Taking my cue from ShoreGuy, I also emailed Dr. Brawley, as follows:
disappointed and angry that you have spoken out in favor of the USPSTF
recommendation against routine prostate cancer screening.
I consider myself to be a
living example of the need for routine screening. I'm presently 66 years old.
My family doctor began including a PSA test as part of my annual physical when
I turned 50. In recent years, the results went from the 2 range, to the 3
range, to the 4 range, and eventually to 6.2. My internist had been urging me
to see a urologist for the last three years, but I, like many men, considered
myself "bulletproof" and convinced myself that I simply had an enlarged
prostate, as many men my age do. In May of 2010, I finally saw the urologist,
who found a palpable tumor on the left lobe, and a subsequent biopsy found 6
cores positive for Gleason 7 prostate cancer (3+4). In August of 2010 I had a
radical prostatectomy via DaVinci robot, healed quickly, regained continence in
two months, but have lingering ED even now (hey, I'll soon be 67 years
Just what do you think would have been my future had my internist not
insisted on including the PSA test in my annual physicals? My cancer was judged
to be organ contained with PNI, but the containment was pure luck....better
outcome than I deserved for my bullheadedness in not seeing the
The biopsy was a mildly unpleasant procedure. I'd rate it a 1 on a
pain scale of 1 to10. The DRE is something we men don't like, but it's really
not a big deal, and I now have one every six months when I see the uro after my
PSA tests. The surgery was much less painful than I expected it to be. I
didn't even use any of the serious painkillers that were prescribed.
that you tend to characterize the routine PSA tests as mere moneymakers for the
medical profession. Your anecdotal reference to one person who told you that
does not impress me.
Demonizing the PSA test is simply ridiculous. It's a blood
test, and though imperfect, it can and does send an alert that something is
amiss in the prostate. Further testing can determine whether the problem is an
infection, cancer, or something else, and if cancer is found the patient and his
physician can decide what might be the appropriate course of action, whether
Active Surveillance, surgery, or radiation.
The half dozen men in my
acquaintance who have been treated for prostate cancer since my surgery have
handled all this quite well. Two had surgery, several had external beam
radiation. All are doing well. If they have ED or continence issues, they're
dealing with those, and these are certainly not the end of the world. Many
other cancer treatments produce SE's that are a whole lot more serious than the
inability to achieve an erection or having to wear a pad.
I say, keep screening
men. The more the better. But when the biopsy results come back Gleason 6, one
core, low volume, don't rush the patient into surgery. That's where the
changes, if any, to the current way of doing business should take place.
If we do away
with PSA screening, I hope you can deal with the eventual parade of men into
their doctor's offices with symptomatic, advanced prostate cancer. Their
suffering will be on your hands, as well as on the hands of the USPSTF
We all know that a lot of men will welcome the news that they "don't
need" to be screened for prostate cancer. Men already tend to find any excuse
to avoid the digital rectal exam. The message many will take away from all this
is that they should just stop worrying about prostate cancer and that they
should worry more about those horrible, horrible treatments. How sad!
I feel we
prostate cancer survivors have an obligation to become advocates regarding this
issue. The message of the USPSTF will harm a lot of men, and that's a real
He repllied within an hour, as follows:
Attached are the recommendations of 8 organizations
regarding prostate cancer screening.
There is a problem with this test when none of the eight will
just outright say men should be screened. I did not take part in any of the
deliberations of any of the eight, including those of my own American Cancer
If you read my writings
carefully or listen to what I have said in the press, I advocate informed
decision making. I am not against screening I am against duping men into
thinking we have proof it saves lives. I am for informed decision making within
the doctor patient relationship.
keep hearing mortality is going down it proves screening saves lives. Truth be
told, prostate cancer death rates have been declining in 21 countries over the
last decade. 2 of those countries screen for prostate cancer. In the other 19,
there is a lot less overtreatment. Keep in mind that the one thing that we do
know is 60% of men with localized disease as found by PSA need no treatment. We
need a test to figure out who each one is and watch him and not treat
PCa advocates have obstructed
clinical research that might help us find such a test by relying so heavilly on
PSA screening for which every study ever done has either failed to show it saves
lives or showed that it saves very few lives.
You see I actually want to solve this problem and realize
opinions like yours prevent it from being solved.
WOW! I never thought of myself as keeping this problem from being solved. What a nice comment from the good doctor!