer often grows very slowly, and older men are more likely to die from other causes before prostate cancer becomes life-threatening. Moreover, the risks of treatment often outweigh the benefits for older men with low-risk cancers.
However, this recommendation is not without controversy. Some experts argue that healthy older men, particularly those with a life expectancy of 10 years or more, should continue to be screened because they may still benefit from early detection and treatment. Discontinuing screening might result in missing aggressive cancers that could benefit from early intervention. Some studies suggest that older men who continue screening are less likely to be diagnosed with high-risk disease.
As with other aspects of prostate cancer care, the decision should be individualized based on the patient’s health, preferences, and overall risk profile.
Conclusion
Prostate cancer is a complex disease with a wide range of outcomes, from slow-growing tumors that may never cause harm to aggressive cancers that can be fatal. Screening and diagnostic tools such as the PSA test and Gleason score are valuable, but they must be used carefully to avoid over-diagnosis and over-treatment. Treatment options range from active surveillance to surgery and radiation, and the choice depends on the individual patient’s cancer characteristics and overall health. Finally, the decision to stop PSA screening at age 70 should be made on a case-by-case basis, with the goal of balancing the benefits of early detection against the potential harms of treatment.
Prostate cancer is a serious diagnosis, but with appropriate screening and treatment, many men can live long and healthy lives.
The Rise of Cryptocurrency
By John Turley
On April 11, 2025
In Commentary, Politics
What Is It, How It Does It Work, and Who’s Using It?
I’ve never really understood cryptocurrency and as a result I haven’t paid much attention to it. Recently Donald Trump signed his Executive Order “Strengthening American Leadership in Digital Financial Technology. The Executive Order established the “Presidential Working Group On Digital Asset Markets”, to explore the creation of a national digital asset (cryptocurrency) stockpile.
That’s when I decided it was time to find out more about it. And, being a guy, my first thought was to just go and buy some. It turned out to be a little more complicated than walking into your local bank and asking to buy a Bitcoin.
To begin with, the current value of a Bitcoin is in excess of $83,000. Most cryptocurrency exchanges allow fractional purchases, some as low as $10. The transaction fee will run about 20% of a small purchase, so it may not be a particularly good investment at that level. The fee is a lower percentage for larger purchases.
You can purchase cryptocurrency such as Bitcoin through cryptocurrency exchanges. There are at least three reputable platforms available in the United States. Bitcoin can also be purchased in small amounts through PayPal and Venmo.
Once you’ve made your purchase, you’ll have to have a Bitcoin wallet, where you will store your Bitcoins. A digital wallet is like a bank account for Bitcoins but with highly sophisticated security. There are two primary types. The custodial wallet is managed by a third-party service and is easy to use, but you don’t control the privacy keys—a serious consideration if you are making a large purchase. There are the non-custodial wallets where you have full control over your privacy key. The most common of these is the Bitcoin.com wallet. It’s user friendly and mobile according to its website.
One thing to consider. Bitcoin purchases for the most part require full identification including Social Security number. This is based on money laundering regulations. The only exception to this is the Bitcoin ATMs (vending machines) that usually only require a driver’s license number and a cell phone number. However, only very small purchases are available through these ATM’s.
Cryptocurrency may seem like a recent invention, but the ideas behind it go back several years. Today, it’s more than a buzzword, it’s a financial tool, an investment asset, and for some, even a national currency. In this post, we’ll explore where crypto came from, how it gets its value, how it’s used in the real world, and which governments (if any) treat it like real money.
Where It All Began: The Origin of Cryptocurrency
Cryptocurrency’s origin begins with a previously unknown person—or possibly a group—known only as Satoshi Nakamoto. In 2008, Nakamoto published a white paper titled “Bitcoin: A Peer-to-Peer Electronic Cash System.” A few months later, in January 2009, the Bitcoin network was officially launched with the mining of the first block, called the Genesis Block. This marked the birth of the world’s first viable cryptocurrency, Bitcoin.
The purpose was to create a form of money that could operate without the control of governments or financial institutions. Bitcoin was designed to be decentralized, transparent, and secure—made possible by blockchain technology. The blockchain is a digital ledger, distributed across thousands of computers, that records every transaction made in the network. Once data is entered, it’s nearly impossible to change—giving it an edge over traditional banking records when it comes to fraud prevention. Earlier attempts to develop a digital currency like eCash and b-money failed because they couldn’t solve the problem of security: protecting their crypto from unauthorized duplication.
By 2011 Nakamoto vanished, leaving a final message that they had moved on to other things. Nakamoto is believed to have mined about 1,000,000 bitcoins which are still sitting untouched in a known wallet address. At today’s prices Nakamoto’s Bitcoins are worth billions. Why did Nakamoto do it? No one knows.
What Gives Crypto Its Value?
One of the most common questions about cryptocurrency is: “What gives it value?”
Unlike the U.S. dollar, which is backed by the full faith and credit of the government (called a fiat currency in modern financial jargon), most cryptocurrencies are not backed by a either a physical commodity or government guarantee. Instead, their value comes from a mix of:
Cryptos like Bitcoin and its major competitor Ethereum gain and lose billions in value in a single day, driven by news, regulation, and even tweets.
Bitcoins are generated through dedicated blockchain technology which ensures their safety and prevents them from being duplicated. As a result, many people view them as a store of value (digital gold). They can also be used as a medium of exchange although that is less common due to volatility and high transaction fees.
There’s another type of cryptocurrency called the meme coin. They often start as jokes or are done by some people as a source of revenue. They have little or no real-world use. They rely on community hype and social media to generate popularity and value. They don’t have their own blockchain, instead they’re built on top of existing platforms. They’re usually created quickly with minimal technical barriers and their security and functionality vary widely.
The best-known meme coin is the $TRUMP coin. It was released just before Donald Trump’s inauguration. A $TRUMP coin reached a high of $75.35 on January 19th, 2025, but it quickly lost almost all value. A $TRUMP coin is currently worth about 27 cents. The Trump family and their associates made millions on transaction fees while investors lost massively in the market. I would not consider meme coins as a real invetment. If you purchase one, consider it as a hobby.
A new advancement in the cryptocurrency scene is the Stablecoin. This type of cryptocurrency is designed to maintain a stable value. It is usually pegged to a traditional asset like the US dollar, the Euro or perhaps gold. The goal is to offer the benefits of cryptocurrency, like fast digital transactions and decentralized access, without the wild price swings seen with other coins like Bitcoin.
Most Stablecoins are backed in one of three ways:
Stablecoins are designed to a hedge against volatility in the standard crypto markets. They provide the same fast cheap international payments as other cryptocurrency and can provide dollar like stability in countries with unstable currencies. Fiat based coins are generally seen as more reliable because they are frequently audited and are regulated more closely. Others, especially algorithmic ones, have greater risk.
How Is Cryptocurrency Used?
People use cryptocurrency in several different ways, and the list is growing:
1. Digital Payments
Crypto was originally created to be a medium of exchange. Some online and brick-and-mortar retailers accept Bitcoin, Ethereum, or other coins. Services like PayPal and Cash App also allow crypto transactions. However, due to high transaction fees and slow processing times (especially for Bitcoin), it’s not exactly the most convenient way to buy your morning coffee.
2. Investment and Speculation
Most people today use crypto as an investment. Others trade coins daily to make quick profits, a practice known as day trading. Like with the stock market, day trading is a risky business—crypto prices can swing wildly based on rumors or regulatory changes.
3. DeFi (Decentralized Finance)
DeFi is a rapidly growing branch of the crypto world. It allows people to borrow, lend, and earn interest on crypto without going through banks. Platforms like Uniswap and Aave are examples of DeFi services that operate on Ethereum’s blockchain.
4. NFTs and Digital Ownership
A non-fungible token (NFT) is a unique digital asset that represents ownership or proof of authenticity of a specific virtual item, such as artwork, music, video clips, virtual real estate, or even tweets, that is stored on a blockchain—a decentralized digital ledger. Its uniqueness is encoded in metadata and tracked on the blockchain, allowing anyone to verify who owns a particular NFT and ensuring that it can’t be duplicated or counterfeited. (It is beyond me why anyone would spend real money for virtual ownership.)
5. Remittances
Crypto can be a low fee way to send money across borders, especially to countries where banking systems are weak or expensive. Some developing nations have embraced this use enthusiastically.
Is Any Government Using It as Legal Tender?
Yes—but just one (so far): El Salvador.
In September 2021, El Salvador became the first country in the world to adopt Bitcoin as legal tender. That means businesses must accept it alongside the U.S. dollar (which is also legal tender there). The country launched a national crypto wallet called “Chivo,” gave citizens a $30 bonus in Bitcoin to download it, and is even planning “Bitcoin City,” powered by geothermal energy from a volcano.
The move has been controversial. Critics argue Bitcoin’s volatility makes it a poor substitute for cash. Citizens have complained about wallet bugs and transaction errors. On the other hand, the government sees it as a way to attract foreign investment and reduce dependence on traditional banks.
Despite rumors to the contrary, there is no evidence that the US is using Bitcoin to pay El Salvadore to imprison US deportees.
More recently, the Central African Republic is in the process of declaring Bitcoin legal tender, but with far less fanfare and infrastructure than El Salvador. Other countries, like Ukraine, have legalized the use of crypto for payments but stop short of declaring it legal tender. Most other nations take a cautious or skeptical approach.
Is It Real Money?
That depends on how you define money.
Cryptocurrency satisfies some of the classic definitions: it’s a medium ofexchange, a store of value, and (sometimes) a unit of account. But most governments still don’t recognize it as “money” in the legal sense. In the U.S., the IRS treats crypto as property for tax purposes, not as currency. That means every time you buy a coffee with Bitcoin, you technically owe capital gains tax if it’s gone up in value since you bought it.
The Federal Reserve and other central banks are exploring Central Bank Digital Currencies (CBDCs) as an official alternative. These would be government-backed digital dollars, unlike Bitcoin, which is decentralized. Think of it as crypto with guardrails.
Final Thoughts
Cryptocurrency is still in its Wild West phase. It’s a fascinating mix of finance, technology, and ideology. While it’s unlikely to replace national currencies anytime soon, it’s already reshaping how people think about money, investing, and even trust in future assets.
Will more countries follow El Salvador’s lead? Will governments roll out their own digital currencies? Or will crypto remain a fringe asset class for techies and risk-takers? That’s still up in the air—but one thing’s for sure: crypto is no longer just a financial experiment. But I must wonder how good an investment it is if you can buy crypto from a vending machine in a convenience store.
Am I ready to jump into the crypto market? I don’t think so — at least not yet. Well, maybe a few dollars just for fun.