UK study of PC screening

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Subdenis
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Date Joined Aug 2017
Total Posts : 575
   Posted 3/7/2018 5:21 AM (GMT -6)   
This study suggests routine screening "without symptoms" is unnecessary and harmful. What I don't get is most of us with PC had no symptoms!

https://www.yahoo.com/news/prostate-screening-saves-no-lives-165020605.html

Erichardson234
Regular Member


Date Joined Sep 2017
Total Posts : 21
   Posted 3/7/2018 5:59 AM (GMT -6)   
Yea that stuff drives me crazy...especially considering the number of us I see here in their early and mid 40's...my screening was certainly neither unnecessary or harmful. I'm grateful for my primary care doc to just happen to test me when he did.
Age 44 @ DX - Only relative with prostate or breast cancer was one great grandfather
PSA on physical 2.7 referred to urologist
DX October 2017 after biopsy G7 (3+4) 3/12 cores
Da Vinci 12/1 @ University of Maryland
Post Surgery Pathology: pT2a, all margins negative, EPE-, SV-, 22 lymph nodes clear

Gemlin
Veteran Member


Date Joined Jul 2015
Total Posts : 714
   Posted 3/7/2018 7:16 AM (GMT -6)   
They misinterpret the result. The study wasn't about a real screening since they only took a single one time PSA test! A real screening program means repeated sampling.

They included more than 400,000 men from Britain. Half received an invitation to have ONE TIME PSA test and the other half (control group) had no PSA test. Only 36% of the men that got the invitation did take the test!

The findings do not support single PSA testing for population-based screening.

Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality
The CAP Randomized Clinical Trial

Everton
Regular Member


Date Joined Jun 2017
Total Posts : 110
   Posted 3/7/2018 7:20 AM (GMT -6)   
Wow I did not find the test unnecessary at all. I had been getting it done since my forties. In Canada we pay for the test to which I have no issues with. I had no symptoms either but PSA was extremely high.
Age 59 when DX
DX Nov 2016
PSA 350
Start Lupron every 3 months
Jan 4 PSA 10.3
Feb 4 PSA 0.60 Feb Testosterone 0.2
Nov scan shows Bone & Lung Mets
Dec radiation to hip
Jan Biopsy 12 samples all positive
Gleason 9 ( 5 + 4 )
Jan Start chemo 6 times 3 weeks apart, Apr 21 done
Docetaxel with Predisone
March start Zometa
April 4 Turp
PSA June .018 Sept .016 Dec .058

BillyBob@388
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Date Joined Mar 2014
Total Posts : 3221
   Posted 3/7/2018 4:26 PM (GMT -6)   
I know, I just never quite understand where they are coming from, that gets them to think:
Somebody said...
Prostate screening saves no lives and may do more harm than good


OK, it definitely is possible for it to do more harm than good, when low risk guys are over treated, I get that. With the obvious cure for that is to crack down on the over treatment and educate the public about this problem.

But when they say "
Somebody said...
Screening for prostate cancer does not save lives, and may do more harm than good, a major study has concluded.

The largest ever trial of PSA (prostate specific antigen) tests - which all men over 50 can obtain on request from their GP - found that death rates were identical among men, whether or not they underwent screening.

Inviting symptomless men for the one-off blood test detects some tumours unlikely to be harmful - while still missing others that were fatal, researchers warned.
, I just don't get it. What do they mean no lives are saved? (plus, are they including extension of life, more years even in the men who finally succumb?

The following chart show that during the PSA era, while the DX of new PCa cases went from 94 per 100K in 1975 to 237 per 100K in 1992 and stayed above 150 through 2009, DEATHS from PCa first increased from 31 per 100K for every year until 1991 to 39.3, where
coincidentally it began to drop virtually every, some might say plummet, until 2014 at a mere 19 per 100K. Cut in half! /seer.cancer.gov/statfacts/html/ld/prost.html

So just how do they argue that PSA screening has not saved lives? As Dr. Catalona said: www.drcatalona.com/quest/Winter04/quest_winter04_1.asp
Somebody said...
PSA began as a detection tool for prostate cancer in 1991, when I discovered, in a follow-up study of my patients, that measuring PSA in the bloodstream could be used as a first-line screening test for prostate cancer.

Before this discovery, the digital rectal exam was the principal way prostate cancer was diagnosed. But, for the most part, by the time a tumor was felt, the disease had progressed too far for successful treatment. Even with treatment, many patients died of prostate cancer. It is the second leading cause of death from cancer in US men.

Fairly soon, the PSA blood test became the accepted method for detecting prostate cancer in the United States and internationally...........


You must admit, that is one heck of a coincidence that PSA screening starts in 1991 and soon after becomes widely accepted, while at the same time DEATH from PC reverses course from increasing every year until that same year of 1991 and falls dramatically after that year. Now I'm sure improved treatment is part of that, but wouldn't even the benefits of improved treatment be reduced if they did not have early diagnosis, as opposed to waiting until there is a clinical manifestation like mets?

What am I missing? I'm not missing that men have been needlessly hurt, and that must be stopped and can be stopped without abandoning the early warning of rising PSA. But how is it that lives have not also been saved?

Post Edited (BillyBob@388) : 3/11/2018 3:23:35 PM (GMT-6)


NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 1159
   Posted 3/7/2018 5:10 PM (GMT -6)   
BillyBob@388 said...
But how is it that lives have not also been saved?



It's really quite simple: total deaths went down, but that change is attributable to improvements in treatments and not to PSA screening.

BillyBob@388
Veteran Member


Date Joined Mar 2014
Total Posts : 3221
   Posted 3/7/2018 5:40 PM (GMT -6)   
NKinney said...
BillyBob@388 said...
But how is it that lives have not also been saved?



It's really quite simple: total deaths went down, but that change is attributable to improvements in treatments and not to PSA screening.


I mentioned that some were saying it was due to improvement in treatments. And as I said, still seems like one heck of a coincidence to me, what with the timing around 1992 of both the big increase in PSA testing and the rapid decrease(as opposed to the previous 20 years of increases) in PC deaths that started at the exact same year. But I suppose there might be a treatment that came on the scene at exactly the same time that has been proven to cut death rate by over 50%,

and would do so even if men were not getting the early treatments that PSA monitoring has led to.

I suppose that is possible, as unlikely as it seems. Would the treatments that we have today still cut the death rates in half compared to 1992 even if we delay treatment by say 5 years? Is there a study that proves that?

Personally, I wish I had started treatment 5 years earlier than I did. And I probably would have if I had not been so stubborn about ignoring rising PSA.
PSA 10.9 ~112013
Bx on 112013 at age ~65yrs, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, G9 down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/14 and all until 9/15 = .01, still .01 9/16, .02 on 3/17,6/17,10/17

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10645
   Posted 3/7/2018 9:16 PM (GMT -6)   
There is widespread misunderstanding about what the word "screening" means. It means that the entire population of men 50-69 get a PSA test. This is the policy that nearly everyone (AUA, ASCO, ASTRO, NCCN, etc.) rejects. I would also point out that a very high percentage (85%) of men who had PSAs over 3.0 went on to have a biopsy. I believe that if they had made an attempt to rule out benign causes, that would be much lower.

The results show why PSA screening is such a bad idea. It makes no difference in cancer detection or survival, and diagnoses excessive numbers of men with insignificant, low risk PC that might never require treatment. But at the same time increases their anxiety and causes rash decisions about treatment. PSA is not the test that should ever be used for population-based screening.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 1159
   Posted 3/7/2018 9:45 PM (GMT -6)   
BillyBob@388 said...

Personally, I wish I had started treatment 5 years earlier than I did. And I probably would have if I had not been so stubborn about ignoring rising PSA.



And at the end of the day what would you have had to show for it? Five more years of treatment, and that’s about all.

“Lead time”

mattamx
Regular Member


Date Joined Aug 2015
Total Posts : 448
   Posted 3/7/2018 9:57 PM (GMT -6)   
I’m biased because I believe an earlier diagnosis would have led to a better outcome for me, but it’s just super hard for me to believe that screening doesn’t save lives. But if that’s what the numbers say, that’s what they say.

BTW NKinney, there is no way you could possibly know that earlier treatment wouldn’t have improved the outcome for myself, or anyone else.

Post Edited (mattamx) : 3/7/2018 8:14:32 PM (GMT-7)


NKinney
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Date Joined Oct 2013
Total Posts : 1159
   Posted 3/8/2018 7:36 AM (GMT -6)   
mattamx said...

BTW NKinney, there is no way you could possibly know that earlier treatment wouldn’t have improved the outcome for myself, or anyone else.



I do 110% agree with you, mattamx...110%. You might get hit by a Mack truck and die tomorrow for all we know (I truly, truly hope not).

But this is where we can reliably draw conclusions from the researched analysis of samples from the total population. High confidence, low margin of error conclusions based on similar cases? Yes. Certainty for any one individual? No. Of course not.




BTW, I just read the interesting new book, "Everybody lies. Big data. New data. And what the internet can tell us about who we really are." The author made a comment that made me pause and say to myself, "yeah, he's right" (similar, I suppose, to what your reaction might be to my comment above).

He wrote (closely paraphrasing from memory), "A medical diagnosis is merely a primative doppelgänger search based on similar cases seen or read about by the doctor." (Yeah, he's right.) The book went into some very fascinating opportunities to use big data doppelgänger searches to do predictive medicine. The potential power and impact of big data in medicine was mind staggering, but also challenges our thoughts on individual privacy and ethics. Early detection of pancreatic cancer makes a powerful difference in outcomes (unlike some other cancer types). If the pattern of your internet searches—made in the privacy of your home—revealed that you were a likely candidate for early pancreatic cancer diagnosis, would you want to be individually notified by "someone" or "some computer program" that you should go get checked out? That would make a good Book Club read. Anyone else read it already?

Anyhow, the conclusions researchers draw from samples of the population are essentially more powerful doppelgänger searches, done so that the doctor sitting in the office with you doesn't have to replicate the effort one at a time...which circles directly back to your original question...

Post Edited (NKinney) : 3/8/2018 9:47:19 AM (GMT-7)


BillyBob@388
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Date Joined Mar 2014
Total Posts : 3221
   Posted 3/8/2018 1:34 PM (GMT -6)   
NKinney said...
BillyBob@388 said...

Personally, I wish I had started treatment 5 years earlier than I did. And I probably would have if I had not been so stubborn about ignoring rising PSA.



And at the end of the day what would you have had to show for it? Five more years of treatment, and that’s about all.

“Lead time”


Most likely, I would have had the same amount of treatment that I have already had, i.e. RP. But it might have occurred 5 year earlier, before SV involvement and positive margins. Or, possibly, with a lower(but still over 4) PSA, a smaller or even non detectable nodule upon DRE, and maybe Bx results not quite so ominous(but still bad enough for treatment), maybe my surgeon would have felt he could spared me one nerve instead of cutting wide all around. And quite possibly, despite not cutting quite so wide thus maybe leving me with less severe SEs, I would have come out of surgery without the positive margin and SV invasion. Or, best of all, maybe with less ominous results, maybe I would have had the wherewithal and courage to do what I should have done in the first place, RT.

Also, what with the big scare it gave me, I would have started my research on non traditional approaches- dietary, supplemental and that might even be helpful, we don't know yet. But whatever I've been doing that has so far MAYBE helped to put off BCR to at least 4 years(checked again in a few weeks) from what should not have surprised me if it had happened at 1 or 2 years. Since even my surgeon told me I had only at best a 50% chance of no BCR, and he seemed to indicate it might well be sooner rather than later. But helpful or not, I would have started all of that 5 years earlier.

So, seems to me I would have been better off knowing about this and taking action 5 years sooner, just as I feel I have been better off not finding out about it 5 years later. Are you actually saying otherwise?

And, are you of the opinion that early diagnoses is of no benefit compared to later diagnosis, probably after PC has escaped the capsule and possibly even after mets are detectable? It sounds like it, but maybe I am misreading you?

And may I ask again: do you know of a study that proves that the 50+% reduction in PC death rate that began with wide spread PSA testing and early detection in 1992 is mostly from improved treatment, and none or very little from early detection?
PSA 10.9 ~112013
Bx on 112013 at age ~65yrs, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, G9 down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/14 and all until 9/15 = .01, still .01 9/16, .02 on 3/17,6/17,10/17

Post Edited (BillyBob@388) : 3/8/2018 11:42:37 AM (GMT-7)


NKinney
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Date Joined Oct 2013
Total Posts : 1159
   Posted 3/8/2018 2:35 PM (GMT -6)   
BillyBob@388 said...

And may I ask again: do you know of a study that proves that the 50+% reduction in PC death rate that began with wide spread PSA testing and early detection in 1992 is mostly from improved treatment, and none or very little from early detection?




Your earlier question was quite different...and in fact it didn't make sense so I ignored it. You wrote: "Would the treatments that we have today still cut the death rates in half compared to 1992 even if we delay treatment by say 5 years? Is there a study that proves that?"

Moreover, this 2nd, different question doesn't make sense either.

There's an old saying:
    The easy way to tell real scientists from hacks and wannabes is that real scientists never use the words "scientific proof" because they know no such thing exists; anyone using the words "proof," "prove" and "proven" in their discussion of science is not a real scientist.
Proofs are not the currency of science. You've been a member here since 2014; I'm a little surprised this fact hasn't caught on with you yet. I hope this explanation helps...not only in understanding this thread, but many others, too.

Proofs exist only in mathematics and logic, not in science. Mathematics and logic are both closed, self-contained systems of propositions, whereas science is empirical and deals with nature as it exists. The primary criterion and standard of evaluation of scientific theory is evidence, not proof. The currently accepted theory of a phenomenon is simply the best explanation for it among all available alternatives.

The conclusion of the currently accepted theory on PSA screening (as well as the "answer" to your convoluted question) is contained in the original poster's link...if the benefits of PSA routine screening outweighed the harms, the conclusion would be different. Not having any sort of scientific foundation, you might choose to think that there's a conspiracy theory out there which is making all this up...but that's not what the rational scientific community believes. To each their own.

Post Edited (NKinney) : 3/8/2018 1:59:59 PM (GMT-7)


alephnull
Veteran Member


Date Joined Dec 2013
Total Posts : 881
   Posted 3/8/2018 4:20 PM (GMT -6)   
Some people sound just like JackH.

A sample of one, me.

If I had been screened earlier, an RP would have been curative.
My PSA Curve
Previous PSA
Curve

Treatment Path
My Blog

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 9377
   Posted 3/8/2018 4:26 PM (GMT -6)   
43.7% of all statistics are made up on the spot.
I'll be in the shop.
Age 58, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Manticore
New Member


Date Joined Mar 2018
Total Posts : 17
   Posted 3/8/2018 4:41 PM (GMT -6)   
I have friends who have made major investment of energy in very strong quality of aging using data from the major aging research centers in the US. Along with that approach they do not take PSA or similar tests even though they are close to 70 . It is an interesting approach.

I do understand the large population overview where psa screening does not seem justified given the small difference in mortality from this large macro perspective, even though there is lots of misunderstanding in the various analyses. On the immediate level, PSA seems very important as a signal, and each choice and opportunity along the way seems like it makes a world of difference. It would be nice if there were more linkage between the macro level and the immediate level.

I am so aware of the big business aspect of health. I call it the Health Military Industrial Complex which has replaced the "Military Industrial Complex" concept of the 1960s. When I got my first PSA test and I went to urology and they were going to immediately take the 12 cores, I had researched a bit and found something reporting Side Effects to the taking of cores. I decided to decline. The nurse practitioner explained to me that 12 cores was the "gold standard" for treatment with my psa (11.2). I tried to explain that the "gold standard" generally was exactly what I did not want to follow in medicine given how the overall system (Health Military Industrial Complex) was so driven by cutthroat capitalism.

Later I learned about the billion dollar race in the pharmaceutical industry to come up with a better test than PSA. I learned that the efforts to date, had failed to replace PSA which was a $5 test at the time. Then the PSA test became a hero to me in retarding higher cost tests. There are some analyses of Robotic Assisted Radical Prostatectomy that it has not significantly improved outcomes (trifecta of avoiding biochemical failure, preserving continence, preserving potency) though it has made for less loss of blood and faster recovery, neither of which justify the major additional cost. (still a debate here)

After two fusion biopsies, one transrectal where I was fully awake with M.D.s-in-training who seemed to make a mistake (yikes) and one transperinial with anesthesia, I wanted to go back to that nurse doing hundred of 12 core biopsies every year, and have her do it. Our perpectives change with further knowledge.

My point is that we all have our set we come in with, some of which is in error. And there are many steps in correcting those errors of understanding. I appreciate this list in helping clarify those errors. Manticore
2015 Dx. PSA 11 at 65. TRUS fusion: lesion along capsule—4 targets negative. 12 cores, one 7(3 + 4)
2016-17: 2 Consults with Klotz (Toronto)
12/2017 PSA 17, TPUS fusion biop. 4 Lesion cores: one 7(4 + 3), two 3 + 4s. two more 3 +4s in 12 cores. Prostate size: 34cc
Recent: consults wi R.Chen, Nielsen--UNC, Polascik, Klotz, P. McLaughlin. Awaiting PET scan results.
DRE's: normal

BillyBob@388
Veteran Member


Date Joined Mar 2014
Total Posts : 3221
   Posted 3/8/2018 9:14 PM (GMT -6)   
NKinney said...
BillyBob@388 said...

And may I ask again: do you know of a study that proves that the 50+% reduction in PC death rate that began with wide spread PSA testing and early detection in 1992 is mostly from improved treatment, and none or very little from early detection?




Your earlier question was quite different...and in fact it didn't make sense so I ignored it. You wrote: "Would the treatments that we have today still cut the death rates in half compared to 1992 even if we delay treatment by say 5 years? Is there a study that proves that?"

Moreover, this 2nd, different question doesn't make sense either.

There's an old saying:
    The easy way to tell real scientists from hacks and wannabes is that real scientists never use the words "scientific proof" because they know no such thing exists; anyone using the words "proof," "prove" and "proven" in their discussion of science is not a real scientist.
Proofs are not the currency of science. You've been a member here since 2014; I'm a little surprised this fact hasn't caught on with you yet. I hope this explanation helps...not only in understanding this thread, but many others, too.

Proofs exist only in mathematics and logic, not in science. Mathematics and logic are both closed, self-contained systems of propositions, whereas science is empirical and deals with nature as it exists. The primary criterion and standard of evaluation of scientific theory is evidence, not proof. The currently accepted theory of a phenomenon is simply the best explanation for it among all available alternatives.

The conclusion of the currently accepted theory on PSA screening (as well as the "answer" to your convoluted question) is contained in the original poster's link...if the benefits of PSA routine screening outweighed the harms, the conclusion would be different. Not having any sort of scientific foundation, you might choose to think that there's a conspiracy theory out there which is making all this up...but that's not what the rational scientific community believes. To each their own.


Oh no! Please not another "scientist" telling me how I don't understand science! Your apparent conclusion that there is no advantage to early diagnosis and treatment, and that the plummeting death rates that started the very year that the testing and early diagnosis started is all really do to a huge advance in treatment that started in the same year, is what does not make any sense. Your apparent conclusion- which you seem to think is a scientific conclusion- that it is all the treatments with no help from early diagnoses, that is what makes no sense. Unless you have- if not proof- evidence? Some studies?

You are side tracking/building a straw man with an argument about "telling the TRUE scientists from the hacks"by saying the hacks demand proof when no proof can ever exist in science. Yet, you make dogmatic statements such as "It's really quite simple: total deaths went down, but that change is attributable to improvements in treatments and not to PSA screening.". Well, if you have no proof, because proof can never exist, then how can you be so sure that is the explanation?

I don't think I will be catching on to something that makes no common sense, if by that you mean I should catch on to the theory that despite death rates plummeting from the year that PSA testing(and the early diagnosis that goes with it) started that it is not due to the early diagnosis but only due to improved treatments which apparently became widely available the very same year. I think I should have reprinted an article I read recently titled something lie "Science's War on Medicine" but I did not do so because I did not want to start a bunch of stuff. But maybe I should?

I think you ignored my earlier question, and my 2nd version of it, and went off on a straw man building adventure about how unscientific I am, because you do not want to answer that question. And you still have not done so. I will try a third time. Do you, or do you not, believe- that there is an advantage to early diagnosis of cancer, PC as well as other cancers? Or do you, conversely, feel we will do just as well if our cancers- and especially PC- is diagnosed at an advanced stage?

Do you feel that your odds of long term survival if you were diagnosed with wide spread mets and a PSA of 2000 is the same as it would be if you were diagnosed while still completely contained in the prostate? Please, just a "yes, odds of survival are the same, or "no odds of survival are not the same" this time, rather than some ad hominem about me being an scientific hack compared to you.

Man, I hate to see a simple discussion deteriorate into accusations against some one with a different opinion. Why does this happen so often? But I sure do long for your yes or no answer!

BTW, even though you say about me "Not having any sort of scientific foundation", and I believe you used the word "hack", I actually did have a biology, anatomy, physiology, chemistry, physics, heck even botany class or two along the way to getting my degrees. 1st in Nursing and later during a degree in anesthesia. All followed by a required minimum 20 hours a year of continuing education X 36 years in anesthesia in order to keep my license. Many of those classes claiming to be about science stuff like gas laws and such and stuff they called "medical science". So despite my obvious lack of understanding all of this science stuff, I actually do have at least a minor scientific foundation. As I once asked another fellow here who tends to make such statements about other folks, if you don't mind me asking, what is your scientific foundation? He never did answer me, but maybe you will, along with answering the previous question? But no matter. Even if you have a Ph.D. in Astrophysics or biology or chemistry, your concept that the plunge in death rates had zero to do with early diagnoses(which you appear to believe) seems illogical.

And if you don't have proof- because there can never be proof in science- do you at least have strong evidence? Maybe evidence can exist? Maybe there was a huge advance in treatment that occurred in 1992 that accounts for all improvements in death rates that started in 1992? You probably have a study showing strong scientific evidence of that. That is all I need, is the study or studies. Do you have them? Being unscientific as I am, if you have strong studies I will go ahead and call that proof, as we laymen are prone to do.

I hope the thread does not get closed. I guess I should not have responded.

Post Edited (BillyBob@388) : 3/8/2018 7:30:13 PM (GMT-7)


NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 1159
   Posted 3/8/2018 9:22 PM (GMT -6)   
That's a lot of blah, blah, blah.

It's not important what I think. Read the darned link in the OP...your answer is (still) right there.

It's time to move on. This feels like I'm having a conversation with a fence post.

Post Edited (NKinney) : 3/10/2018 6:05:54 AM (GMT-7)


BillyBob@388
Veteran Member


Date Joined Mar 2014
Total Posts : 3221
   Posted 3/8/2018 9:34 PM (GMT -6)   
NKinney said...
That's a lot of blah, blah, blah.

It's not important what I think. Read the darned link in the OP...your answer is (still) right there.


Blah, blah, blah, you will not answer because you have no answer. If it is not important what you think, why do you keep telling me how it is? Face it: the reason you won't answer is because you know darn well that- proof or no proof- if you have a potentially deadly cancer, you want it diagnosed now, while it might be contained, rather than 5 or 10 years from now, when you have symptoms and wide spread mets. Don't you? Why do I ask? It is useless.

BillyBob@388
Veteran Member


Date Joined Mar 2014
Total Posts : 3221
   Posted 3/11/2018 8:14 PM (GMT -6)   
Gemlin said...
They misinterpret the result. The study wasn't about a real screening since they only took a single one time PSA test! A real screening program means repeated sampling.

They included more than 400,000 men from Britain. Half received an invitation to have ONE TIME PSA test and the other half (control group) had no PSA test. Only 36% of the men that got the invitation did take the test!

The findings do not support single PSA testing for population-based screening.

Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality
The CAP Randomized Clinical Trial


Hey, WTH, I am just seeing your point, Gemlin. One lousy PSA? And based on that a very small additional # ended up being Dx'ed with PC(4.6%) over the next 10 years as opposed to the men who were not in the original PSA group(3.6%)? (were they all diagnosed at the time of the one PSA, or later after symptoms?)

Well, how did any of them end up Dx'ed? Were there additional PSAs? Apparently not. So, did they end up with guys in both groups who were later diagnosed only when they got symptoms? I'm starting to suspect this is one of the studies designed to fail, i.e. fail to show a benefit, like Vitamin D studies that rather than comparing against a placebo, compare against an already plenty adequate dose where most of the benefit may have already been obtained? Something stinks.

So, is this right, they only took ONE PSA and then 10 years later checked to see how many were dead from PC in each group? Well isn't it at least possible that while there a small # diagnosed with what was probably on average low risk PC in the PSA group at the time of the PSA, that both groups had an equal # of men who LATER developed high risk PC, which went without being diagnosed for 10 years until it killed about the same # in both groups?

Good grief, as I am always saying, you really have to watch your studies for bias and being designed to give a probable result. I can't believe that based on such flimsy evidence they would make such a bold statement. I wonder why they didn't go ahead and do a more thorough study like following DREs and PSA trends over that 10 year period? Although, the declared result it is accurate as far as it goes, I'm just not sure it is very useful info.
Somebody said...
Among practices randomized to a single PSA screening intervention vs standard practice without screening, there was no significant difference in prostate cancer mortality after a median follow-up of 10 years but the detection of low-risk prostate cancer cases increased. Although longer-term follow-up is under way, the findings do not support single PSA testing for population-based screening.


I almost feel like saying "well, duh". So they are telling me that 1 single PSA failed to diagnose a roughly equal # of men(compared with zero PSA group) who turned out to harbor PCs that ended up killing them? That does not strike me as all that unexpected. If I had only gone by 1 PSA (1 point something) that I had 10 years previous to my diagnoses(PSA 10.9), I would not have been diagnosed until I had obvious symptoms.(and I should have had the biopsy when I hit 4.1, which would have diagnosed me several years earlier!) Wouldn't that put me in the same dang boat as the guy who never had any PSA to start with and was not diagnosed until he had obvious symptoms? Both in a sinking boat I might add? The only way PSA led most of us to a diagnoses - and hopefully even for us very high risk guys a diagnoses before symptoms- is by way of watching the trend of a rising PSA over several years. It appears that neither group in this study had the advantage of that. Hence, an almost equal % died of PC.

You don't suppose this is a study designed by folks who do not want to pay for screening NOR do they want to pay for possible lifetime of cancer treatments? Probably not, I am maybe being too cynical. But it sure seems it could have been a lot better study giving us a lot more useful info. I will say this: they have given strong evidence that if you do only one PSA and then check PC death rates 10 years later, it is not going to be of much use.

Post Edited (BillyBob@388) : 3/11/2018 7:30:14 PM (GMT-6)


Skypilot56
Veteran Member


Date Joined Mar 2017
Total Posts : 737
   Posted 3/12/2018 12:09 AM (GMT -6)   
Billy I understand your frustration with a certain individual here. It's kinda strange I have asked many times if any body has ever seen his signature? Can't believe that someone who as experienced this disease can be so critical of others. I think we have to be very careful of how we interpret all these studies. I don't believe there is anything wrong with guys getting screening. It's what happens afterwards is where the trouble starts. I for one will have to agree with you that most of the time earlier detection in intermediate and higher risk patients would absolutely have been better could have changed treatment options and possibly the outcome. If one doesn't believe that Then why are they on here and why have they had some sort of procedure done since they could have just lived with PCA and had the same results? I was with a lot of gentlemen down at the hope lodge with PCA that had metastasized and every one of them i talked to all said the same thing " Wished we would have found it earlier!" Of course maybe it was just a lot of blah,blah,blah

Larry
Male 62 DX @ 60
Dad had PC
2002. Psa. .08 Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo, Mn
Gleason 9, pt3b, SV + 1 nerve, N-Margins 35 LN removed clear
Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia
6-13-17 psa 0.13
7-19-17 psa 0.12 3TMRI with coil - clear
10-11-17 psa 0.16
10-12-17 Lupron
12-13-17 psa <0.10
12-18-17 SRT
2-7-18 SRT done 72gy

BillyBob@388
Veteran Member


Date Joined Mar 2014
Total Posts : 3221
   Posted 3/12/2018 9:15 AM (GMT -6)   
Skypilot56 said...
Billy I understand your frustration with a certain individual here. It's kinda strange I have asked many times if any body has ever seen his signature? Can't believe that someone who as experienced this disease can be so critical of others. I think we have to be very careful of how we interpret all these studies. I don't believe there is anything wrong with guys getting screening. It's what happens afterwards is where the trouble starts. I for one will have to agree with you that most of the time earlier detection in intermediate and higher risk patients would absolutely have been better could have changed treatment options and possibly the outcome. If one doesn't believe that Then why are they on here and why have they had some sort of procedure done since they could have just lived with PCA and had the same results? I was with a lot of gentlemen down at the hope lodge with PCA that had metastasized and every one of them i talked to all said the same thing " Wished we would have found it earlier!" Of course maybe it was just a lot of blah,blah,blah

Larry


Thank you, Larry, for what seems to be a rational approach. I also am not expecting many to argue in favor of later detection, unless possibly for the low risk. I am fairly aggressive myself in arguing against what happens to so many low risk guys, and campaign strongly against that. That is where the problem is: uneducated patients- let's face t, that is most patients- demanding that a surgeon get it out of there. Combined with surgeons who are all too happy to either comply with such demands, or who actually influence the patient to needlessly go that route. And then destroying some of those men's QOL. That is what must be stopped. I am going to do my part, at this forum and any men I talk to. But admittedly, any advice coming from me- compared to from someon's trusted physician- is not likely to have much influence! But we can and should all keep at it. Men must be made aware of the frequent over treatment and the price they pay. That is the problem, not a blood test that alerts some fewer # of men to an aggressive cancer at an earlier stage.
PSA 10.9 ~112013
Bx on 112013 at age ~65yrs, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, G9 down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/14 and all until 9/15 = .01, still .01 9/16, .02 on 3/17,6/17,10/17

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2680
   Posted 3/12/2018 9:52 AM (GMT -6)   
I had posted a comment but decided to delete it. Let me just say that this thread contains some excellent examples of the rudeness and the dismissive attitude that has driven some of us off this forum. A reality which, I'm sure, is quite pleasing to a certain poster.

BTW, thanks for some excellent insights, BillyBob.

NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 1159
   Posted 3/12/2018 10:44 AM (GMT -6)   
BillyBob, there are many, many points on which we can agree. You have just listed many.

Let's see if we can constructively build upon this atmosphere of agreement:

1. Do we agree, also, that nobody has rationally suggested stopping all PSA testing?

2. Do we agree, also, that there have been studies which have concluded that routine PSA screening has not been shown to save very many lives--some earlier studies concluded no lives, others concluded few lives which result in more harm than benefit.

(I'm going to highlight that these two simple questions utilize 2 distinctly different terms which have been previously described in this thread: testing and routine screening.)

Can all of these points—from your last post plus these two—co-exist in your head simultaneously? Some people seem to have trouble with all these...balancing/separating their emotional side from their rational side.

Post Edited (NKinney) : 3/12/2018 12:07:46 PM (GMT-6)


alephnull
Veteran Member


Date Joined Dec 2013
Total Posts : 881
   Posted 3/12/2018 11:40 AM (GMT -6)   
Hmmm, I really try to stay out of the scuffles that occur. But sometimes I feel the need to point out the similarities of one poster in this thread and another poster who hasn't been seen since last year. A poster that I used to routinely get into it with.

Abrasiveness, condescension, and accounts that were created on the same day within an hour of each other (45 minutes to be exact). Might I add, writing styles are very similar also.

Nothing conclusive mind you, but facts that may or may not be coincidental.

I might be wrong, and I am sorry if I am!
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