American Urological Association Statement

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 3/16/2010 11:09 PM (GMT -6)   
I thought you all may like to read a recent letter (e-mail) sent to me from our local USTOO chapter leader in Idaho.
 
It contains what I think is good advice from the American Urological Association.
 
Enjoy.
 
Barry
-----------------
 
  Last fall a statement was published implying that prostate cancer testing was not that important and the message to our government was that this may be a way to cut back on health care. The National Cancer Institute has the following quote on its' website http://www.cancer.gov/
 
 "Using the PSA test to screen men for prostate cancer is controversial because it is not yet known for certain whether this test actually saves lives. Moreover, it is not clear that the benefits of PSA screening outweigh the risks of follow-up diagnostic tests  and cancer treatments."
 
  They basically tried the same thing for breast cancer but the breast cancer coalitions pushed back and the National Cancer Institute backed down.
 
  Well on the eve of the first U.S. Congressional hearing on prostate cancer in 11 years, the American Cancer Society has created more doubts on prostate exams. You may have seen the article in todays' Idaho Statesman on page A7 and we are trying to respond to this.
 
  The American Urological Association has published a response which states:
 
"Prostate cancer testing is an individual decision that patients should make together with their doctor. The AUA believes that all men, with a life expectancy of 10 years or more, should have a baseline PSA test at age of 40. Physicians should determine rescreening intervals for each patient based on PSA (and, on occasion on its change over time). Likewise, the decision to proceed to prostate biopsy should be based not only on elevated PSA and/or abnormal DRE results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and co morbidities. Although prostate cancer risk correlates with serum PSA, there is no PSA value below which a man may be reassured that he does not have biopsy detectable prostate cancer."
 
  What is Us TOO Treasure Valley doing about this? Well take a look at The News of the Week page on our website at
http://www.ustootreasurevalley.org/ . Remember that Idaho has the 7th highest incidence of prostate cancer in the nation according to the Center for Disease Control.
 
  What can you do? Push back. Talk about this to everybody you can think of. Write a letter to the Idaho Statesman.  Let me know if this is important to you and we can publish some of your thoughts on our website or you can send them to us on our Us TOO Treasure Valley Facebook page.
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


Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 3/17/2010 12:33 AM (GMT -6)   
From the National Comprehensive Cancer Network Prostate Cancer Early Detection Panel (including Drs. Catalona, Kawachi, Lange, and Moul, among others):

"It is not clear if screening a man with the PSA test lowers his chance of eventually dying of prostate cancer, or helps him live longer. It is also not clear if screening a man with the PSA test lowers a man's chances of eventually having to deal with the complications of prostate cancer, such as painful spread of prostate cancer to the bones, but the lower rates of advanced-stage disease at the time of diagnosis and the lower rates of prostate cancer deaths suggest that fewer men may suffer from advanced disease. As a result, doctors disagree over the value of screening men with the PSA test. However, it is well-established that screening has been associated with an unprecedented shift in the stages of prostate cancer at the time of diagnosis. More than 75% of cancers are now detected when they are confined to the prostate gland, when current therapies are most effective. The actual relationship to PSA testing however remains unknown, but available evidence suggests that the lower mortality rates may be due, at least in part, to PSA testing. Special studies called randomized trials are the best way to determine how PSA testing affects the death rate from prostate cancer."
...
In summary, there are advantages and disadvantages to having a PSA test, and there is no "right" answer about PSA testing for everyone."
http://www.nccn.org/professionals/physician_gls/PDF/prostate_detection.pdf

As I've written before, the NCCN guidelines are quite detailed and nuanced, and call for the discussion about PSA testing - NOT mass screening - be done at age 40.


From the president of the American Urological Association, in a letter to the New York Times:

"Regarding prostate cancer detection and diagnosis, the American Urological Association does not advocate universal yearly P.S.A. testing, nor does it support routine biopsy.
We recommend that men ages 40 and older talk to their doctors about prostate health and the pros and cons of having a P.S.A. test."
http://www.nytimes.com/2010/03/12/opinion/l12prostate.html

From the American Cancer Society:

"The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. "
http://www.cancer.org/docroot/cri/content/cri_2_4_3x_can_prostate_cancer_be_found_early_36.asp

The NCCN, the AUA, and the ACS - none of these groups advocate universal screening. They all recommend that men talk to their doctors and make an informed decision, and then get a test if desired, after discussing the pros and cons. The ACS has distanced itself a little more from PSA testing than the other groups, is how I see it. (For example, they suggest talking about PSA testing at age 50 instead of 40, unless the man is at high risk).
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1
http://pcabefore50.blogspot.com


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 3/17/2010 1:29 AM (GMT -6)   
The screening saved my life. If I waited until 50, I'd be dead.
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/17/2010 7:04 AM (GMT -6)   
Geebra said...
The screening saved my life. If I waited until 50, I'd be dead.

Geebra, it sounds like you fairly closely followed the American Cancer Society's guidelines.  With a "first degree" relative with PC, your discussion about PSA testing should have started at age 40...and it sounds like it did!  Without knowing much more about your story, I would say kudos to you and your doctor...

Post Edited (Casey59) : 3/17/2010 7:53:18 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/17/2010 7:50 AM (GMT -6)   
Barry, thanks for posting. Finally an article with some good common sense about PSA, testing, and PC. Sure beats a lot of the other stuff I have seen lately.

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


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 3/17/2010 8:21 AM (GMT -6)   
Hi David,

What I liked about the statement is the reasonable approach. Some of the other statements we've seen on the news in the past year are so black and white. I think those statements are misleading as to the reality of how different each person's case may be.

I hope you're doing well today, kind Sir.

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 3/17/2010 9:32 AM (GMT -6)   
Thank you Barry. It was a reasonable approach, I thought that too, and even handed. Ever notice how most things in life that are right, are the things that are balanced, reasonable, and fair, and not on the extreme ends of things.

I don't beleive there is a man here, with a Gleason 7 or higher, that doesn't feel thankful that there was a reasonable avenue for himself after dx.

What scares me in hindsight, is I had never been tested, or if I had refused the 3rd biopsy after much insistence from my uro's gut feeling, that I might not know even know, that I had a fast
moving cancer going on.

Knowing gave me options, no knowing....well...the PC would have got me eventually, and I would have hated myself forever for being too ignorant to follow normal testing criteria.

Hope you are doing well too, my friend

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


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 3/17/2010 4:11 PM (GMT -6)   
Well said, David.

Thank you.

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

New Topic Post Reply Printable Version
Forum Information
Currently it is Friday, September 21, 2018 4:33 PM (GMT -6)
There are a total of 3,005,525 posts in 329,236 threads.
View Active Threads


Who's Online
This forum has 161781 registered members. Please welcome our newest member, Grey Eagle1.
273 Guest(s), 14 Registered Member(s) are currently online.  Details
Georgia Hunter, ksk54, Deep_sleep, mauricesr, Artist Mark, SG091, MG0351, 3timechamp, Depov, Girlie, Chow Wan, ddyss, kittytalk371, jwebb