Posted 9/14/2020 8:08 AM (GMT -6)
You are absolutely correct. When I wrote that I fully reworded a thought and did not reread what I typed well enough. I have changed the statement to:
"Last note: And many probably won't like this one. As an advocate that supports active surveillance, I fully acknowledge that after PSA screening changes, AS is the leading cause of increase in stage shifting in prostate cancer perhaps combined with the lack of science to improve screening."
And you also point out great reasons for this in inconsistent or early protocols being used. I do apologize to the AS guys. Solid AS protocols while it may lead to stage shifting, has not shown in the mortality stats yet, or if it will in the future. This was pointed out to me in the "Localized Prostate Cancer Guideline" panels I served in that MO's are seeing an uptick in advanced cases in patients that were diagnosed years earlier but not yet definitely treated. I am a supporter of the use of AS at a very high level. My comment was an error. The USPSTF Grade D Draft in 2009 and its implementation in 2012 are absolutely the #1 cause of mortality increase in recent years..
I intend to compare all guidelines for screening by major consortiums today but I caught ASA's note and went back and called a party foul on myself. Actually ASAdvocate did so correctly. I needed to fix that first.
ASAdvocate - apology for the error. Thank you for the correction.