I echo Bob's thoughts about
Ralph's commitment to patient advocacy and support groups. And, like Bob, I listen to everything he offers.
One of the statistics that Ralph has echoed time and again is that in the PSA testing era we have seen as high as a 40% decrease in PCSM. This number is a real number but how much reduction can be attributed to screening versus how much has been attributed to improved treatment protocol is an
open debate but I am certain that that reduction can be attributed to both.
Can we ask the AUA and ASTRO to put restraints on their current setting of treating as much as 90% of patients that they care for. It would go a long way of reducing overtreatment but it would have no effect on overdiagnosis. In addition, as davidg's surgeon has
openly declared, he will ignore all guidelines and diagnose and treat as many men as possible. This represents precisely where the USPSTF has positioned themselves in that they do not think that is a realistic goal to solve ODOT.
I don't crunch numbers as well as Ralph, but I will use his 40% reasoning for my next point. If we did not have any form of screening today how many lives would we be losing to PCSM?
Well Ralph's data says 50,000 is about
in the ballpark. (A 40% reduction with all credit given to screening would lower that 50k to 30k which is where we actually are today).
So by diagnosing 250,000 men every year, or doubling that number by extensive screening, we are saving at most 20,000 per year to go with that 30,000 we didn't save. The rest according to the guidelines will largely fall into the overdiagnosed or overtreated category. Now I know that in 1992, there were 43,000 fatalities to PCa. And according to SEER data there were 78,000+ diagnosis in 1992. The numbers may vary, but they won't drastically. So it look like a great reduction rate but in reality we are treating a whole lot more men that won't be saved.
But now to be finally clear. I am for screening men for PCa. I am for reducing the screening but that we must not be locked into any specific guidelines and the AUA takes these things into consideration when you read the document. They say quite clearly that some patients are not comfortable with the guidelines as written and that each patient should be treated on a case by case basis. And that document also says that. If a man wants to be screened at 35, he won't have any issue getting a screening anywhere in the US.
The reason I threw out those ridiculous things in my post was to point out that the USPSTF was ridiculous in suggesting that we end all screening. But somewhere between that position and the screen every man as early and young and frequently as possible position is where we need to place a balance of best practice. And no matter where in between those two points we place that marker it will be a highly criticizable and completely arguable point.
If we can't convince the AUA and the ASTRO members to exercise more restraint, and we do not try to get a happy agreeable median of guidelines
in place that Uncle Sam and the insurance companies can buy into, then we run a real and serious danger of having the USPSTF guidelines becoming the norm.
And all the bickering about
when and whom to test will be moot.
Post Edited (TC-LasVegas) : 5/23/2013 6:56:36 PM (GMT-6)