Posted 5/27/2012 7:29 PM (GMT -6)
From an avid HW reader who posts infrequently. I hope you will read and consider my viewpoint.
I cannot help but notice how much caring is expressed by members of this forum. We embrace the problems of those who appear to be perfect strangers and meet them with compassion and support. So it is natural that when outside forces attempt to interfere with our beliefs, we choose to agree or disagree with the same level of passion. Consider this viewpoint after much careful thought.
The final recommendations of the USPSTF comes as no surprise to us. We saw this coming based on the preliminary report. As a wise person (my wife) told me after I complained the day the final recommendation came out, "Why should you be concerned. You had your treatment. The report is moot for you." While this is somewhat true, I and I think many would agree, the HW community cares deeply for each other and for those who will come after us. I care about those who will come to face this issue in the future.
Basically having males today take to heart the recommendation to skip getting PSA tests became the take home point because it made for a good sound bite, but the part that got lost in the static was the part about making individual responsible decisions. It speaks to the population in a condescending way, treating us like children who cannot decipher a graph, read a technical report or heaven forbid, understand what a doctor is telling us during an office appointment.
Supporter of the USPSFT here at HW mount the argument that the decline in the death totals due to PCa is non-existent. However, my argument is that when anyone examines the research conducted by the centers of academic excellence in this country, the take home message is that the PSA test has done wonders to provide advanced warning of disease in men. Men are being diagnosed BEFORE PCa becomes evident via symptoms, a positive DRE and a biopsy that indicates a high likelihood that the disease has reached an incurable state. The Brady Urological Institute at Johns Hopkins states: "In 1991, before PSA testing was in place, 20 percent of men with a new diagnosis of prostate cancer had tumor that had already spread to their bone. Today that number is less than 4 percent. It’s hard to imagine now, but in 1991, one out of five men had metastases. Today, it's one out of 25. The effect on deaths is equally dramatic. Between 1994 and 2004, prostate cancer deaths plummeted 40 percent -- more than for any other cancer in men or women. But what would have happened if PSA testing and effective treatment had not come along? Using the age-adjusted death rate from 1990 of 39.2 prostate cancer deaths per 100,000 men and applying it to 2007, there would have been 59,000 deaths. Instead, because the death rate fell to 23.5, there were 35,000 deaths."
We know the argument posted by some who say that it serves the best interests of urological surgeons to recommend surgical treatment over active surveillance because of the profit in doing surgery. At 57 years old and working in Washington DC, I have had my share of jaded, cynical thinking and am skeptical about many things. However, in my core, I don't believe that doctors who practice in large, centers of academic excellence are concerned with surgical volume and are merely profit driven. Speaking from personal experience, hospitals like Hopkins are a magnet for people from all over the earth who come for treatment. Doctors there can turn away patients and not be concerned that they will starve to death. They have more than enough business. It is hard to secure an appointment. Further, if we focus on cost, active surveillance is not an inexpensive alternative. The PSA tests, consults, and yearly biopsy requirements canshortly add up to more than the cost of an RP if men adhere to the requirements of that program.
So what really bothers me with this USPSFT recommendation? For me, the thought of turning back of the clock to live once again in the pre-PSA era is horrifying. However, more bothersome is the notion that we are incapable of making sound decisions as to our health treatment choices, especially under the pressure and stress of a diagnosis of PCa. Sadly, the impact on the African-American community will have the greatest repercussions if men accept the message to decline having a PSA test. It is sad that scores of men, the ones who have yet to search out HW because they just got word that they have a problem, may never come our way because they will take to heart the USPSF message and skip the test. The window of potential curability will close shut on them and they will face the trials of multiple drug and treatment regimes in an attempt to buy precious time.
Until we have better testing that can tell indolent, non-life threatening cancers from those that need to be treated quickly and aggressively, our best hope is the current use of the PSA test to indicate that something should be examined further to find out what is going on inside of us. Don't tell me the test should be scrapped and have nothing better to offer. If low volume, Gleason 6 biopsy results with PSA under 10 should not be treated, have all the academic centers of excellence amass the data, run the statistics and tell men that without a doubt the evidence is conclusive that PCa below a certain level should not be treated and above a certain level should be treated. Short of that, I will continue to believe and embrace the NCCN Prostate Cancer guidelines.
Those of you who were treated and cured deserve a level of excellence from our medical system. Instead of condemning the PSA test, institute education on the proper use of the PSA testing for doctors and patients. Curb the overtreatment with education, but don't hinder men by planting the seed of doubt that the test is evil and should never have been implemented.
Good thoughts and prayers to all of you who are in need.
Biopsy: Gleason 3+3=6, PSA 6.6 One core of 12 with 5% T1c
Surgery: July 2010 J. Hopkins
Path: Gleason 6, Neg Mar, Neg LN, Neg Sem Ves
9/15/10 1st post op PSA <0.1 undetectable
3/11 - <0.1 10/11 <0.1 4/12 <0.1
Sept 2010 - 4-5 pads Nov 2 pads, Jan 2011 - 1 pad
Measure pads and leveling off at approx. 10 cc in 24 hours (1/3 oz)
ED: nearly normal again - Excellent with blue pill