Two articles on screening controversies

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Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 3/12/2010 4:00 PM (GMT -6)   
I saw this one on MSNBC today:

www.msnbc.msn.com/id/35834880/ns/health-health_care/

And this on on the InfoLink from Forbes.com:

http://www.forbes.com/2010/03/11/prostate-cancer-health-care-opinions-contributors-marc-siegel.html
Prostate Cancer Forum Co-Moderator


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/12/2010 4:31 PM (GMT -6)   
Tony, I don't like conspiracy theories in the least, but with the barage of stories like you posted, and others in recent months, one can't help but think we are getting set up by the insurance companies in the future for them to deny to pay for tests that people have been told for years to undertake. I thought pre-emptive care with medical matters was suppose to be smarter, and could be cheaper than dealing with things after the fact. Just don't like where this is going.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 3/12/2010 4:59 PM (GMT -6)   
David,
While it's probably no connection, one could argue that why these controversies have gained so much legs in recent months is no coincidence to the health debate dominating our headlines. Insurance companies are profitable and they are fiscally responsible and can make money whether we test or not. The federal government is not profitable and no testing will save money even in just the programs that right now do cover these tests. I'd like to believe that the argument is a healthy phase to better treating future patients. But I am an optimist?

Andrew there are two separate arguments ~ over testing and over treating. But they argument against testing does not save lives, it saves money and in some cases side effects of an "overtreated" patient.

Tony
Prostate Cancer Forum Co-Moderator


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/12/2010 5:14 PM (GMT -6)   
Ohio - my long term GP has openly discussed his fear of lawsuits, he's very meticulous, and dots every "I", etc. He sends out a lot of patients for both tests and to specialists on a daily basis, not because he doesn't trust his own training, experience, etc, but to protect himself from a frivious lawsuit. It's a shame a good doctor has to be that way, but I certainly understand.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/12/2010 5:34 PM (GMT -6)   
I wish the focus would shift. Just in orders of magnitude, if we spend tens-of-millions-of-dollars on testing, we spend hundreds-of-billions on treatment. Most PC does not need aggressive treatment. Energy discussing testing is being spent debating the wrong areas. Lets test everyone starting at age 25; but then lets treat only those that need treating.

In our current fee-for-service health care model, this won't happen. Doctors and hospitals are paid for how much care they provide, not the quality of the care, so one can easily understand how expensive treatments are growing increasingly popular & common. Not to get into a health care reform discussion, but his won't change until behaviors (and incentives) are changed.

My crystal ball sees more active surveillence & deferred treatment if and only if the tiny amounts of detected PC grow marketly worse despite patient lifestyle change efforts to avoid aggressive treatment.

My crystal ball also sees a tsunami of PC overtreatment controversy on the horizon (boosted by the upcoming Scholz book); and then the focus will shift from testing to treatment.

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 3/12/2010 6:01 PM (GMT -6)   
Casey,
I hope you are right, but I think that Tony nailed it about the government trying to reduce costs. With Health care now at 16% of GDP and a large portion of that will now be transferred to the government with the new health care bill, they have to reduce costs or give up other programs. This is just the start of a movement to question the costs of not just screenings but all treatments. The thing that really scares me is that it will become politicized and money allocated for political reasons rather than for the patient's welfare.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 3/12/2010 7:03 PM (GMT -6)   
Purgatory said...
Tony, I don't like conspiracy theories in the least, but with the barage of stories like you posted, and others in recent months, one can't help but think we are getting set up by the insurance companies in the future for them to deny to pay for tests that people have been told for years to undertake. I thought pre-emptive care with medical matters was suppose to be smarter, and could be cheaper than dealing with things after the fact. Just don't like where this is going.

David in SC


You're all getting paranoid. The cost of testing PSA is not that expensive. The reason for most of these recent studies and articles is the resulting over treatment. The cost for radical treatments is not only financial but emotional too. I understand that many here will never admit that they may have well never needed radical PCA treatments but that is the truth. Once again I must state the obvious that it's about those with low risk numbers. If someone has a biopsy of 7+ and/or a family history they should keep getting tested. But numbers don't lie, if it saves only one life has never been a valid argument for me on anything be it lowering the interstate speed limits or saving that one life while lowering the quality of life for 48 other men. Education is what is needed here but if any article comes out wanting doctors to explain the problems with PSA testing to patients beforehand there are many here who jump to conspiracies and more.

Do you all think that because we have Pca that we know more or can question the motives of both doctors that developed PSA? That you all can question the veracity of any well known respected urologist just because you disagree with his recent thinking on PCa and testing? Do you think the New England Journal of Medicine is in cahoots with the powers that be to kill off men for some ulterior motive? If much of the thinking here could be transferred a few years ago to breast cancer, lumpectomies would now possibly be just a clinical trail and most women would still be receiving radical mastectomies.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/12/2010 7:51 PM (GMT -6)   
Realziggy, not paranoid here. I said I don't like consparicy theories, and I don't.

The two issues here are light years apart, testing vs. overtreatment. Perhaps 50 years from now, or less, a person will be able to have a single body scan that can pick up in advance all sorts of maladies, long before they become an expensive treatment issue.

The subject of overtreatment with PC has merit, of course, but still very subjective at best. Who can guarantee the man with a Gleason 6, low PSA, low velocity cancer that it won't turn on him and become agressive. And with any Gleason 7, it makes this process even more touchy and complicated. One modern school of thinking feels that all Gleason 7's should be considered Gleason 8, because of some mix of the "4" cells. Not against AS by any means either, but who makes the rules and standards, and who decides if they are fair or not?

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 3/12/2010 9:06 PM (GMT -6)   
Interesting that another post comes up about the controversy over PSA screening and over treatment. My SIL (I have 5 of them) called and asked me how John's diagnosis of PCa came about. Apparently, a family member of a friend was recently diagnosed, and Cathy (my SIL) was curious about all the recent attention to over treatment. She said to me "it looks like the trend for prostate cancer is to do nothing." Hmmmm...

John T...you hit the nail square on the head. I am reluctant to believe that any of the hype that has come out recently about over testing and over treating PCa has far more to do with politics than with health care.

Like others have said, I think all these new "guidelines" are setting us up for drastic changes in our healthcare.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3742
   Posted 3/13/2010 8:21 AM (GMT -6)   
I've said this before. My PCP was following the guideline recommended by a European study and didn't order a PSA for my 50 year physical. If I had a PSA when I was 50 or 55, when it was presumably 4 or 6 or 8 rather than 23, would I be sitting here in pee pads deciding if it is too late for a shot of Trimix this morning? How much more is my treatment costing because my PCa was found so late? Sadly, there is no way to tell.
Married 34 years, DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 6=3+3. Bone and C/T scans neg.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next See Uro 1/22/10 Trimix #1. Try 0.08- 25%, 0.12-25%, 2/26/10 try 0.16 First Success! 90%.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
12/11 5 months: Still 3 pads per day. 400-450ml/day
2/26/10 7 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/13/2010 5:27 PM (GMT -6)   
Sephie said...
"... drastic changes in our healthcare."
Sephie, you have hit the nail on the head...we need change, and we need it soon before we drown under the unsustainable costs. 
 
Just to be clear, I'm building onto my earlier posting in this thread about treatments—not testing—because the cost of PSA testing is a drop in the bucket compared to unnecessary PC treatments.
 
It is crucial to reduce the unnecessary costs that are dragging down our health system's efficiency.  Unfortunately, we have preverse financial incentives which pay generously for high-cost services while underpaying for primary care, prevention and illness management.
 
I am glad to see & read about the growing energy and enthusiasm behind Active Surveillance/deferred treatment, primarily for the benefit to the patients who have tiny, microscopic amounts of PC but are far too often rushed into aggressive, expensive treatments (that often do more harm than good), but secondarily for the common sense approach to medical treatment that A.S. represents.
 
My crystal ball into the future foretells of more aggressive resistance to aggressive treatments.  Aggressively treat those that need treatment; don't aggressively treat those that don't need aggressive treatment.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/13/2010 10:51 PM (GMT -6)   
Casey, you closing sentence sounds both fair and reasonable, that would be a good sound approach to the overtreatment issue.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 3/14/2010 7:51 PM (GMT -6)   
Hi Tony,
 
Great post.  I read the articles with great interest.  Thank you.
 
Funny story: about one year ago, I was talking with a friend of mine about the increasing pressure on men to opt out of prostate cancer screening.  I joked with him that there would NEVER be pressure applied to women to opt out of breast cancer screening.   Well, in the autumn of last year we heard a barrage of reports on the news, encouraging women to do just that!  Here's just one link on a report from a government task force: http://www.msnbc.msn.com/id/33973665/
 
I do not believe this is a consipracy against men or women.   I believe this is a deliberate action to reduce the "burden" on the health care industry by some governmental and private health care officials.
 
I think the increased screening has really been a good thing.  People are taking charge of their own health care.  They want answers.  I know many men and women who clearly would have died long ago from various forms of cancer had they not been "aware" and proactive and sought screening and treatment. 
 
Try to tell these people that living long enough to see a child or grandchild born,  to see a child or spouse graduate from college, or to celebrate another birthday or anniversary with loved ones wasn't worth seeking out treatment.
 
My mother died recently and she appreciated every moment that she could see another sunrise and communicate with family.
 
It is true that some tests are not necessary and we know that medical science is not an exact science.  However, I see people like those on this forum asking good questions and trying to make informed decisions about their journey in this life.  What more could you ask? 
 
As long as we have choices, we should feel free to make them to the best of our ability in consultation with whomever we have chosen for a health care provider.  We should not allow others to make us feel guilty for making those choices, especially if the tests expose that we don't have a dreaded disease.  What a blessing!
 
You guys are great.
 
Thanks for "listening" to my rambling.
 
Barry
 
 

Surgery: Da Vinci; July 31, 2007; 54 on surgery day;
Pathology: PSA: 4.3; Gleason: 3+3=6; T2a; Confined to Prostate;
Post RP PSAs: 09/07 <0.04; 12/07 <0.04; 03/08 <0.04;
06/08 <0.04; 12/08 <0.04; 06/09 =0.06; 09/09 <0.04;
Latest PSA 12/09 =0.05


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/14/2010 8:07 PM (GMT -6)   
Great words there ,Barry, thanks for posting them
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 3/14/2010 9:05 PM (GMT -6)   
realziggy,

I admire your clear thinking, not to mention your patience and persistence.

Zen9
No family history of PC.  PSA reading in 2000 was around 3.0 .  Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.   
Urologist advised a repeat PSA reading in six months = 4.0 .  Diagnosed May 2008 at age 56 as a result of 12 core biopsy.  Biopsy report by Bostwick Laboratories = Gleason 3 + 3. 
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3. 
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist.  Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.   
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008.  Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear.  Gleason = 4 + 3. 
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances. 
PSA readings: 
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1   
December 2009 = <0.1
 


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 3/15/2010 9:54 AM (GMT -6)   
Zen9 said...
realziggy,

I admire your clear thinking, not to mention your patience and persistence.

Zen9


AW shucks, gee thanks Mister.

Seriously I try although my posts in the past have not been all that welcomed by many. I have to admit though my views are becoming more main stream by the day and at least AS is more tolerated in this forum that it had been, not too long ago
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