What’s wrong with free prostate-cancer screening?
Why? Well, for one thing it would be a tad bizarre having a blood sample taken at a ball game. More important, though, is that deciding whether to get tested for prostate cancer is a surprisingly complicated matter. That’s because there’s still no proof that screening for the malignancy saves lives overall, and considerable evidence that it can lead to unnecessary medical procedures that can cause impotence, incontinence, or both. That doesn’t mean that all men should necessarily skip the test. But it does mean that the decision should be a considered one—one that involves researching the risks and benefits of the PSA blood test, understanding the limitations of prostate-cancer treatments, and having an honest and thorough talk with your doctor. None of those things, it goes without saying, is particularly easy to accomplish at a baseball game.
Unfortunately, all too often getting screened for prostate cancer is presented as a no-brainer, with none of those counter arguments. For example, during this year’s U.S. Tennis Open the former tennis star John McEnroe has been promoting prostate-cancer screening for men as young as age 40, citing new recommendations from the American Urological Association. But during his appearances on CNN’s Larry King Live and the Early Show on CBS, there’s been no mention that most organizations, including the American Cancer Society and the United States Preventive Services Task Force, emphasize that the evidence for the test is sketchy. As a result, those organizations say that men should discuss the pros and cons of the test with their doctor.
Nor was it mentioned on the Early Show that McEnroe was being paid for his efforts by the pharmaceutical giant GlaxoSmithKline—which just happens to make dutasteride (Avodart), a prostate medication. And the Web site he promotes during those appearances, no surprise, is also funded by the drug maker. That Web site links to a number of free screenings at golf tournaments, football games, and other sporting events. My advice: Sure, learn all you can about prostate cancer—but not at events funded by drug makers, where you’re likely to hear only one side of the story.
—Joel Keehn, senior editor
Read more on the risk factors for prostate cancer. And if you've been diagnosed, take a look at our list of questions to ask your doctor.
Posted by: Ed Dwulet | Sep 30, 2009 11:47:27 AM
True studies on the effectiveness of cancer treatments are difficult if not impossible because no one wants to be in the control group. Just about everyone told they have cancer wants to do something, anything to treat it -- proven or unproven. The closest thing we have to a control group for prostate cancer is watchful waiting. I submit that all of those watchful waiting controls have been contaminated by biopsy. In 2009, studies are finally available showing little to no difference between watchful waiting and treatment groups. But "no difference" could actually mean a HIGHER death rate for both groups than would occur in an unscreened, unbiopsied, untreated group (in other words -- men just left alone).
Studies are designed to minimize variables. So none include: men who die on the operating table, men who die from other complications of surgery or hospitalization or medication errors, or those who might contract antibiotic resistant staph infections, subsequent suicides due to post operative depression, subsequent metastasis mis-classified as a different primary cancer -- all of which would make the treatment group statistics much worse. On the other hand many of those same factors could affect men receiving biopsies as part of watchful waiting. I really don't like testimonials but sometimes they are useful to illustrate a point. Incidents like the following are also never recorded in the various prostate studies: my neighbor, just who turned 50, went for his "50 year physical," blood test PSA=7, they tell him to come back in 2 months, PSA = 10, then biopsy, 2 days later a 104 fever, ER in the middle of the night, e coli infection into his blood from the biposy despite pre/post antibiotics, all his organs affected, double pneumonia, 3 & 1/2 weeks in the hospital, mostly the ICU, touch and go for a while, nearly died. And what about his biopsy? All cores negative! I am as certain that some people are killed by prostate biopsies as they are by the complications of surgeries. How many times it happens is a little more difficult to ascertain. They are lost to the statistics of hospital mistakes and errors (aka complications). This immediate risk is added to the long term risk that biopsies may cause inflammation which is linked to the development of aggressive prostate cancer and metastasis. Biopsies may be a great diagnostic tool for many medical conditions, but prostate cancer isn't one of them. One doctor I spoke with likened it to walking in the jungle and poking a sleeping tiger with a stick.
"No difference" between watchful waiting and treatment groups could still mean a BIG DIFFERENCE between those two groups and those men who are simply left alone to begin with and who were never drawn into the system by PSA testing in the first place -- with that latter group having a much lower overall death rate.
Autopsy surveys of men who die of trauma find prostate cancer in 8% of 20 year olds. That percentage continues to increase with every decade of life until it reaches 100% of men who live to be 100. For the most part PSA testing and biopsies are detecting this normal component of aging. Since there is no way to predict the future course of cancer in any individual, telling these men they have "cancer" leads to "cut it out" surgeries in almost every instance. For the most part these are surgeries of pseudo-cancers that would have never threatened their lives.
This year the risks of PSA testing are finally being exposed for all to see. As the 1996 article I first referenced foretold, men being subjected to PSA screeing were subjects of an experiment -- without being informed of that fact. In 2009 we can finally say that the overwhelming data clearly shows that the harms of PSA testing far outweigh the benefits.
Posted by: Lee Smith | Sep 24, 2009 7:25:19 PM
Can anyone describe to me what actually takes place at the free PSA events. What sort of literature is given out, what sort of descriptions of what may happen next and when to see a urologist?
Posted by: Ed Dwulet | Sep 24, 2009 8:20:54 AM
In a capitalist society the value of any test can be seen in the "market" price you can charge for it. With "free" a PSA test you are getting exactly what its worth ... ZERO... the price you paid for it. Are you kidding! This is the USA! If I invented a test that would actually save someone's life I might charge $10,000 for it! I wouldn't give it away for FREE! And if it was really saving lives, I wouldn't be able to keep up with the demand. Do drug companies give their life saving drugs away for free? Do hospitals give life saving operations away for FREE? Does anybody give away anything worthwhile for FREE in this society? Not on your life! In the good old USA you usually get what you pay for.
Don't you think its interesting that 15 or 20 years ago, when the test was first being marketed ... you never saw free PSA screenings? Why now all of sudden the last few years?
With the new Yankee Stadium there was a lot of press about the cost of tickets ... with many in the thousand dollar range. Can you imagine someone setting up a booth at the stadium and putting up a big sign: SAVE YOUR LIFE! Get a PSA test for only $1000 dollars! You know and I know that booth would be empty the entire game. People will pay a $1000 to watch a silly ballgame but not $1000 to save their life! What the hell is that all about!
Free is the "come on" for all sorts of marketing scams. People will unthinkingly accept all kinds of things for free. On the other hand for $1000 dollars ... people tend to start asking questions ... and "they" don't really want that ... they want you start asking the questions "after" they tell you that you have cancer! The free part is to just to get you in the door. You know and I know that the "real money," the big money to be made comes later ... when the sucker you drew into your tent becomes your patient for the rest of his f***ing life!
If the Yankees and whoever were really concerned about "saving lives" they might have set up a booth to screen people for alcoholism! Alcoholism kills about 3X the number of people who die from prostate cancer each year. Look it up: "Alcohol abuse kills some 75000 Americans each year and shortens the lives of these people by an average of 30 years! " Three times as many people! And these are lives you could REALLY save. Not lives you'll just screw up as with pc. Many of them young people and in the prime of their lives! 30 years! Prostate cancer doesn't even shorten most men's lives by anywhere near 30 years!
Do you know why you don't see something like "free" alcoholism screening at Yankee Stadium or anywhere else? NO MONEY IN IT! ...... NO MONEY IN IT! .... Lots to be made selling alcohol. But treating alcoholism ... forget it ... no where near the money to be made when you reel in a bogus cancer patient the rest of his life.
Ain't capitalism great!
Posted by: Lee Smith | Sep 23, 2009 10:34:23 PM
The truth is that I really don't know much about "active surveillance". It wasn't a term in use when my prostate cancer was diagnosed following a routine PSA exam some 13 years ago. What I could do then, and presume can be better done now, was look at the predictive charts as they applied to me (not some impersonal statistic). I could learn based on my PSA, biopsy outcome, etc what percentage of men in my situation were found to have organ confined cancer, and what percentage had cancer that left the organ. I didn't want the cancer to get out and invade the rest of my body. I looked at the statistics of complications from the various treatments, looked at the records of several surgeons and oncologists. I and my wife weighed the "costs" of the various outcomes -- invasive prostate cancer, impotence from treatment, etc, etc. Then I could my a decision, OUR decision, based on real detailed data, not massive impersonal statistics that averaged over all possible states. I admit that I was not comfortable with "watchful waiting" and perhaps would be just as uncomfortable with active surveillance for many of the reasons mentioned. My choice -- try to get the cancer out before it spread and bet on good treatment, rather than leave it in and bet that it wouldn't go out. It's not just the odds but also the weight that each of as as individuals attached to each outcome. Some who are posting aren't afraid of dying of prostate cancer, they are more afraid of a negative outcome of treatment. So be it, but without numbers such as PSA and gleason score you are completely in the dark when it comes to your personal situation.
Posted by: Lee Smith | Sep 23, 2009 9:57:09 PM
Men out there and the women who love them it's your choice -- stick your head in the sand and you probably will be okay except for the ten's of thousands of men who die each year from prostate cancer. But we all die someday and from the statistical point of view it probably won't be from prostate cancer unless of course you are one to the ten's of thousands in which case it suddenly becomes 100% certain that you died of prostate cancer -- a horrible way to go but you can console yourself that this was an unlikely event even as you realize you could have reasonably prevented this particular ending if you had routine PSA testing. Check out the websites at the major cancer centers and you will learn the substance of this issue. The truth is out there.
Posted by: Ed Dwulet | Sep 23, 2009 7:09:36 PM
As usual Lee is right about some things and wrong about others. He is right when he says pc doesn't strike all men "out of the blue." ARPD strikes ALL men as a natural component of aging. Some sooner than others -- based upon genetics, diet, chemical or radiological exposures AND apparently bacterial, viral or traumatic inflammation. Left alone, most men will never have a single symptom in their lifetime.
Lee is mistaken when he says "active surveillance" will tell you when the cancer "becomes aggressive." No technology in existence today can do that -- all you'll get is an updated Gleason score. Paradoxically, the "active" part of active surveillance, (i.e. letting someone stick lots of needles in your prostate over and over again on a regular basis and the traumatic inflammation that causes) may well be just the thing that turns your cancer "aggressive."
Lee doesn't like statistics until he quotes one from a study that lends minimal to zero support for his position. As an aside, anyone taking Lee's point of view in this discussion would be well advised to completely disregard his remarks and take a close look at patient outcome statistics for both your surgeon and your hospital.
Posted by: Jerry S. | Sep 23, 2009 6:21:37 PM
Calling on used car dealers and racetrack punters with inside information for help in building an argument reeks of some sort of desperation.
From bloodletting to post menopausal hormone replacement, medical science is filled with examples of widely accepted therapies implemented on a false or mistaken premise. The over treatment of prostate cancer appears to be one of the more egregious.
Posted by: Ed Dwulet | Sep 23, 2009 5:37:03 PM
Any condition that 100% of men will get if they live long enough must be by definition a completely normal derivative of human aging.
Calling it "cancer" benefits nothing but the fear based marketing of screenings and unproven treatments that harm many more than they help. Age related prostate degeneration is a better choice and hopefully someday, sooner rather than later, it will be commonly referred to as ARPD.
In 1996 a perceptive medical professional asked: "Should patients who are to be screened by PSA measurement be told that the test is inaccurate? Should they be told that therapies available to treat the disease, if detected, are of no proven benefit? Should they be informed, prior to being screened for PSA, that they are subjects in an experiment?"
Well here we are 13 years later and the overwhelming evidence just continues to mount ... the grand experiment has been a dismal failure!
PSA screenings at baseball games should be called OUT for what they are: nothing more than a search for guinea pigs to keep feeding our great mindless American medical-industrial-complex profit machine.
Posted by: Lee Smith | Sep 23, 2009 11:43:21 AM
True the odds of winning a lottery are small whether or not you buy a ticket, but the odds of winning a lottery are infinitely greater if you do buy a ticket. Now I do know a few folks who have won lotterys but maybe two or three. On the other hand I know about 20 men who have been treated for prostate cancer and 10 to 15 years later are apparently cancer free with relatively acceptable side effects. These are mostly professionals, PhDs in scientific fields who have a good understanding of statistics, do not blindly follow MDs, read the literature, etc, etc. So either my small city is some sort of weird exception or the mass statistics are misleading us. I think that the reason they are so misleading is that they lump together all levels of physicians competence and treatment . Imagine if some car dealers were know to take good care of the cars before and after they sold them, while others were known to mess them up. The goal would not be to simply look at overall statistics but to find the right car dealer. You can, in my opinion, move the odds in your favor , by getting inside information. You can be the equivalent of a professional gambler who studies the race track, speaks to the trainers, observes the horses, and makes an educated choice. Prostate cancer does not randomly strike all men out of the blue -- the signs are there and more and more information is being gained from them. As crude as it was, the European study showed that PSA testing produced A 30% reduction in deaths from prostate cancer.
Posted by: Lee Smith | Sep 22, 2009 11:38:22 PM
I should add that the promise of active surveillance is that close observation and watching will alert one if and when the cancer starts to become more agressive. It doesn't mean do nothing -- it means ongoing observation and testing to avoid overtreatment but produce necessary treatment.
Posted by: Lee Smith | Sep 22, 2009 11:35:05 PM
Ed: I'm still waiting for specific references for the outrageous claims you are making. I pray that no man is talked out of a PSA test because of your assertions. It's one thing to say that one must try to avoid overtreatment --- you claim one should avoid any knowledge and any treatment.
I do agree that one should seek information and learn of the possible outcomes before being faced with a diagnosis. However, the source should be experts in the field -- with experience and knowledge of the literature -- not folks who dogmatically reject the existence of a disease called prostate cancer.
Ugh!
Posted by: Ed Dwulet | Sep 22, 2009 11:32:30 PM
Say I wanted to buy a used car and I had two models in mind. I talked my friend Lee and he really touted Model X because he had one and it was a great car. On the other hand my friend George told me not to buy a model Y because his uncle had one and it was the worst car he ever had. If they were good friends I might be swayed one way or the other, but if I were smart I might turn to Consumer Reports for the maintenance history STATISTICS on both models. There I would find ratings based upon data from thousands of vehicles. I might find that Lee must have had one of the few Model X's that was not a lemon and George's uncle was simply unlucky with his Model Y.
No one wants to think of themselves as a statistic at any time, let alone during a time of illness. I appreciate Nils open-minded post and I really appreciate the fact that he is not urging anyone to follow in his footsteps. Testimonials about illness are almost always heart-rendering and they bring up emotions that can cloud clear thinking. All testimonials about illness should be accepted with compassion and then totally disregarded.
We are all statistics whether we like it or not.
Its very normal to hope that we alone are the lucky ones who will benefit from a therapy with a low probability of success, especially when the stakes are high (our very lives). The popularity of the lottery attest to the fact that blind hope is a powerful motivator.
Statistics say your odds of winning the lottery are about the same whether you buy a ticket or not. Right now the statistics are also telling us that your odds of surviving prostate cancer are about the same whether you are treated or not or if you ever have a PSA test or not.
Posted by: Lee Smith | Sep 22, 2009 7:30:53 PM
t’s like there are two different worlds out there. The world of urologists studying and treating prostate cancer, and the world of public health experts looking at mass statistics. To the dedicated urologist you and I are individuals to be saved from the ravages of prostate cancer. To some undoubtedly we are sources of income. The the public health expert you and I are grains of sand who they will unfortunately sacrifice in the name of the $$ saved. Not for them, perhaps but for impersonal society at large. The urologists have lots of statistics based on well studied individuals showing that PSA, PSA velocity, gleason score, etc and changes over time are pretty good predictors of the aggressiveness of one’s prostate cancer. They tend to err on the side of saving individual lives. In contrast the public health folks, they tend to err on the side of mass societal — so what if a few more of us get knocked off, if it saves funds for their own pet illnesses. So who do you trust — if you are an individual or know an individual whose life is of great value, perhaps even sacred, get yourself a good urologist. If you are prepared to sacrifice yourself for the "greater good" — don’t get a PSA test and let the public health folks have another number for their studies.
Posted by: Ed Dwulet | Sep 22, 2009 6:29:18 PM
A great post Nils. I can certainly understand the decisions you've made and the essentially no win situation you find yourself in -- most probably as a direct result of PSA testing. I wish you all the luck in the world. What I say next is not necessarily for you, or for purposes of having you second guess any of the decisions you've made -- its for others who may still be on the fence about PSA testing.
I am postulating that Nils might have been better off not knowing, and never getting a PSA test to begin with for the following reasons:
The same number needed to treat, namely between 20 and 48 depending upon the study, applies to his situation. The actual odds that he personally will benefit from treatment are small.
Nils Gleason 4+3 might have been there 10 years ago and ,had he never been tested, it might have still been a 4+3 ten years from now. Despite his PSA's and PSA velocity and all its variations, there is currently no reliable way to predict the course of prostate cancer in any one individual.
And while the odds that he will personally benefit from treatment are minimal, the odds that he will suffer the side effects are more certain -- in the case of radiation, to include an increased risk of colon and bladder cancer.
A recent released study showed little to no difference between watchful waiting and treatment in men 65 and older. Its very likely that the results might be the same in a study of men 50 and older -- but doing that study is impossible because like Nils, almost all younger men are forced into treatment.
PSA testing leads to biopsies. If the research I referenced in my earlier posts pans out, Nils may have already compromised his eventual outcome and worsened his future prospects by getting a biopsy that might have accelerated the progression of his cancer. I know this very controversial, I consider it an unknown risk but a real one and a distinct scientific possibility.
I sincerely hope Nils will live to be 100 -- all of the data I have seen tells me that his chances of doing that would have been better if he had completely avoided the medical system with respect to this "disease." The chances that his life might be extended by treatment are about equal to the chances his life might be shortened -- and the quality of his life will certainly be very negatively affected. I know this is counter intuitive to most people's way of thinking, doing something ... anything ... has to be better than doing nothing. Not always. With respect to prostate cancer anyway ... we just aren't there yet.
I've seen it too many times, if you get a PSA test and get a biopsy and are presented with results like Nils it is impossible to just do nothing. The genie has been released from the bottle and there is no putting it back. Nils should have been told all of these things BEFORE his PSA test -- in my experience this rarely happens -- so I am writing it here in the hopes that it will encourage men to learn more and make a fully informed choice about whether or not this is a road they want to travel down.
Note: I personally would never make a medical decision based upon someone writing in a online blog. I am confident that EVERYTHING I said here can and should be independently verified by your own research.
All the best to you Nils.
Posted by: Ed Dwulet | Sep 22, 2009 4:43:53 PM
Lee I'm sorry to be the one to tell you this at this late date, but there is no test for "aggressive" prostate cancer -- and there is no such thing as a prostate removal "done in time."
Your prostate "cancer" (I'd prefer to call it degeneration) most likely began sometime in your twenties. Autopsy studies of men who died from trauma in showed that 8% of men in their 20's already have prostate cancer. That percentage increases with every decade of life until it reaches 100% of men who reach age 100. It makes evolutionary sense. Most species are born, mature, reproduce and die. Modern man has found a way to long outlive the evolutionary usefulness of his prostate gland. Which as an aside, has led to our current dilemma. We can accept that degeneration as a normal part of aging, knowing it will vary from person to person and some of us unfortunately just won't make it -- or we can try to "fight it," as many do even in vain, just because its the "American way" -- all very consistent with our national materialistic obsession with quantity over quality [of life].
Throughout our history there have been medicine men and hucksters peddling ineffectual magic elixirs for longevity -- they are still out there today taking advantage of the gullible among us -- and our current era of "for profit" medicine has bestowed an unjustified air of respectability on too many of them.
Yes, you're right, its possible that "early treatment," will work to save some lives (i.e. removing the prostate of every man soon after he reaches his sexual peak ... say at 18 years of age)
Its a great idea. I suggest that you bring it up at the next town hall meeting with your congressman. Maybe they'll include it in Obama's health care bill.
Posted by: Lee Smith | Sep 22, 2009 3:56:57 PM
Nils is on target, but what is a man to do today while more refined medical answers are being developed. Nils feels that PSA testing saved his life, and I think it probably did so why should any one avoid PSA testing. My recommendation is to give the urologists the overall benefit of the doubt (while seeking multiple decisions). Don't accept that money drives them to overtreat but rather that their professionalism will guide them to help you as an individual make the right choices, which in the end are yours to make. Stick to the AUA and NCCN if you want to find your way through a potentially dangerous situation. If urologists are guided my $$ so are all MD's -- epidemiologists, public health specialists etc. They all have an ax to grind so if you can't trust a urologist --unfortunately you can't trust any of them so go to the witch doctor. Alternatively, look at the serious urological websites, and you will see the basis for their approaches and find that they make a lot of sense given the legitimate uncertainties we all face.
Posted by: Nils O | Sep 22, 2009 2:44:26 PM
I am a hopefully fairly objective prostate cancer survivor, whose PSA of 15 and Gleason 4+3 upon detection at age 54 should be enough to indicate that I did not have the choice of watchful waiting. I had radiation treatment in part because I was indeed wary of the possibility of surgically-caused remote metastases, an issue raised here by more than one person. I don't really think my choices were to die in 10 years or consume more than my share of medical resources, as seems to be implied by some.
I think that to steer the sensible middle course between the Scylla of wilful ignorance and the Charybidis of over-treatment, we will need still-better studies and more carefully thought-out statistical models. What are we comparing when we look at differently treated populations? If one group gets surgery, another does not, how do we know the actual extent of cancerous involvement in the non-surgical group (because only the radical prostatectomy gets a full pathologist's examination of the removed gland)? And if one group gets biopsies and another does not, how can we possibly have more than a vague guess as to the Gleason score of the non-biopsy group even if PSA is the same? These and more are the sorts of questions that need to be answered before we, as an informed society, can really decide what treatment "option tree" should be recommended to men.
Posted by: Lee Smith | Sep 21, 2009 9:29:50 PM
I accept that some treated cancers would never had become agressive, but what is the basis for Ed saying re deaths from prostate cancer (which are declining) that "most of these 27,000 have aggressive cancers for which no amount of early detection or treatment will ever help". Won't removal of the prostate help agressive cancer if done in time? What are the data that early treatment won't work?
Posted by: Lee Smith | Sep 21, 2009 7:46:52 PM
Just about every article on Prostate Cancer for the past few months stimulates letter after letter on both sides of the issue. Statisticians on one side claim that data are inconclusive, while man after man testifies to the success of their treatment and we are called anecdotes. Well I'd rather be a living anecdote than a dead statistic. Public health analysts have no interest in each of us as individuals but it's our lives not theres. In a way the discussion is a good thing but the important thing is not to scare men off and convince them to avoid PSA testing and also to make sure men don't get scared into treatment if they are unfortunate enough to find out that they have prostate cancer. Even those opposed to PSA testing base it on "lack of evidence" not evidence that it's a bad thing. But the latest short term European data show a 30% reduction in deaths from prostate cancer and the US "science" is terribly confounded by PSA testing of the control group. The important thing is to do your best to avoid being an unfortunate statistic --- either suffering from and unfortunately perhaps dying from invasive prostate cancer (a horrible disease for which there is no cure, no matter what anyone seems to be saying) or to jump into unneeded treatment (for which there are actually NO statistics -- we simply don't know which men were needlessly treated -- and treatments are getting better and better). So yes look at the odds but as an individual based on the the numbers that apply to you as detailed by the American Urological Association -- PSA, PSA velocity, etc, Gleason score, etc if biopsied. Then you can get the best statistics medical science has to offer so long as you deal with credible physicians and yes get more than one opinion including a major center. You can and should make your own choice based on data as it applies to YOU, not public health statistics and not recommendations of folks who think cancer will just go away by itself, Sorry but impotence is common, although nerve sparing surgery can provide functions -- you need to look at the latest literature -- so if sex is the be all and end all and a few good years of sex are worth many more good years without erections -- that is a choice you need to make for yourself.
Folks interested in this topic should check out what the knowledgable professionals are saying. it is complex. Here is a site that seems to cover a lot:
http://prostablog.wordpress.com/2009/04/30/prostate-aua-best-practice/
Posted by: Ed Dwulet | Sep 21, 2009 7:38:29 PM
George I'm very sorry about your uncle ... but statistics are the scientific basis for most of modern medicine including both pro and con PSA testing as well every treatment option for prostate cancer.
What you fail to realize is that no doctor and no treatment could have ever guaranteed that your uncle would have died of something other than prostate cancer. The most any treatment might have done is to slightly reduce his RISK of metastatic cancer (and in my opinion the jury is still out on even that).
As hard as it might be for you to believe, the statistics say its very likely that your uncle's outcome would have been exactly the same had he been treated. So in addition to a high probability that he would receive no benefits of treatment, he would have certainly suffered the side effects, which would have only added to the burden of his final days. In this respect, I believe his doctor may have served him very well.
Medicine does not yet have all he answers, nor does any doctor have a crystal ball for every patient -- in the interim we need every tool we can get our hands on to help us make intelligent decisions -- statistics is one of them.
Posted by: georgeh | Sep 21, 2009 5:18:30 PM
It's interesting to note that the opponents of PSA testing do so largely on the basis of statistics. You really want to have a doctor that tempers knowledge of statistics with knowledge of you as an individual. My uncle died from prostate cancer which spread to his bones because his doctor determined that statistically he would probably die of something other than prostate cancer before the prostate cancer could kill him.
As a patient you should have a right to see all pertinent information including the results of PSA tests; then you can research the various options and opinions, discuss them with your urologist and decide what course of action is right for you.
Posted by: Ed Dwulet | Sep 21, 2009 4:29:22 PM
To CR: in my previous post a )is included at the end of the hypelink which is preventing the website from opening.
The correct link is:
http://www.issuesinmedicalethics.org/043mi074.html
Thanks
Posted by: Ed Dwulet | Sep 21, 2009 3:58:07 PM
"1 in 6 men will get this disease" is certainly ominous sounding ... but if GlaxoSmithKline were really interested in "educating" men about prostate cancer they might have prefaced that statement with "Because of overdiagnosis..."
If GlaxoSmithKline were really interested in educating men about prostate cancer their PR rep would have included this statement: "There are about 380 men with cancer of the prostate for every patient who dies of the disease." (Please see: http://www.issuesinmedicalethics.org/043mi074.html)
But something honest like that just might get men to thinking that they have little to worry about when it comes to prostate cancer ... and that's not good for profits.
Posted by: Ed Dwulet | Sep 21, 2009 3:29:03 PM
Repeating over and over the number of men who die from prostate cancer each year is clearly a part of the scare tactics of all the fear-based Prostate Cancer "Awareness" campaigns including GlaxoSmithKline's. The clear implication always is that all 27,000 of these men could be be somehow saved if they were only made "aware" of prostate cancer early enough. The facts are that many, if not most of these 27,000 have aggressive cancers for which no amount of early detection or treatment will ever help. The facts are that many, if not most of the these 27,000 are elderly who would never ethically be treated and have to die of something. That leaves very very few remaining to be "saved" by a massively disproportionate screening program that has ensnared millions of men and will eventually harm many of them.
Posted by: Rob Perry, GlaxoSmithKline | Sep 21, 2009 12:01:47 PM
We appreciate you urging men to learn all they can about prostate cancer, particularly since 1 in 6 U.S. men will get this disease. Educating men is one of the chief objectives of the Get Serious About Prostate Cancer program. (http://www.prostatecancerwatch.com/know-the-facts.html)
As you know, far too many men – some 27,000 in the US this year alone – die from prostate cancer (http://www.prostatecancerfoundation.org/site/c.itIWK2OSG/b.4983495/k.5C76/About_Prostate_Cancer.htm). That’s among the reasons why the American Urological Association recommends that education, risk assessment and detection of prostate cancer be offered to men 40 years of age or older who wished to be screened. You are right that not all medical organizations agree with this. Where most do agree however, is that men should talk to their doctors (http://www.cancer.org/docroot/CRI/content/CRI_2_2_3X_How_is_prostate_cancer_found_36.asp?sitearea=) about the appropriateness of prostate-cancer screening and that they have access to such screening (http://www.reuters.com/article/pressRelease/idUS117564+23-Mar-2009+PRN20090323).
GSK has an ongoing focus on men’s health concerns, and we’re proud of our involvement in this campaign, openly disclosing our support (http://www.morethanmedicine.us.gsk.com/blog/2009/08/john-mcenroe-gets-serious-about-prostate-health.html). The Larry King show you referenced did, in fact, mention that John McEnroe was a paid spokesperson for GSK. As an engaged member of the healthcare community, we gladly support many organizations that conduct cancer research, offer education, and provide support to cancer patients.
It’s fair for you to explore GSK’s involvement in this campaign, but we wanted you and your readers to have the full story ….
Posted by: Bill | Sep 21, 2009 11:09:15 AM
I'm seeing a Urologist soon based on a PSA test. There's so much information out there on both sides of the "what to do" argument, I'm confused.
Can someone please tell me this - I'm 52 years old. If I need a biopsy and it shows cancer, do all treatments lead to impotence ??? I'm a young, divorced guy.
Posted by: Ed Dwulet | Sep 21, 2009 1:45:46 AM
In closing I would like to call your attention to the study released last week: "Prostate cancer linked to sexually transmitted disease."
The CNN news release carries this statement: " The germ, a type of parasite, can infect the prostate and may cause inflammation that spurs the growth of prostate cancer later in life, says senior author Lorelei Mucci, Ph.D., an assistant professor of epidemiology at the Harvard School of Public Health. "Our underlying hypothesis is around inflammation and, in particular, we believe that inflammation from a variety of sources is leading to prostate cancer progression," she says."
Hmmmm ... inflammation? Where have we heard that before? How about: "A biopsy can stimulate the inflammation that helps the cancer" (scroll down to my earlier posts).
Inflammation appears not to be a good thing when it comes to prostate cancer. In the case of inflammation caused by this STD "those (men) with a past trichomonas infection were two to three times more likely to develop an aggressive and potentially life-threatening form of prostate cancer."
Please ... if you are a man reading this ... before you consent to allowing someone to unnecessarily stick a needle in your prostate 12 times and remove 12 cores ... THINK ABOUT THE INFLAMMATION THOSE NEEDLE STICKS WILL CAUSE! And think about its possible ramifications for aggressive prostate cancer down the road.
The inventor of the PSA test said "all you need is an excuse to biopsy and you'll find cancer." PSA testing has provided that excuse. A biopsy may very well be a great diagnostic tool for many medical conditions but prostate cancer isn't one of them. I've brought this subject up with many doctors (some who are friends) and many admitted to privately subscribing to the risk of biopsies. But more than one has responded " well ... we can verify your cancer now via biopsy or we can do it later on the autopsy table." (I think its something they must teach them in med school - How to Deal with the Reluctant Patient 101) Fear sells and in so many words they are saying "we have no choice."
BUT YOU DO HAVE A CHOICE!
Ask yourself if it is worth it for a pseudo-disease that has a benign course for almost all men throughout most of their lives.
Ask yourself if it is worth it for a pseudo-disease for which "no treatment has been PROVEN to be superior to doing nothing at all."
Ask yourself if it is worth it for a pseudo-disease that the medical-industrial complex insists on calling "cancer" but might better be called "Age-related-prostate degeneration."
Ask yourself if its worth for a pseudo-disease that recent research has conclusively proven to be overdiagnosed and overtreated to the tune of 1 million men in the past few years.
When it comes to prostate cancer screening: JUST SAY NO!
I rest my case.
Posted by: Jerry S. | Sep 19, 2009 6:33:27 PM
To ignore the recent over-diagnosis/over-treatment studies and fail to revise your thinking when presented with new evidence is a better example of sticking your head in the sand.
Someone famous once said "When the facts change, I change my mind. What do you do, sir?"
Posted by: Ed Dwulet | Sep 18, 2009 7:19:41 PM
You want to base your medical care on testimonials? I have lots of testimonials. One 60 year old friend who was being railroaded into a radical prostatectomy with PSA 3.2/Gleason 6 was actually told: "have this operation and there's a 96% chance that you'll be around in 10 years." But what he wasn't told was that there was a 95% chance he would survive 10 years if he did nothing! And he certainly was not told that he might end up with lung cancer in 11 years! In the end I suggested that he at least send his biopsy samples somewhere else for second opinion. Johns Hopkins rated the samples a
5 rather than 6! A simple difference of opinion? Maybe ... maybe not. A little bit of further investigation found that my friend's urologist and the original pathologist were business partners in the same lab! This is the kind of "for profit" medicine that the idiots at these town hall meetings are fighting to keep!
I have another friend who had his prostate removed 15 years ago, when he was 69. PSA began showing up in his blood 2 years ago and he now has probable bone metastasis. Lee, I sincerely hope this doesn't happen to you. Prostate cancer is very slow growing, there is science that says a few cells introduced into your bloodstream during surgery might take many years to resurface. Everyone I know that has been though this has been given the same reassurance, implicit or otherwise, have the surgery and you'll never have to worry about prostate cancer again. WRONG ... and a LIE!
Google: "Robert Novak's battle with 4 cancers highlights importance of making informed treatment choices" OK ... this 100% speculation but I've just seen it happen too many times with friends and relatives and I'm saying that that Mr. Novak may have made a poor choice to battle prostate cancer to begin with. Did he die of primary brain cancer or metastatic prostate cancer? Only his doctor knows for sure. Did Paul Newman die of primary lung cancer or metastatic prostate cancer? Author Dominick Dunne just passed away. Read most obituaries and you'll find the cause of death: bladder cancer. Look a little closer and in one article it states that "he recovered from prostate cancer in 2003" -- whatever that means -- most probably that he recovered from the operation to remove his prostate. Only his doctor knows for sure. Causes of death are notoriously inaccurate -- and require rarely performed autopsies to validate -- these mis-classifications may be the the real source of the statistical reduction in deaths from pc since the introduction of PSA testing -- . Most prostate cancer is benign, mess with it and you risk spreading it. Aggressively treating every pc may be saving some lives but it also may be promoting metastasis and eventual deaths that end up being recorded as being from other causes. No one really knows yet -- when the long term data are in the net gain in lives saved may in fact be negative.
Capitalism is great at marketing and creating demand. Cancer fears, "free" prostate screenings (but curiously, not free treatments); and don't forget to get your "free brake inspection" at Midas -- they really care about your safety ...there's no real difference. Its all a part of the "ask your doctor if ______ is right for you" philosophy of medical care. Get people in the door -- more patients = more profits for all involved ... its as simple as that. PSA testing has been a boon for our "for profit" medical system and a travesty of unnecessary mutilation and death for many American men.
The current health care debate is all about "choice." Yes, choice is really important in our for-profit medical system so at some of the better medical facilities all manner of equally unproven prostate cancer treatments are marketed like soft drinks to their newly created pc patients (who are often encouraged to choose their own poison)... each has their own profit-driven advocates within the system (Notably not results-driven because there is no convincing evidence any of them are superior to doing nothing). But its more likely that if your doctor happened to invest in a DaVinci machine he would end up convincing you that it was the best thing since sliced bread. Or if your doctor is a partner in a proton radiation facility, Its likely you'll end up there -- and on and on. (Google: Specialists offer biased advice for prostate cancer).
This is modern "for profit"medicine in America. I believe the damage it is doing to people's lives completely dwarfs that of our similar profits-at-all-costs economic meltdown. Its become all about money ... and money really should have no place in good medicine. I've lived in France and seen the other side -- and if ever I had a real medical need -- I'd be back there in a flash -- having a doctor who has no financial interest in treating me just seems to be a better way of doing things. The same underlying economic forces that are fighting health care reform are also doing their best to maintain the status quo with respect to prostate cancer ... and it really stinks!
Posted by: Rob Perry, GlaxoSmithKline (GSK) | Sep 18, 2009 4:59:53 PM
We appreciate you urging men to learn all they can about prostate cancer, particularly since 1 in 6 U.S. men will get this disease. Educating men is one of the chief objectives of the Get Serious About Prostate Cancer program(http://www.prostatecancerwatch.com/know-the-facts.html).
As you know, far too many men – some 27,000 in the US this year alone – die from prostate cancer(http://www.prostatecancerfoundation.org/site/c.itIWK2OSG/b.4983495/k.5C76/About_Prostate_Cancer.htm). That’s among the reasons why the American Urological Association recommends that education, risk assessment and detection of prostate cancer be offered to men 40 years of age or older who wished to be screened. You are right that not all medical organizations agree with this. Where most do agree however, is that men should talk to their doctors(http://www.cancer.org/docroot/CRI/content/CRI_2_2_3X_How_is_prostate_cancer_found_36.asp?sitearea=) about the appropriateness of prostate-cancer screening and that they have access (http://www.reuters.com/article/pressRelease/idUS117564+23-Mar-2009+PRN20090323 to such screening.
GSK has an ongoing focus on men’s health concerns, and we’re proud of our involvement in this campaign, openly disclosing our support (http://www.morethanmedicine.us.gsk.com/blog/2009/08/john-mcenroe-gets-serious-about-prostate-health.html). The Larry King show you referenced did, in fact, mention that John McEnroe was a paid spokesperson for GSK. As an engaged member of the healthcare community, we gladly support many organizations that conduct cancer research, offer education, and provide support to cancer patients.
It’s fair for you to explore GSK’s involvement in this campaign, but we wanted you and your readers to have the full story …..
Posted by: HIFU | Sep 18, 2009 2:20:43 PM
All treatment options should be looked at by patients that need prostate cancer treatment. There are too many options not to look at that may prevent incontinence and impotence, i.e. preserving your life!
Free prostate screening is one perk to get men to the office for a routine checkup.
Posted by: Ed Dwulet | Sep 18, 2009 2:12:57 PM
PSA testing was a great concept on paper. It was introduced without proper scientific evidence of efficacy. Our "for profit" health system took the ball and blindly charged forward with it, ruining many lives in the process. Thankfully, that train is finally slowly down a bit, with the release of multiple studies showing the extent of all the needless treatment -- but the special interests are fighting it all the way -- paradoxically supported by many victims (aka "cancer survivors") who understandably don't want to hear that their debilitating surgeries and treatments may have been for nothing.
Here is my own testimonial. In the early 90's, in those early days of PSA, my father was first diagnosed with prostate cancer at 85 years of age based upon a PSA test! At 85! As he was happily going about enjoying the last years of his life a urologist, an m.d. who took a do no harm oath, sat him down and told him he had "incurable" cancer. But not to worry, the doctor said, we have a great treatment that will probably hold the cancer at bay -- and it involved regular painful injections at the doctor's office. That "big C" diagnosis psychologically devastated my Dad for all his remaining days.
A few years after my father died at age 89 (of congestive heart failure) this story hit the national news: "Pharmaceutical Companies to Pay $1.2B in Medicare Fraud" "Prosecutors also indicted six current and former employees of TAP -- including Alan MacKenzie, now the president of Takeda Pharmaceuticals North America -- charging them with conspiracy to pay kickbacks to doctors if they prescribed Lupron. The kickbacks included trips to resorts, medical equipment and money offered to the doctors as ''educational grants,'' prosecutors said."
The drug company got fined -- a few of the worst offending doctors also paid fines - but none lost their licenses -- instead they got to continue on with their unethical practices. Maybe one of them went on to remove Lee's prostate?
I seriously considered looking up my dad's urologist and trying to arrange a meeting with him and a baseball bat -- to my father, a doctor's word was God's -- what a violation of trust! Instead I became determined to learn as much as I could about prostate cancer and to help as many men as I could to avoid becoming an AUA and AMA sanctioned victim of prostate cancer for profit.
Posted by: Lee Smith | Sep 18, 2009 12:40:30 AM
Before you "close the case" I would sincerely recommend you read the following and check out the websites. As an aside, the fact that there are now several excellent ways to eliminate prostate cancer is to me a good thing, but for some reason Ed sees it as a bad thing???
Recommendations:
"If you are a healthy man with a more than 10- to 15-year life expectancy and you don't want to die from prostate cancer, you should have PSA testing; intelligent testing and treatment could save your life," said Dr. Patrick C. Walsh, university distinguished service professor of urology at Johns Hopkins.
The American Urological Association (AUA) and the AUA Foundation believe that early detection of and risk assessment for prostate cancer should be offered to asymptomatic men 40 years of age or older who have a life expectancy of at least 10 years. Men who wish to be screened should have both a prostate-specific antigen (PSA) test and a digital rectal exam (DRE). The decision to proceed to prostate biopsy should be based not only on PSA and DRE results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and comorbidities. The AUA strongly supports informed consent before screening is undertaken and the option of active surveillance, in lieu of immediate treatment, for certain men found to have prostate cancer.
Websites with lots of good information about why you shouldn't stick your head in the sand when it comes to prostate cancer:
http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf
Www.drcatalona.com
http://prostatecancerinfolink.net/treatment/first-line-localized/have-to-choose/
Posted by: Ed Dwulet | Sep 17, 2009 2:46:00 PM
This is an excerpt from the very respected Merck Manual for Physicians, available on-line, this information reflects all the latest studies although its been included in their prostate cancer info for years:
"Screening is based on the hypothesis that early detection allows treatment of the cancer while it is still localized, thereby reducing mortality. However, the hypothesis that early treatment reduces mortality is unproven. Patients with well-differentiated cancer do just as well with or without treatment, and those with poorly differentiated cancers tend to do poorly with or without treatment." Case closed! That's all you need to know in a nutshell. Read it over and over. In other words people, who have aggressive cancer (poorly differentiated) are screwed twice - once by the cancer and then by the useless treatments they desperately seek and that the medical system obliges. But in the end they die anyway and leave the system. On the other hand the majority of men who have benign pc and are drawn into the system by PSA testing are screwed over and over again by all the useless and needless testing, suffer debilitating treatments and side effects until they eventually die of something else. I contend they all would have been better off had they been just left alone.
The New York Times incorporated that info in an article that got it right about a year ago titled "No Answers for Men with Prostate Cancer." The key phrase: "...no single treatment emerged as superior to doing nothing at all."
And that says it all. But no one makes any money doing nothing and the prime driver for prostate cancer screening and treatment has been our "for profit" medical system. Fear sells. I'm not saying the doctors involved are evil, anymore than all the bankers and Wall St execs involved in creating the current mess are all evil -- but there is evil in a capitalistic medical system that will always reward action or "doing something" over doing nothing. Added to that is the medical industrial complex's constant media barrage that has indoctrinated people to think that "fighting" cancer is the "American way." Making lots of money is also the American way -- and there's lots to be made treating a "pseudo-disease" that 100% of men will get if they live long enough. Lots of people walk around proudly calling themselves cancer survivors (when what they really are, are survivors of the medical system). "What? ... you want to just watch and wait? ... you must be French."
Posted by: Ed Dwulet | Sep 17, 2009 1:48:18 PM
For Lee: I'm very sorry for your own personal situation. I know many men who have unnecessarily gone through what you have gone through. Whenever one of these is articles is published there are usually a plethora of testimonials about how someone's particular PSA test and someone's particular treatment saved their particular life. They totally disregard the science and urge every man to follow in their footsteps and get their PSA tested. All I can say is that misery must really love company. It seems most of the US population cannot comprehend the even the simple statistics behind the latest studies on screening and treatment. At best somewhere between 20 and 48 men have to be treated to save one! This is science and it trumps your "belief." Informed consent, though sadly lacking with respect to PSA testing and cancer treatment in this country, if it were offered, still requires a certain minimum level of intelligence and education. This latest research proves that most men walking around in diapers without their prostates and calling themselves "cancer survivors" are statistical survivors of our medical system, not of a disease that would have killed them. I'm sorry but most people are just clueless about the statistical basis for modern medicine's treatment protocols and the concept of risk. I don't know what you were told 13 years ago, but today and especially in light of the recent studies, if a urologist tells a man that HIS protatectomy will save HIS life he is guilty of malpractice. A doctor shouldn't do it and neither should you. An honest doctor would tell you that the operation may only slightly reduce your risk of dying of prostate cancer in return for a even higher risk of a lifetime of diapers and impotence (and the anxiety of endless PSA testing for biochemical relapse). I urge you to open your mind and read some of the articles I referenced in my previous posts.
Posted by: Lee Smith | Sep 17, 2009 8:16:05 AM
Ken said it so well I can't add much but do want to make a few points. First, disclaimer, I and many men my age, late 60's were discovered to have fairly agressive prostate cancer in our 50's. Many of us are still alive and believe that without a PSA test, leading to biopsy and treatment, we would either be fighting, or dead from metasticizing prostate cancer. I looked at the odds for my situation 13 years ago, and saw pretty clearly that there was a substantial chance that I would be in serious trouble -- let's say 1/3 men in my situation. Now I had a choice -- wait an see and probably, 2/3 of the time no problem. But after long discussions with my wife and family, we all decided, given the odds, and looking at the odds of complications from treatment, that a 1/3 chance of invasive prostate cancer or death was not acceptable, while the treatments were. These are the kinds of things one needs to be able to try to objectively consider with 1 or more professionals. However, without a routine PSA test I would never have known to do any of this so I highly recommend following the American Urological Association and National Comprehensive Cancer Network reports which chart reasonable courses. Don't be an Ostrich and stick your head in the sand, men. Realize that the various groups opposed to screening don't see things the way you may. You, if you are anything like me, place almost unlimited value on trying to stay alive and be healthy. They see you and me as simple statistics, and deal with the lowest common denominator. Re the recent scientific studies, the American study was hopelessly contiminated by PSA testing in more than half the control (non PSA) group. Interestingly, and not reported by the anti PSA folks, the European study has now revised its conclusions and reports that there is a 30% REDUCTION in death from Prostate Cancer based on PSA tests. This statistic "coincidentally" matches the reduction in USA deaths since PSA testing started here. So don't be afraid to be tested, and don't be scared into immediate treatments -- active surveillance is now quite sophisticated in following the state of your cancer, but find out -- start with routine PSA testing and yes, detailed discussions with a respected urologist or two if there is an indication of a problem.
Posted by: edwulet@yahoo.com | Sep 17, 2009 12:51:32 AM
Also for Ken: Google "STANFORD RESEARCHER DECLARES 'PSA ERA IS OVER' IN PREDICTING PROSTATE CANCER RISK" and read what the inventor of the PSA test said about it in 2004! But nobody listened. Too many people were making too much money mutilating too many men. He says: "All you need is an excuse to biopsy the prostate and you are going to find cancer." He says that researchers examined the prostates of healthy men who died from trauma, finding that 8 percent of those in their 20s already had prostate cancer! Would catching cancer in a 25 year old be "early enough" for your hypothetical doctor? Early detection of prostate cancer is now and has been an outright fraud. But we may yet get to screening 20 year olds if our "for profit" health care system continues on its present course. September is Prostate Cancer "Awareness" month. What a joke! Brought to you by Glaxo-Smithcline and the makers of the DaVinci robot. You'd have to be living in a cave the last 20 years not to be aware of PC. More likely they want to publicize the new guidelines from the AUA (American Urological Association) -- the special-interest lobby and cover organization for urologists. After those two big studies last March showing no benefit to PSA screening, the AUA went and changed its guidelines, they completely disregarded the science and LOWERED the recommended age for screening from 50 to 40! Unbelievable! But smart ... they are well aware that sometimes the best defense is a good offense. They see the train coming and they want to slow it down ... or more likely it could just be that over the past 20 years they have completely depleted the 50 and 60 year old patient pool and there are still lots of swimming pool and McMansion payments their members have to make.
Google: "At 32, a Decision: Is Cancer Small Enough to Ignore?" and read a Pulitzer Prize winning article about a poor guy who inadvertently got a PSA test when he was 29 and after numerous biopsies and consultations around the country was facing a radical prostatectomy at 32! Very very sad. I've asked the Wall Street Journal for a follow up story many times without a response -- maybe Consumer Reports has the resources find out what eventually happened to this guy.
In a different world, maybe a non-profit world, what all men will get if they live long enough, and will die with rather than from, would be called "Age-related prostate degeneration" (how about ARPD) -- calling it "cancer" benefits no one and only serves to helps the fear-based marketing of screenings and unproven treatments. ARPD has no relation at all to the real aggressive prostate cancer that luckily kills relatively few -- and for which, unfortunately as of today, there is no scientifically proven screen or test or cure.
Posted by: Ed Dwulet | Sep 16, 2009 6:47:24 PM
For Ken and his hypothetical doctor "wishing he had known about this earlier" -- this could be his patient: Google "An elusive tumor in a man who has evidence of prostate cancer metastasis" the article is about imaging techniques but the interesting thing is the patient's case history: A radical prostatectomy 11 years ago at 54, PSA only 3.0, Gleason only 6, he was told his "disease was organ-confined with no lymph nodes involved and now he's suffering from metastatic prostate cancer in his lung!
All of the latest studies released in 2009 followed men for 10 years. Metastasis of slow growing prostate tumors caused by all these unnecessary surgeries can take a long time to show up. The supposed benefits of aggressively treating all prostate cancers to possibly save a few lives may disappear when longer term studies become available. Google: "A biopsy can stimulate the inflammation that helps the cancer," and you can read about the guy who developed a scientific basis for the theory that biopsies can cause inflammation that may lead to metastasis. Its highly technical but if you read it through to the end you'll get to the point (pun intended) in plain language. This isn't wacko "alternative" medicine --this is cutting edge research at a reputable medical research institute. In that case study of the guy with lung metastasis, it came from somewhere -- was it the biopsy or his surgery. I say he might have been just fine and lived a full life had he never had a PSA test or a biopsy or surgery and never been told he had cancer. How many more like him are out there?
Sometimes you see studies trying to knock "watchful waiting" by citing the number of participants who eventually decide to seek treatment. Other than the simple fact that its difficult for most people to live with a "cancer" diagnosis (however bogus that may be) ... it could also be because the "watchful" part is not benign observation. It consists of repeated biopsies every so often to monitor a cancer progression that may well be accelerated by the repeated biopsies in the first place.
Posted by: Ed Dwulet | Sep 16, 2009 6:38:04 PM
Google: "The great American pseudo- epidemic of cancer of the prostate" and read the best article ever written on the subject from the Indian Journal of Medical Ethics in 1996. 1996!!! Everything!!! And I mean EVERYTHING in that article has only been reinforced by study after study since then. People in some other countries saw the PSA era for what it was a long time ago.
Posted by: katie h. | Sep 15, 2009 2:08:56 PM
Ken, it's not simply a matter of false positives, but of finding and treating cancer that never would have shortened life. From the NYT story (http://www.nytimes.com/2009/03/19/health/19cancer.html) on new PSA studies from the spring:
"Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center, says one way to think of the data is to suppose he has a PSA test today. It leads to a biopsy that reveals he has prostate cancer, and he is treated for it. There is a one in 50 chance that, in 2019 or later, he will be spared death from a cancer that would otherwise have killed him. And there is a 49 in 50 chance that he will have been treated unnecessarily for a cancer that was never a threat to his life."
The major problem with PSA screening is NOT false positives. It's pseudodisease.
Posted by: Ken Kirkland | Sep 14, 2009 10:03:56 PM
While your points may be well taken, you need to consider it from the opposite side. A PSA test is a simple blood draw that can be done in a couple of minutes; it is worth discussing the results with your doctor. In either case, it's a few minutes of your time. If it is elevated, the doctor might suggest several more to see if the result is consistent and/or is trending upward. At worst, it might lead to a biopsy -- a procedure that can be done in a doctor's office in less than an hour. If, after all that results are negative, at worst you've wasted a little time (and perhaps some of your health insurer's money).
Consider the opposite -- you decide to avoid such tests because they don't really seem to help, and they may have false positives. Could be fine unless for some other reason (frequent urination, erectile dysfunction) you go in for some tests and discover that you do have prostate cancer. Your doctor says to you, "I wish we had known about this earlier, so we could have treated it with surgery and/or radiation. Unfortunately, yours has metastasized so it's too late. We can treat you with hormone therapy, but you will have hot flashes that are far worse than any woman's, risk of embolism, and the complete loss of all sexual function, along with weight gain, loss of energy and muscle tone, not to mention bone density loss. This won't be a brief phenomenon, but will last for the rest of your life. On the other hand, you probably won't live more than 10-15 years more, so there is an end in sight".
I leave it up to you to decide which outcome is worse. From my point of view, too frequent screening can either allow you to catch prostate early or at worse waste your time with negative results. Neither of those outcomes seems as bad as what I have described, and have seen people live through.