Question:

Hello Jim, I have read many of your articles concerning prostate cancer and thank you for the information. A pathology from a TURP in 2008 revealed Gleason 6 adenocarcinoma for me and I have been on active surveillance since. Currently the VA has again sent me a proposal to reduce my disability based upon the residuals. I understand the concept that the VA will never grant a permanent disability for this. I had sent a letter from my Dr saying that I have not received treatment and have a current diagnosis of prostate cancer. They did this before, and the Dr’s letters prevailed. This time it seems that they did not. Previously I sent for a copy of my C&P examination, because the VA advised me that they found a different problem during the test. So, I noted a few mistakes on it. One was that I had had treatment, which I never had. It seems they viewed the TURP as treatment. My, Dr provided a rebuttal letter at that time. This time my C&P was conducted by telephone. I mentioned to that DR that I had just had another TURP performed in MAY 1989 for blockage. His question to me was if that TURP removed all of the cancer. (That was a red flag for me) As the VA did before, they cited inactive disease this time for the reduction. Also they cited an improved condition. ?? Incidentally the sample they tested from this last TURP did not show as cancerous. It was not a large amount of tissue that was examined. The VA is proposing 40% based on residuals. How can they determine residual when I have not received treatment? One residual was waking at least 5 times a night to urinate. The other was daytime urination frequency of less than an hour. Since wearing that CPAP I do not have that nighttime frequency, but the daytime frequency exists. I noted on my last decision that they cited I would be re-examined in 6 months. That language is right out of the regulations and pertains to cancer that has been treated. (right)? Anyhow I have been getting re-examined yearly in the past. I am 80 years old! I have no intention of receiving treatment, as I fear the prospects. Also the Oncologist recommended that this cancer can be slow and I may die of other things first. My PSA has been staying very low these past years. I am almost at a point where I will not appeal. I am thinking it over, but I am at a point where they can wear you down. Here is my question to you. If I accept that 40% reduction, what do you think they will do for future C&P’s for that. Will they continue to hound me? Any other advice you can provide will be respected and appreciated. Regards Leonard

Jim's Reply:

I'm confused and I have to wonder if you really understand just what's going on? The TURP you refer is is a Trans Urethral Resection of the Prostate. The bulk of the prostate is removed through a tube inserted into the penis and then using various instruments to 'shave' away the bulk of the prostate, opening the passage and ridding any cancer that may be there. This is one of the standard treatments for prostate cancer.

TURP is also used for Benign Prostatic Hypertrophy or BPH as the blockage caused by the swollen prostate can cause significant urinary tract obstruction. I can understand why there would be confusion about whether you've had treatment or not.

Most often these days VA will determine the presence of prostate cancer by a simple blood test...the PSA or Prostate Specific Antigen test. If your PSA is high, tell VA you have cancer. If your PSA is within normal limits, your rating will be reduced.