David hits the point I am trying to make. The last link I included is clearly showing the confusion coming out of the ACS with regards to prostate cancer. It clearly says that the best way to deal with prostate cancer is with the early detection, and yet it also states that the ACS does not support screening in men.
1> Exactly how do you find asymptomatic early stage prostate cancer without PSA screening? A DRE? It would be just as easy to say that DRE's would cause the same concerns and don't help either. However, in the NEJM, the European study clearly supports screening is helping by as much as 20% in reduction in mortality, even the US study supports this though to lesser degree. And to far too many, Brawley is saying PSA screening does NOT save lives by saying it is misleading to say it does. To me that is a 100% false statement. One he admits to later in the same paper that PSA screening in fact does save 1 in 43. More on those NEJM things later.
2> Brawley states that testing should only be done when doctor and patient have had a thorough conversation about
the test. My point is ~ Exactly what can be discussed to improve what he says is the problem with PSA screening? He also states that folks are saying that PSA testing absolutely saves lives and that he does not agree with that. PSA is a screening test, in itself it saves no lives. It is not a treatment. What it gives a patient is valuable information. The patient can make better informed decisions if AFTER the PSA test when the doctor does a great job explaining the ramifications. The fact is that many patients will require an intervention (remember the ACS says early detection is key). And without PSA screening how will they know that they have treatable prostate cancer?
One more tidbit on the NEJM screening controversy. Those studies clearly are flawed. They have one very huge common flaw. They both skip a younger generation of men. Neither study, nor the ACS, has screening information on men in their 30's and 40's. The question of if PSA screening can help younger men is widely accepted as plausible and likely.
Until such time, I will gladly take the world re-knowned word of Dr. Catalona ahead of Dr. Brawley when it comes to prostate cancer. He has quite a few more prostate cancer patients as I don't believe that Emory College has a world re-knowned prostate cancer program...ACS spends 80% of it's money on Breast, Lung, and Cervical cancers, and the rest on all of the others combined. But it's stature in the press is taken for way more than it's worth in prostate cancer. If anyone wants to donate to prostate cancer research because they have prostate cancer or know someone who does, perhaps they should be aware of this fact before they choose the ACS...
Please note: I respect Dr. Brawley for all the good work he does. But I personally find him to be too obtuse when it comes to prostate cancer and the only tool we have for early detection. As flawed as it is.
Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
Hormone Therapy May '07 to September '09 ~ Currently off.
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (October 7, 2009): <0.1
My journey is at: www.caringbridge.org/visit/tonycrispino
My InfoLink page is at Tony's Prostate Cancer InfoLink Page
Post Edited (TC-LasVegas) : 10/19/2009 2:04:38 PM (GMT-6)