This is a great thread as it allows us to explore an important topic with different viewpoints as well as the addition of new information. As far as the PSA testing is concerned, I am firmly in the camp with those who believe regular PSA testing is a good thing. I have said before...knowledge is power. Armed with the knowledge of PSA score, an individual, IMHO, is better able to make future decisions. Not having that knowledge, again IMHO, is like putting your head into the sand. So, I personally think anyone is nuts to forego regular PSA testing.
Having said that, there is the issue of overtreatment. Personally, I'm a big believer in personal responsibility. No doctor forced me to get a biopsy and no doctor forced me to undertake PCa treatment. I did the research and made informed decisions on both counts. If I get overtreated for anything it's not because I had some test or some doctor made me do it. My treatment is MY decision and if I get overtreated it's because I was to blame.
Re the issue of "watchful waiting", "active surveillance" or, as Johns Hopkins references it, "expectant management", had I had the right stats I would have chosen that course. I didn't and don't regret choosing treatment. Re Tony's comment about John being too general, here are some specific guidelines from Johns Hopkins for patients they allow into there "expectant management" program:
1. Age 60+.
2. T1C, i.e. nothing felt on DRE.
3. PSA density of .1 or less (this is PSA divided by size of prostate, e.g. PSA of 3 divided by prostate size of 35cc equals PSA density of .086 which is less than the .1 threshhold.
4. Gleason 6 or less.
5. 2 or fewer cores of cancer.
6. No core with more than 50% cancer involvment.
So, you can see that these requirement eliminate most of us. In other words, only older men with VERY early state PCa are suggested to consider "expectant management". However, for those that do, they undergo frequent PSA testing and biopsies and, as John mentioned, only a small percentage require treatment after 3 years. Hence, these men don't get "overtreated". To take this approach, however, DOES require a mindset of living with cancer, something many men cannot do, hence their urgency to "get it out". Those men may indeed be "overtreated", but it's because of their own decision making not because they took a PSA test...