AUA 2010 Press Release...

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Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/1/2010 4:41 PM (GMT -6)   
This might be the biggest news of the AUA 2010 conference....This press release was out just a few hours ago...

Tuesday, 01 June 2010
SAN FRANCISCO, CA USA (UroToday.com) June 1, 2010


Two new studies show that large-scale prostate cancer screening can save lives
Does population-based prostate cancer testing actually save lives and, if so, how many men need to be tested in order to save one life? These questions will be addressed by top prostate cancer experts at the 105th Annual Scientific Meeting of the American Urological Association (AUA). A special press conference will be held on Tuesday, June 1, 2010 at 11 a.m. PDT to share data from two new studies addressing the value of population-based screening efforts.

Early Detection of Prostate Cancer (Tyrol Prostate Cancer Demonstration Project 1988-2008): 20 Years Experience: Researchers in Innsbruck, Austria, evaluated data from Tyrol Austria, where an early detection and treatment program has been in place for more than 20 years and found that these programs have been associated with a reduction in mortality in areas where effective treatment is available to all men. The Tyrol project was started in 1988, offering free prostate-specific antigen (PSA) testing to men ages 45-75 years starting in 1993. In men with organ-confined lesions, prostatectomy was recommended (2,153 radical prostatectomies were performed); 86.3 percent of patients with T1 or T2 disease were treated with low-morbidity radical prostatectomy, 8.7 percent with brachytherapy, and 8.7 percent with radiotherapy. After one year, 95.1 percent of men were continent and potency was persevered in 78.9 percent of men younger than 65 years of age. Researchers found that since 1996, a significant reduction in mortality from prostate cancer has been observed in the Tyrol. In the years 2003-2008, prostate cancer mortality rates decreased by 48 percent, 55 percent, 52 percent, 49 percent, 41 percent, and 64 percent (2008) respectively. Researchers concluded that when screening and treatment are available and free, prostate cancer mortality is decreased by population-wide screening efforts.

What is the True Number Needed to Screen and Treat to Save a Life with PSA Screening? Prostate cancer is a leading cause of cancer deaths in the Western world. One way of decreasing prostate cancer deaths is through screening with prostate-specific antigen (PSA) blood testing. However, the tradeoff between reducing prostate cancer deaths and possible over diagnosis and over treatment is the subject of continuing intense debate. In 2009, prospective, randomized clinical trials of prostate cancer screening reported disparate results, with the Prostate, Lung, Colorectal, Ovarian Cancer (PLCO) trial finding no mortality benefit and the European Randomized Study of Prostate Cancer Screening (ERSPC) showing a 20 percent mortality benefit (30 percent in men actually screened). However, ERSPC estimated that at a median follow-up of 9 years, 1410 men would need to be screened (NNS) and 48 treated (NNT) to avoid 1 prostate cancer death. The most frequently quoted and troubling statistic to physicians and patients alike is the estimate that 48 men need to be treated to prevent 1 PCa death, which is high compared with a NNT of 10 for breast cancer screening. Alternative explanations for a high NNT could be that screening over detects a large proportion of indolent cancers or that the limited follow-up of the ERSPC population overestimated the true NNS and NNT. Using extrapolated data from the ERSPC, a multi-center team of researchers set out to discover the true number of men that needed to be screened (NNS) for prostate cancer and the number needed to treat (NNT) in order to save one life and to assess the effect of follow-up times on these calculations. Based on published ERSPC data, researchers from Chicago and Baltimore estimated the cumulative hazard ratios and NNS/NNT out to 12-years of follow-up. At year 10, the model yielded an NNS of 837 and NNT of 29, similar to the ERSPC report; by year 12, the NNS decreased to 503 and the NNT was 18. The numbers needed to screen and treat to save a life are directly affected by the length of follow-up; thus, we are seeing only the early effects of screening, and more than 10 years of follow-up may be necessary to truly show the value of population-based prostate cancer screening. A prominent feature of prostate cancer screening is that the benefits take a long time to achieve and the true magnitude of over diagnosis and over treatment remain largely unquantified.

"The Tyrol study shows the benefits of freely available PSA testing and the importance of effective treatment once cancer is found," said AUA spokesman Christopher Amling, MD. "Although the ERSPC screening study showed a significant mortality reduction with PSA screening, it also showed that with early follow-up, a relatively large number of men need to be screened (NNS) and treated (NNT) to prevent one prostate cancer death. By extrapolation of data from the ERSPC trial, the researchers from Chicago and Baltimore were able to demonstrate that with longer follow-up the NNS and NNT are significantly lower suggesting that the value of PSA-based screening may be greater than this study suggests."

The AUA believes that early detection of and risk assessment for prostate cancer should be offered to asymptomatic men 40 years of age or older who have a life expectancy of at least 10 years.
Disease:
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/1/2010 4:52 PM (GMT -6)   
This is a significant announcement that shows that the studies in the New England Journal of Medicine last year were both inadequate in guaging the value of prostate cancer screening. the European study was taken from a window of 9 years. I have said all along that 10 year studies and papers are fairly useless in a 20 years disease.

Here is what this is telling us:
The ERSPC document said 48 men will have to be treated to save one life. This based on the 9 year data. This is what many quote here...

However, at year 10 that number was reduced to 29 men needed to be treated. And year 12 it is down to 18 men need to be treated to save one life. Since PSA testing only really became common in the mid 90's, we are just seeing the tip of the iceberg on how effective it is.

The AUA has included a very simplified screening guideline in the last sentence of this press release...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/1/2010 4:55 PM (GMT -6)   
Tony, I think these findings just cement what many of us here have believed all along, the value of PSA screenings.
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, 4/8 .04, next one:  July
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, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/1/2010 9:14 PM (GMT -6)   
TC-LasVegas said...
Prostate cancer is a leading cause of cancer deaths in the Western world.
Not the main point I wanted to make in this post, but my understanding is that this statement is not correct.  Lung cancer is the leading cause of cancer deaths, followed by colorectal cancer and also breast cancer...but prostate cancer is just behind those...a too high number.
 
 
That minor inconsistency notwithstanding, Tony, I assume you were open to, or soliciting for, comments.  I thought I would try to offer something thought provoking...

 

 

In our conversation earlier today in another thread (“AUA Day 2”), you had posted that prostate cancer mortality (i.e., death) is tied to one’s socio-economic status.  You wrote:  There is no doubt that social-economics plays a role in who get proper care and who doesn't. 

 

I agree with this, and in fact your postulation was in response to my comment:  There is an amazingly high number of poor and uninsured men in this country who simply do not visit the doctor for almost any reason. Many never see a doctor in an office; rather, they only see them in the emergency room...which does not lead to a dialogue about the benefits of PSA testing.”  I was commenting about how my own informal study found that most men who die from PC have not had PSA testing at all in their 50's; they waited until they became symptomatic or had other health problems which led to a PSA test in their 60's or beyond.  (Of course, the natural reaction of so many men who (hypothetically) at age 50 have a PSA test, then have a biopsy, and find 5% cancer in 1 of 12 cores is "I'm gonna die!"  This is, of course, hugely irrational, but very natural to think.)

 

So, in disporportionate numbers, it appears that prostate cancer mortality is a "poor man's outcome."  Here’s where I would be interested in inputs from our friends in Canada, UK and other countries with socialized medicine.  The US, as you probably know now, is the only country in the world with health insurance tied to one's place of employment.  Is PC mortality more evenly spread in a system of nationalized healthcare?

 

[Interesting NPR discussion took place recently during the healthcare legislation debates about the historic evolution of employer-based insurance; it basically grew out of WWII when factory wages were frozen across the board by the government, and companies had to find other ways to compete for scarce workforce resources.  Hospitals were just emerging from places where people went to die to becoming places where people went to get well, or to give birth...these were new concepts at the time.  Some innovative hospitals partnered with some large industrial firms during WWII to swap guaranteed business for the hospital in exchange for reduced group rates which the firm offered as an added benefit of employment.]

 

 

Second comment:  PSA screenings are valuable, but I would say (provocatively, perhaps) that this is largely because the PSA test is also only the "best available" screening at this moment in time.  I am hoping for improvement as my son becomes of age.  With such a horrible NNT, it is clear that things need to get better.  To their credit, the AUA statement did recognize this link to overtreatment.  Were there papers persented at AUA 2010 on improved screening?

 

 

 

 

_________________________________________

edit:  fixed some typos and clarified some wording

Post Edited (Casey59) : 6/2/2010 8:49:29 AM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/1/2010 11:21 PM (GMT -6)   
Casey,
The statement is 100% correct. You miss understood one word and that word is "a" and not "the". Prostate cancer is a leading cause of cancer death. While lung cancer is "the" leading cause of cancer death, prostate cancer is the second leading cause of cancer death in men. So 100% correct is the statement...


Also we do agree that social-economics does play a role, I think ignorance and heredity play a bigger role. Men do not take care of themselves as well as the ladies. Getting a man to the doctor is a challenge. Compared to the ladies when seeing an OB/GYN starts in high school, men can have lapses of 20 years or more getting a routine physical. For me it had been 9 years when my doctor turned an unrelated visit into a physical with a PSA box checked. And for some unexplained reason, some men are diligent about their prostates because of family history and they still don't fare well. We have a list of famous rich men that died of prostate cancer and it grew by one this week. Social-economics was not a problem for Dennis Hopper.

While I do not agree that death by prostate cancer is a only poor mans outcome, your post is excellent and provocative.

But I also have a thought to add...

If this finding is correct, and it appears to be, then if at say year fifteen that the number of men saved by prostate cancer screening improves to 1 in 12 men treated. Remember that does not mean that 11 men were over-treated. It means that some of them died of prostate cancer. And some of them actually had an improvement in quality of life by being treated...Remember that treating prostate cancer is outlive prostate cancer and die of something else. If the median aged (64) man gets treated for prostate cancer and lives 20 years and dies of heart disease he will not fall into the category of "cured" by screening...

My provocative thought is that sometimes incontinence or ED from treatment is better than dead in 15 years. Sometimes it is better to outlive the disease through treatment and die of something else.

The numbers is the press release do not reflect which men needed treatment to be able to do so...


Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/2/2010 7:19 AM (GMT -6)   

 

Tony,
 
Yes, I misread the "a" for a "the"; thanks for the correction.
 
Not wanting to turn this into a Dennis Hopper discussion, but in his case I believe it was decades of living as one of Hollywoods most notorious drug addicts, and living as an "outcast" right through the period of his life when he should have been starting PSA testing, which led to him eventually becoming systemic with PC.  He probably never had a PSA test until he started peeing blood and then went to the doctor...sometime in the 2000's.  So, he was on the opposite end of the socio-economic scale from many of our poor and unemployed, but in many ways he was living a wide-open life like many of them do...
 
 
I tried to pick my words carefully, because I also don't believe that PC mortality is ONLY a poor man's outcome...
TC-LasVegas said...
While I do not agree that death by prostate cancer is a only poor mans outcome, your post is excellent and provocative.
...but I do believe (re-using my previous wording) it is so in greatly disproportionate numbers...
 
Frankly, I believe this to be a failure of our existing system of healthcare in this country.  I am not, however, wanting to turn this into a political discussion, although politics, big pharma, influence peddlers, etc. are primarily at fault. 
 
Anyhow, glad to hear that your Father's Day event is in an economically depressed area of town, where the need is greatest.
 
 
 
 
 Finally, to your comment:
TC-LasVegas said...
...sometimes incontinence or ED from treatment is better than dead in 15 years. Sometimes it is better to outlive the disease through treatment and die of something else.
 
No arguement.  I think this comment was intended to support my statement that PSA testing is good only because it is the best available today.  We despirately need a test which is more specific and better able to identify the much more rare aggressive forms of PC so that we can stop the over-treatment.  Until then, the invasion of the prostate snatchers will continue.
 
Thanks for the conversation.
best regards...

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/2/2010 7:54 AM (GMT -6)   
Casey the last comment you quoted was to support that many men that weren't "saved" by prostate cancer therapy in the statistics, still benefitted from treatment by outliving the disease through therapy. And before that I stated some of them men diagnosed using screening, still died of the disease in spite of their therapy. In these cases, they were not over-treated. While still too high, I believe that the ratio of over-treated patients to patients that benefitted from therapy is in favor of those who were treated...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/2/2010 8:06 AM (GMT -6)   
TC-LasVegas said...
While still too high, I believe that the ratio of over-treated patients to patients that benefitted from therapy is in favor of those who were treated...
 
 
Agreed.
 
Don't remember exactly off the top of my head, but to my recollection several sources have estimated the number of PC cases "over-treated" at around 30%.  It's not the majority, but as you said, "...still too high."
 
tks

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/2/2010 9:06 AM (GMT -6)   
Casey,

I think its way out of line for you to imply/insinuate that Dennis Hopper's life-style and life choices were the underlying reason for his advanced PC dx, and subsequent death recently. Sounds a bit on the judgmental side to me. Plenty of Bible reading, Hymn Singing, never cussed or had a drink or smoke men die of PC every year too. Just like men in great physical health die of it, and even life time Vegans die of it.

Its not always the same story that is passed around HW commonly, there are variants of PCa they come on strong and fast. It is not, repeat, not, always slow moving and slow growing. I had a good talk with my radiation oncologist about that very point, and she agreed.

But we don't need to bring lifestyle choices and remarks into the mix. Plenty of rich and famous die of PC too, despite having the best resources available to them. Least let the poor man rest in peace.

David in SC

Post Edited By Moderator (James C.) : 6/5/2010 5:06:54 PM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/2/2010 9:27 AM (GMT -6)   
Purgatory said...
...there are variants of PCa they come on strong and fast. It is not, repeat, not, always slow moving and slow growing...
 
 
You are correct, repeat  cool  , correct, that PC is not always slow moving and slow growing....just most of the time.  
 
 
We are in such great need of moving to the next generation of test which is specific to the aggressive strain so that we can retire the current PSA test.  The current PSA test is the best available today, but the efficacy is poor.  I'm hopeful that the next-generation screening method comes along before my son becomes of age. 
 
Our contributions to the American Cancer Society will help the advancement of research and development for improved prostate cancer screening.
 

Post Edited (Casey59) : 6/2/2010 10:18:16 AM (GMT-6)


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2301
   Posted 6/2/2010 11:34 AM (GMT -6)   
Here was another research finding that was reported in the press regarding PSA velocity

"The team "found that a man whose cancer PSA increased 50 percent each year over the course of the study had a 35 percent risk of having an aggressive form of prostate cancer," while a "man whose cancer PSA increased about five percent each year had about a 12 percent chance of having an aggressive cancer." The method may help "eliminate at least 80 percent of unwarranted biopsies that can lead to surgery in men with elevated PSA levels, said Thomas Neville, one of the study researchers."
PSA quadrupled in 1 yr (0.6 to 2.5)  
DRE negative  1 of 12 biopsies positive (< 5%) 
Open surgery June 2006 at age 57
Organ-confined to small area, Gleason 3+2   
Prostate weight 34 grams
PSA's undetectable  < 0.1  


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/2/2010 11:56 AM (GMT -6)   
Tim,

I am a big believer in the PSA velocity impact with agressive PC variants. It was the rate of acceleration of my own PSA readings leading up to my PC dx that concerned the dr's so much, especially the two years prior to the dx. On paper, it doesnt look good long term for those with high velocity pre-primary treatments, but like anyone else in a group like that, we hope to beat the odds and be on the spared side.

The only thorn I see in the PSA velocity view, is that there are still men with very aggressive cases of PSA with low PSA and low PSA velocity numbers, as usual, nothing is every consistent in dealing with PC.

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, 4/8 .04, next one:  July
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, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/4/2010 8:30 AM (GMT -6)   
Purgatory said...

I think its way out of line for you to imply/insinuate that Dennis Hopper's life-style and life choices were the underlying reason for his advanced PC dx, and subsequent death recently....


But we don't need to bring lifestyle choices...into the mix.

"Today, advanced PC at diagnosis is mostly seen in men who have not undergone periodic PSA testing due to their own neglect or due to neglect that reflects the medical and economic policies of certain so-called 'HealthMaintenance Organizations (HMOs).'"

I should emphasize, again cool   that the work "most(ly)" is used here, not "all."

Time to move on...




.

Post Edited (Casey59) : 6/6/2010 8:44:31 AM (GMT-6)


gold horse
Regular Member


Date Joined Nov 2009
Total Posts : 360
   Posted 6/4/2010 5:46 PM (GMT -6)   
very interestig article thanks.

DIAGN=46 YEARS
GLEASON=3+3
FATHER HAD PC,THEN I THEN MY BROTHER STILL HAS TWO BROTHER PC FREE.
MARRIED,TWO CHILDREN.AGE 13 AND 8.
LAPROSCOPY SURGERY 6/2005
PATOLOGY REPORT.
GLEASON=3+3
TUMOR VOLUME=5%
LYMPHOVASCULAR INVASION=NEG
PERINEURAL INVASION=POSI
TUMOR MULTICENTRICITY=NEG
EXTRAPROSTATIC INVASION=NEG
SEMINAL VESICLES BOTH=CLEAN
MARGIN ALL=NEG
PT2ANXMX
DEVELOP SCART TISSUE AND NEEDED A SECOND SURGERY BECAUSE COULD NOT URINATE,
PSA 6/05=0.04,0.04,0.04,6/06,0.04,0.04,0.04,6/07,0.04,0.04,0.04,6/08,0.04,0.04,1/09
0.04,10/09,0.04
 


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/5/2010 12:39 PM (GMT -6)   
TC-LasVegas said...
Researchers concluded that when screening and treatment are available and free, prostate cancer mortality is decreased by population-wide screening efforts.
 
 
I will deliberately be very apolitical in this statement, but I was surprised that there wasn't more comments at this site strongly in favor of reform/changes to the U.S. healthcare system which would have led to saving lives from PC.  PC mortality is disproportionately a poor man's outcome; healthcare reform would have brought insurance to the 42 million uninsured...1 plus 1 equals 2. 
 
If you choose to reply to this comment, please do also keep your reply apolitical.
 
 
 
 
 
 
.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 6/5/2010 1:49 PM (GMT -6)   
Casey,

Being apolitical, the presence of "health insurance" might have less impact than we think.
It is more likely that the type and parameters around the insurance would be important.

An example - with ultra-high deductible policies being used by a lot of US employers, that first $1500-$3000 of deductible (range in my situation considered there - some are higher) comes out of pocket. Therefore, if "I" don't get sick during the year, "I" probably won't go get tests in general, knowing they will come out of pocket. I hear that a lot from co-workers. Yes, you can save in an HSA to cover them, but that is extra $ out of the paycheck, added to the increased premiums over the last few years, so those living paycheck to paycheck don't save -
OK, that's bad planning - I save the max and can/do use the HSA, so that's not me.

This year, having blown away deductibles and copays with IGRT, sure, I'll update my vaccinations and get everything looked at no matter how small. Oh, drat, now I have to take a half day of my total Paid Time Off, since sick days were done away with when they changed benefit plans - and arrange for someone to cover my work -


So having "insurance" may not mean being encouraged to take time off to take care of yourself.
Granted, my insurance has some wellness provisions. One PSA test a year would be covered (they refused the second that the doctor requested to verify the bad numbers on the first as "excessive", so when I had to pay it, it did not even count against deductible).

Also, when you do get blood work done - dozens of tests, are you thinking PSA, did you ask if it was in there? I didn't, how could it not be in there after all the hundreds of dollars that visit cost? No risk factors, no sign of illness -
It was an observant nurse who realized there wasn't one in my file. She called and asked if they could add it, I said sure, why not? And then Padora's box opened.

I would have been much more likely to get a PSA if I have passed by one of Tony's screenings at a fair, even with my insurance. It's easy to roll up your sleeve if you don't have to leave the office on a weekday to do it, even if your insurance would reimburse it.

OK, so I almost vented, and I hope I was apolitical. But I do see a lot of people who by comparison are well-insured, but still do not get tests. I preferred a workplace some years ago, where they lined you up and did various screening tests on company time. Downside, before HIPPA, if they knew you had something that would be costly to treat .......

Post Edited (142) : 6/5/2010 1:54:15 PM (GMT-6)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted 6/5/2010 2:00 PM (GMT -6)   

Casey, as you requested I will not turn this into a political discussion which is indeed forbidden by Rule #11. 

I have no problem with your premise that broader screening and better health care improves prostate cancer mortality rates.  But "better" is in the eye of the beholder.  I believe it is a stretch to conclude that a specific healthcare reform proposal, e.g. universal health care is necessarily the answer.  In a study (funded by the CDC) of almost two million cancer patients that was reported in The Lancet Oncology, August 2008, it was clear that the survival rate for prostate cancer was highest in the USA...warts and all.  The five year PCa survival rate in the USA was 92% vs. 57% for Europe...where universal health care is...well....pretty universal.

I'm sure there are problems with this study...most of us can find problems with any study...but my point is that I respectfully (and statistically) disagree with your conclusion that recent proposals for healthcare reform are necessarily the answer.

Tudpock (Jim)


Age 62, Gleason 3 + 4 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/5/2010 3:53 PM (GMT -6)   
Thanks for the comments, guys.
 
Yea, I've seen that study, Jim (Tud), and the criticism that most people have with it is that the definitions weren't equivalent; there was a follow-up study that specifically made a point of defining the endpoints equally, and the percentages were much closer...not equal, but much closer.  In other words, the statistics are not so strong.
 
Nonetheless, I would imagine you are in favor of more men having a PSA test as a screening for prostate cancer...correct?  Today, millions of men in the prime age are not being tested.  The most recent count I read was that 42 million people in the U.S. have no insurance whatsoever.  A high percentage of the men who do not get tested have no insurance.  The U.S. is the only—the only—country in the world with primary health insurance through their employer.  We have millions unemployed, and millions underemployed and underinsured (in additional to the un-insured). 
 
So, without universal healthcare, how should we bring about the universal screening and treatment which is necessary to decrease PC mortality?
 
Just for discussion purposes...Not really a question directed to Jim (anyone can reply).  I don't pretend to have the solution.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted 6/5/2010 4:14 PM (GMT -6)   
Casey, I certainly do not have the answer otherwise I'm sure that the bureaucrats would be beating down my door and begging me to divulge it. However this is clearly a very complex issue and one can't just simply wave a magic wand and move to universal coverage and have the answer,  Otherwise the statistics would clearly say that the UK, Canada and many European countries would have a BETTER survival rate...and the statistics do not say that.
 
Tudpock (Jim)
Age 62, Gleason 3 + 4 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 6/5/2010 4:59 PM (GMT -6)   
This post addresses actions between 2 posters, and does not relate in any way to the subject or the discussion in the rest of the thread. Just so you know, if you've lost your program..

Ok, guys cool off and drop the hot tempers. This argument ends now., I try to allow both sides fairly free rein to express themselves, but outright fights and feuds will not be allowed. Since you 2 are making this a public argument, with public slurs and insults, I'll make it public saying stop now, Any further argumentative discussion between you will be deleted. There's no place for ill tempered arguments, slip to the side attacks, belitting or making character judgements. So, I repeat, stop it now. Go outside, look at the sky and think how lucky we are to have what we have, whatever our state is. There's many, many others much less fortunate. We are all here for the purpose of help, support, and education, so let's get back to the point of joining this site. This quibbling amongst ourselves is beneath us and makes us less men for it.

I'm deleteing the offending posts, just so you know. I don't need to quote the rules.
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 110 gms., margins clear
3 Years: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN

Post Edited (James C.) : 6/5/2010 5:10:04 PM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/6/2010 7:17 AM (GMT -6)   
Tudpock18 said...
...this is clearly a very complex issue and one can't just simply wave a magic wand...
 
Clearly.  As we have seen (and as you've said, above, in different words), change won't happen overnight.  Change is difficult.  Especially when plenty of folks are satisfied with the status quo.  We all need to keep working towards changing to improve this situation.
 
In the mean time, we will, I suppose, continue to be dependent on projects like Tony's (TC-LasVegas) Father's Day PSA screening project in an area characterized as "high poverty stricken and minority population" to try to make an impact on PC mortality.   [http://www.healingwell.com/community/default.aspx?f=35&m=1799903]   I coundn't find the number in his posting, but I recall that Tony said he received funding for several hundred tests (and accompanying literature, per ACS guidelines for community screening).
 
We should thank the CDC, the ACS, Health and Human Services, US Too, and individuals like Tony for their effort...big effort in LV, but recognizing it as a drop in the bucket for what needs to be done big picture.
 
Thanks, Jim (Tud), for engaging in a little conversation while keeping it apolitical within the site guidelines. 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/6/2010 7:38 AM (GMT -6)   
Once a year, in my region, the two largest hospital systems team up, and set-up free PSA testing and DRE's for those in need. Since SC has a large population of African-Americans by %, they set up the test centers closer to their neighborhoods. All the tests are free, of course. Last year, I want to say they tested almost 300 men, who by lack of money/insurance probably would have never been tested before. I think its a good thing and wish it was more wide spread than just the urban areas.

BTW, the local newspaper donates free advertising for the event, so there is a bit of a community interest with it.
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, 4/8 .04, next one:  July
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, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17

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