Maybe this will help answer your question. Last May, Dr. Brawley wrote this in an email reply to me. I take these to be his actual personal beliefs:
Indeed I struggle with the"Informed decision" concept. I struggle with the fact that literally we know how many die of procedures related to PCa screening or I should say intervention linked to it. We really don't know if it saves lives.
So many men are cured needlessly and so many relapse after treatment that we really do not know if we cure anyone who needs cure. The European study which is really suspect for quality suggests we cure 2 or 3 per 100 treated. Treatment outcomes studies show we kill !out 1 of every 100 getting surgery. That is so close to a draw at the population level. The three other studies and 5 of the 7 sights in the European study do not give us numbers that good.
At times I prefer selective screening of men at high risk and informing them this is based on opinion interpreting the science and not based on hard science.
I had a friend who died of radiation induced bowel injury while being treated for a 3+3 low volume cancer. He was 73 when diagnosed after a mall screening. I met hom after his radiation. He often told me during his 2 years of suffering that no one ever told him that screening and treatment could do other than help him.
I got several emails from screening widows this week and several from guys who think their lives were saved.
In a separateI email he said,
All of my statements have been for informed decision making. I believe that men should know the truth about screening and treatment which is we have precious little scientific evidence of benefit even though many of us think some men do benefit.
I actually think the written AUA statement is right on as to what we should be doing.
If a man wants screening and treatment I respect and defend that decision.
If a man does not want screening I respect and defend that decision.
I never am surprised if people change their minds and their positions on complex issues. In fact, as Ralph Waldo Emerson once observed, "A foolish consistency is the hobgoblin of little minds."