“The facts are, whether we like it or not, tumour detection and it's (sic: its) subsequent treatment (involving many millions and millions of dollars) has increased markedly as a result of PSA testing, but has not altered in the slightest the death rate due to PCa.”
In the USA this is not accurate. From 1992 to 2007 there has been a 40% reduction in the PCa mortality rate according to SEER statistics.
Then he said:
(2) early treatment is saving many lives but the incidence of PCa within the general population is increasing at a matching rate to the lives being saved. If the later is the case then we need to ask ourselves why the incidence of PCa would be increasing so dramatically.”
Mortality is expressed as per 100,000 population and not as per 100,000 men diagnosed.. Incidence tends to increase with more use of the PSA test. In countries where the use of PSA is higher, PCa mortality has dropped. The opposite is true in countries where the use of PSA is low. Examples:
U.S.A.'s rate is 19.8 men per 100K population
Canada's rate is 23.3
On the other hand, where PSA use is low, the trend is flat or even
increasing and more men are dying.
Sweden's rate is 54.8 men per 100K population
Norway's rate is 45.4
Switzerland's rate is 34.7
U.K.'s rate is 34.4
I thank RV for posting in a better manner what I would have posted if he hadn't beaten me to it
All I can add is the following quotation from one of the best and brightest PCa oncologists:
"With all of the talk about
the hazards of PC diagnosis and
unnecessary treatment, the PSA remains, without any doubt, the best
and most useful biomarker for a common malignancy in the history of
medicine. The problem, dear Brutus, lies within the lack of
perspective of the physicians who abuse the tool or are not sensitive
to the understanding of biology and whether or not invasive
interventions are called for. It is the typical "bull in the China
shop" approach of many of the "scientific" community that screws up
the distinction between the message and the messenger..... So, whatever you do,
say so many doctors, don't order a PSA since a diagnosis of PC may
occur and a physician may remove your prostate or give you radiation
or something else that can harm you.
"The key is to use this outstanding biomarker in the CONTEXT of the
patient's biological milieu. This is not something that is common in
the American landscape. Context is a foreign phenomenon."
--Stephen B. Strum, MD
Dx 2004 at 67 yoa: Extensive Gleason 9 + Gleason 8.
Uro wanted to do cryotherapy, which I would have declined had I known anything. It failed, except I was rendered totally impotent; the only thing that worked as advertised.
IMRT + Lupron.
Studied PCa extensively.
Fired rad onc, who refused to read Dr. Strum's evaluation of my case.
Hired med onc. Have been on IADT since 2006.