Why don't we hear more about this?

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ralfinaz
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Date Joined Jan 2011
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   Posted 4/10/2011 1:57 PM (GMT -6)   
In countries in which the PSA test is more used to detect PCa, the rate of
PCa mortality and trend are down and fewer men are dying of the disease.

U.S.A.'s rate now is 19.8 men per 100K population
In 1994 it was 27.5 per 100K population

Canada's rate is 23.3/100K
In 1994 it was 25.0/100K

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
In 1994 it was 49.3/100K

Cuba’s (Michael Moore’s medical paradise) rate is 40.1 per 100/K population
In 1994 it was 29.4/100K

U.K.'s rate is 34.4 men per 100/K population
In 1994 it was 33.7/100K

Finland’s rate is 31.6 men per 100/K population
In 1994 it was 26.6/100K

We constantly hear about the widespread use of PSA testing in the US. Well, that “widespread” use amounts to a some 55% of men at risk admitting to being tested. That means that 45% do not get tested and are at a higher risk of an advanced diagnosis.

In the countries mentioned above where PSA use is low, PSA testing is in the range of 20% to 7%.

In spite of all this, experts can’t determine that the reduction in mortality since the commercialization of PSA testing is related to its use. As this debate goes on, many men at risk do not get tested, have a higher risk of an advanced disease diagnosis and many more die unnecessarily. Sad but true…

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/10/2011 2:22 PM (GMT -6)   
Ralph,

What you write, is sad but true. For every actions, there is always a motivation. What is the real motivation for trying to downplay PSA testing and its use here in the US? I think we all know the real answer.

As I have always said, its just a simple blood test. Not even expensive. It doesn't have to end up with overtreatments because of the results, that is a seperate issue in my mind. Better and widespread education of pre-PC dx men based on PSA tests could be the defining factor in the future.

There are plenty of low grade case, minimal presence of cancer, that could be monitored with AS or something similar. Downplaying the use or discouraging the use of PSA testing is foolish at best.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

davidg
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Date Joined Feb 2011
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   Posted 4/10/2011 4:23 PM (GMT -6)   
David - could you elaborate? what do you think this motivation is?

Worried Guy
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Date Joined Jul 2009
Total Posts : 3739
   Posted 4/10/2011 4:39 PM (GMT -6)   
I'll jump in here and take a stab at why I think my GP didn't order the test. He did not want to look like he was ordering too many tests for patients. He is part of an HMO and all the statistics are recorded and available. He can appear progressive by saying "There is a study in Europe that shows screening only saves one man in 1000 but results in much unnecessary treatment. Therefore I won't check the PSA box on your blood work for your age 50 physical (actually at age 52)" . He might even get a promotion or a write up about this wise practice in a local medical circular.

His numbers look good. And Kimberly Clark stock goes up because I need extra pee pads. ;-)

I'll bet he knew his PSA when he was 45.
Jeff

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/10/2011 5:33 PM (GMT -6)   
Is this a quiz show question?

If a simple PSA test is discouraged, then less men would be diagnosed with PC, and if they don't know they have it, then they won't seeking treatments, and thus saving millions upon millions of dollars in primary and secondary treatments. That's my opinion. Why else would they be afraid of men having a simple blood screening test?
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/10/2011 5:39 PM (GMT -6)   
isn't there the belief among a few that we are over treated and this starts with PSA tests done too early.

I find that line of thinking potentially dangerous, but my BIL recently experienced it with his own doctor and I think some here have suggested the same.

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 4/10/2011 5:55 PM (GMT -6)   
Over diagnosis and over treatment are currently possible because it is not easy to separate kittens from tigers. That said, with our current diagnostic capabilities along with better and knowledgeable information by both doctors and patients we could reduce this situation. Active surveillance is a possibility for men who are diagnosed with low PSA, low volume of well differentiated cancer. The current situation, in my view, is under detection which results in more advanced disease at diagnosis and potentially worse treatment results. Not many talk about this or explain why a good percentage of treatments for seemingly localized disease fail in a good percentage of men.

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/10/2011 6:01 PM (GMT -6)   
Hi Ralph it is a good post and good for us to see the numbers (thanks), believe it or not Dr. Chodak answered that similar question on PPML.....his thoughts are we have better treatments, protocols and thus improved results for especially USA patients, but if I remember correctly said something about otherwise the numbers thing didn't amount to much difference or such(his words)....best to go to that website and you can search back one week or so and find that discussion, if you are interested in reading his opinion. Myself would look at various doctors of high excellence from all fields of PCa and weigh it all and see what that reveals on this huge question, I know you don't jump at anything one particular doctor makes statements on and we have seen evidences of how that can play out.

There are indolent forms of PCa and aggressive forms, psa alone cannot necessarily distinguish that and exceptions exist, like ultra low psa and known mets happening upon diagnosis. So, yeah like Dr. Strum mentioned years ago in his book, you do alot more than look at psa numbers, you do other marker tests if you know PCa oncology.
Dx-2002 total urinary blockage from PCa emergency room, bPsa 46.6,
12/12 biopsies all 80-95% vol., Gleasons found 7,8,9's, scans appeared clear, ADT3 prior to Neutron & Photon radiations, DES since 2004-5.

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 4/10/2011 6:43 PM (GMT -6)   
Personally I'm glad I insisted on a PSA test starting when I got my new Dr just after moving here and every time I had my "annual" (actually 16-20 months)

My Dr didn't think it was worth doing, (false positives) I insisted, she didn't bother to tell me when the PSA more than doubled in 18 months, said my prostate felt fine at my last exam (uro 2 weeks later felt 1.5cm lump) and is no longer my Dr but that's another story.

Let's face it, PSA saves lives, maybe only 1 in 50 or 500 men is saved by a PSA which doesn't seem like much 'till your that one.
Dave in Durango CO

07-06 PSA 2.5
01-08 PSA 5.5 (Dr never told me)
09-09 PSA 6.5
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5
03-01-10 Age 55 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson
03-16-10 Path' G-8 (4+4+5) Bilateral involving 21% of left lobe, 3% of right lobe, SVI, Focal positive margin, pT3b NO MX

All PSA as of 1-25-11 <0.04

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 4/10/2011 6:46 PM (GMT -6)   
Hi Bob,
Yes, I saw his reply. No question that treatments have improved and are part of the improved results. On the other hand, in the absence of a PSA test, most men would be diagnosed with more advanced disease and the improvement of treatments would not account for such differential in deaths. Early detection plus treatment account for the current improvement.

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 7:05 PM (GMT -6)   
We could pretty much wipe out prostate cancer if we simply surgically removed the prostate of every man at age 40...

As it turns out, a fairly significant percentage of men at age 40 have PC (based on autopsy results of men dying in car accidents, for example)...

davidg
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Date Joined Feb 2011
Total Posts : 4093
   Posted 4/10/2011 7:13 PM (GMT -6)   
they check such details during autopsies after car accidents?

You don't have to remove it out of every man. Don't think anyone thinks that. But if every man at 40 knew he had pc he would be in a position to make a better and very personal choice.

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 4/10/2011 7:18 PM (GMT -6)   
Hi Casey,
That would result in overkill. Most of those autopsy cancers in younger men are far from clinical cases. They tend to be insignificant in volume and differentiation. It is better tor males to have an eight-grade education about PCa risk at that point in their lives to avoid being railroaded...

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 7:19 PM (GMT -6)   
...the saying goes, "the only way to avoid prostate cancer is to die young."


Klotz 2005 study said that among low risk patients, we are currently treating 100 to save one life....repeating for clarity: among low risk patients.

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/10/2011 7:24 PM (GMT -6)   
the other 99 are making a decision to do whatever they do.

the value of the life of the 1 cannot be measured.

Besides, those numbers are dubious at best.

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 4/10/2011 7:27 PM (GMT -6)   
Tell Dr. Klotz to read the Goteborg study. The screened 293 to treat 12 and save one...No need to die young...
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 7:32 PM (GMT -6)   
So we are already surgically removing the prostate of many young men with clinically insignificant prostate cancer who would never otherwise be affected by it in their lifetime...and the PC incidence statistics show that younger and younger, and less significant and less significant PC is being looked for (and therefore discovered) year over year, why not wipe prostate cancer completely out by getting surgically proactive...?

davidg
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Date Joined Feb 2011
Total Posts : 4093
   Posted 4/10/2011 7:38 PM (GMT -6)   
you don't know that. Even someone who is qualified to make such assumptions cannot know that.

Besides, those people have a right to know they have cancer and a right to make a personal choice on how to best treat it.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 7:42 PM (GMT -6)   
Yes, I'm separating the overtreatment epidemic from PSA testing. The PSA test is a lousy test...it is prostate specific, but it is not prostate cancer specific. I have no real issue with testing because we don't have anything better. I think the real shame, which is too slowly changing, is the overtreatment of younger and younger men with less and less significant cancer.

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 7:45 PM (GMT -6)   
...but it is encouraging that more an more leading surgeons and radiation oncologists are stepping forward publicly and saying that we are overtreating. We need to aggressively treat those that need aggressive treatment, and not aggressively treat those that don't need aggressive treatment.

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/10/2011 7:50 PM (GMT -6)   
PSA testing saves lives.

We need to give people the information they need so that they can make sound personal decisions.

As with everything else, people need to be empowered to make such decisions for their own benefit.

normek
Regular Member


Date Joined Feb 2010
Total Posts : 49
   Posted 4/10/2011 7:52 PM (GMT -6)   
I think it should be up to the "younger and younger" men to decide if they want to be treated or not. They have a right to know what disease they have, its up to them to gather all revelant information, and its their decision if they want treatment or not.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 8:00 PM (GMT -6)   
In populations that are heavily screened, the incidence figures increase dramatically...but again, I have no real issue with testing.

The problem, as I see it, is that patients hear the word “Cancer” and want definitive treatment. The word “Cancer” evokes a response which is disproportionate to the natural history of prostate cancer. It is a communication challenge to overcome this…to explain why an aggressive treatment might not be the best choice. There are still too many doctors who are dragging their feet to avoid this, and sticking with the gravy train by rushing their patients into treatment before they get properly educated.

Low risk patients have a significant "window of curability"...basically, plenty of time to see if they really need treatment or not. Studies have specifically been conducted to see if deferred treatment is as good as immediate treatment, and using reasonable trigger criteria they are basically indistinguishable. Don't think the "window of curability" is large? Check the nomograms for low risk patients...

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 8:04 PM (GMT -6)   
My crystal ball says that this question will evolve to an ethical question...with doctors preceived as rushing their patients into aggressive treatments coming out on the short side...

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 8:14 PM (GMT -6)   
...which is why we now see the good ones speaking up publicly about slowing down and not rushing.
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