I think Mike is getting there but as much as I love and respect, and he is a great friend of mine, I don't think his proposal goes far enough. And I think in principal it's great but not good enough. Screening is not a bad word but "mass screening" is. Should every man be educated before they ever do a screening, or "risk stratification procedure" if you like? Absolutely. But if men like me at age 44 are in the "risk stratification" category and I heard to the effect that screening does more ham than good, I likely do not find an early for of advanced prostate cancer at age 44.
My approach would be to educate men throughly when a high PSA is detected, or a lump felt, BEFORE any biopsy is done. This to do a few things:
1> Let the patient know that they are a higher risk for prostate cancer due to the screening.
2> That a continued monitoring is not a bad idea in below 10 PSA cases to determine if there is an aggressive doubling rate of the PSA.
3> If the PSA was high and/or the doubling rate is high, then they should consider a biopsy, and a thorough explanation of the procedure and the risks of infection are also high.
4> Also, to notify men then before a biopsy they need to understand that prostate cancer is common and that these results could prove the presence of prostate cancer that does not need to be treated or treated immediately due to various indicators that we do have.
5> That men be offered classes and that they be encouraged to attend them to better educate themselves before any procedure than is invasive.
Change is tough but in this case the most responsible party is the doctor with whom the patient is considering biopsy with. I would not be against "Screening Centers" where the screening and the biopsy are done by doctors who will NOT be treating the patient. That these centers be equipped with support folks, much like our forum here, and a library and access to videos such as those that Dr. Chodak has put out there at www.prostatevideos.com.
After that you can call it whatever you want. Don't like the word "screening"? I don't like the term USPSTF. If their Grade D recommendation was done ten years ago, what do you tell guys like me? Better yet, what do we tell guys like me ten years from now who did get lucky with a screening opportunity?
Advanced Prostate Cancer at age 44 (I am 49 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Post Edited (TC-LasVegas) : 6/20/2012 8:45:09 PM (GMT-6)