So I've been following this thread since it's inception, and while I have my own personal thoughts on this I guess I'm not quite ready to put them here, yet.
What I have found interesting (unless I missed it) is that no one has posted anything about the panel's "Other 4 Proposals" so I thought I would put them out here:
"The Other 4 Proposals"
"In addition to changes in cancer terminology, the 4 other major proposals are wide ranging and varied. The first is a public relations effort. "Physicians, patients, and the general public must recognize that overdiagnosis is common and occurs more frequently with cancer screening," the working group writes. "The trick is to provide the information evenly across all specialties and across the entire United States," Dr. Thompson explained.
Another proposal is to create observational registries for lesions with low malignant potential. This would improve information about related disease progression, which would help in the uptake of "alternative treatment strategies, such as active surveillance," the group explains. Dr. Thompson worries, however, that because registries are an expensive undertaking, they will be the "least likely" of the proposed steps to be implemented.
Another proposal by the working group — designed to "mitigate overdiagnosis" — includes an array of strategies to reduce the detection of indolent disease, such as reducing low-yield diagnostic evaluations appropriately, reducing the frequency of screening examinations, focusing screening on high-risk populations, and raising thresholds for recall and biopsy. "This is already happening," said Dr. Thompson.
"We can, for example, do a fairly good job before a biopsy of the prostate is performed of predicting what sort of tumor is most likely to be found (a slow-growing likely inconsequential tumor or a fast-growing lethal tumor)" with a risk calculator such as the Prostate Cancer Prevention Trial Prostate Cancer Risk Calculator.
Here's the link to the Calculator: http://www.prostate-cancer-risk-calculator.com/
Finally, the working group proposes expanding the "concept of how to approach disease progression." This concept would yield, ideally, alternatives to surgical excision by "controlling the environment in which precancerous and cancerous conditions arise," the group writes. "Strategies such as diet or chemoprevention may be as effective and less toxic than more traditional therapies in lower-risk tumors," Dr. Thompson explained."
Here are the restrictions for using this Calculator:
"The calculator is in principle only applicable to men under the following restrictions:
- Age 55 or older
- No previous diagnosis of prostate cancer (NOTE: You have to put "Never Had a Biopsy" in the final field)
- DRE and PSA results less than 1 year old"
I decided to run my personal stats through the "Calculator" and would recommend everyone do the same - it really gave me pause to think. . . . So then here are my results:
"Based on the data provided, the person's estimated risk of biopsy-detectable prostate cancer is 42.4%.
The 95% Confidence Interval for this prediction is 39.1% to 45.8%.
More information about the confidence interval
The person's estimated risk of biopsy-detectable high grade prostate cancer is 9.5%.
The 95% Confidence Interval for this prediction is 6.1% to 12.8%.
More information about the confidence interval"
To me these results say a couple of different and perhaps conflicting things - on the one hand my estimated risk of biopsy-detectable prostate cancer came in at 42.4%, and of course my biopsy results showed G7 cancer - so then had I NOT gone ahead with the biopsy based on the 42% / at a 95% Confidence Interval I would have been in trouble.
On the other hand, my risk of high grade PCa is only 9.5% - so then does that mean it would have been better to NOT have gone ahead with the biopsy????
Interesting food for thought, no?
I'm wondering if it would be an interesting exercise to put the calculator out here as a new thread, to have others go through the same exercise, and see what the data tells us? Having said that - there is the risk of what we all say NOT to do - don't look back and 2nd guess. . . . . .
56 yrs old, excellent health - DX'd with PCa July '12
9 of 12 Gleason: 3+3 and 3+4 (All neg PNI)
Negative DRE’s / NO / MO / T1C / Gland size 40gm / Vol. 22gm
Volume Study 8/14/12
Casodex 50mg daily 5 wks prior 2 wks post BT
LDR BT 9/21/12 – no issues
3 mo PSA 12/20 0.48!
6 mo PSA 3/14 0.21!
9 mo PSA 6/18/13 0.30!