does this study make sense ??

I know that MSK is supposed to be the best cancer in the world or one of the top, read this ;

In summarising the results, the NYT report indicates a Dr Peter B Bach,. a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center as saying ‘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’.

Hmm  … now I know these odds, in future I will not have any PSA tests done.  And that is even before I factor in the incontinence and impotence which treatment might bring.

But reverting to my more professional role as a health economist, why have all these tests been being carried out and at great financial cost to the taxpayer and the private insurance holder? And what about all the anxiety cost they have caused?

I have never been a big fan of fee for service medicine. Doctors are human and if we pay them according to piecework, of course they will do more pieces. Who wouldn’t?

But it is a bit much when they do things which are not evidence based, which can make patients anxious and for which patients struggle to get relevant information on which to make informed choices.

Part of the answer is to look very closely at the heavy reliance our health care system has on FFS medicine. If doctors were paid by capitation (ie by the number of people they serve) or by salaries would there be so many PSA tests?

Will we see the end of the epidemic of PSA testing? Will we see a decline in the dominance of FFS medicine?  And will clinical trials and especially trials of screening

Here we go again. PSA tests saves lives, lots of lives, every day, every year. You could argue away the logic of having any medical tests if you follow that path. It's not about how many men don't need PSA tests, it about how many of them that do need them. You don't want to have an agressive strand of PC and not know about it, or find out when it's too far gone, or even a lesser stage that jumps the fence because the patient didn't know it was there.

You write: "Will we see the end of the epidemic of PSA testing?"

Strong opinion about the fact that more men are informed these days and are having a simple blood test to determine if they have PC or not. The larger number of men testing is a testimony that men are finally listening to men's health issues, something that has not always been the historic case.

The money part of your argument has some merit of course, and would always make one suspicious of motivation, but I would stick to what is best for the man, the patient. And not knowing, because of a lack of a simple test, do me, doesn't show much faith in acquring basic information to help yourself.

David in SC

I think the PSA test is a valuable diagnostic tool, as is the biopsy.

But I also think that in light of this new report, this era will be viewed as the era of overtreatment.

I understand there are many variables to be considered in making the decision to have PCa treated.  But if I had been told I had a 98% probability that the PCa would not be the cause of my death, I'm not sure I would have pursued treatment. 

The tremendous impact of  quality of life side effects from treatment needs to be given greater weight in the treatment analysis.  Knowing people IRL, in the prime of their life, who have been rendered totally incontinent and/or impotent is heartbreaking.  And to now learn that there was a 98% probability the treatment wasn't necessary is frustrating, to say the least.

I also think the relatively low decrease in the incidence of death by PCa vs the astronomical increase in radical treatment confirms that more needs to be done to confirm the aggressiveness  of PCa prior to making a treatment decision.

Dave7 said...
I think the PSA test is a valuable diagnostic tool, as is the biopsy.

But I also think that in light of this new report, this era will be viewed as the era of overtreatment.

I understand there are many variables to be considered in making the decision to have PCa treated. But if I had been told I had a 98% probability that the PCa would not be the cause of my death, I'm not sure I would have pursued treatment.

The tremendous impact of quality of life side effects from treatment needs to be given greater weight in the treatment analysis. Knowing people IRL, in the prime of their life, who have been rendered totally incontinent and/or impotent is heartbreaking. And to now learn that there was a 98% probability the treatment wasn't necessary is frustrating, to say the least.

I also think the relatively low decrease in the incidence of death by PCa vs the astronomical increase in radical treatment confirms that more needs to be done to confirm the aggressiveness of PCa prior to making a treatment decision.

You're wasting your time Dave. Congratulations you can look at the latest news releases on PSA tests and the resulting over treatment logically. Most here can't. I understand that somewhat but I am a little surprised when posters think these respected doctors and such organizations as the NCI and ACS have secret hidden agendas. Another poster was angry because "so called experts" were trying to say his choosing treatment was stupid. That's ridiculous, everyone here makes that decision on the facts or what they think are facts that are presented to them at the time nobodys decision here was called stupid. Medical science moves on, things change. Also the only if it saves one life viewpoint here has run amuk. I do disagree with your statement that PSAs are as valuable as biopsies. They aren't, many men have 4.0 and higher PSAs and never get Pca. PSAs can rise for other reasons than PCa.

You're exactly right about the quality of life vs possible longevity argument, I've been saying that all along. I also confess that my viewpoint has always tilted towards the quality of life side, and that was why I had a hard time in pulling the radical treatment trigger, and I'm sure happy now that was so. Personally I'm mad at the first three urologists and radiologist I saw upon and after dx. I never heard of the PSA controversy from them or the fact that there may be quite a bit of over treatment. I was very fortunate by just watching a local news report to find a clinical less invasive study going on at the local university. It was those doctors who I first heard about the current wave of over diagnosis and over treatment. Because of their beliefs they are pioneers in less invasive treatments such as my targeted focal treatment along now with also doing one of the initial hifu studies in the country. I was told I could do either the TFT by them or just watchful monitoring. I chose the TFT because I had the required 3D biopsy approved by my insurance after a refusal and the TFT by then. Who knows if I would later. That said after more of these studies like the 50 = 1 saved life. I now may have said no to even that. That said I still have a functioning prostate after my TFT, never any incontinence because I still have all my valves and just temporary ED problem and I still have wet orgasms. Yes in time this will be known as a era of much unnecessary treatment. Many men will have had to put up with incontinence and the other effects. The lucky ones not too long others as tragic as permanently. Of course I am just referring once again to those dx as low risk. Although every time I make that disclaimer people here who are advanced knock all I am saying like I've included them. Basically Dave for most here these reports result in a mental picture of some sticking their fingers in their ears shouting lalalallall I'm not listening, I can't hear you...lalalalalal..... What can you say?

For years I had an elevated PSA of 4.5 taken yearly. My urologist watched and waited. The PSA then jumped to 6.0 and the urologist watched this for 3 years performing a biopsy each of the 3 years.  The biopsies were negative. The next year the PSA jumped to 9.5 and a biopsy indicated cancer.  The biopsy showed 10% of one of twelve cores at a Gleason 6. After surgery the actual pathology showed 40% of the prostate was cancerous at a Gleason 4+3=7. Good news is that it was caught in time and contained. In my case at age 60 the PSA was a signal of a problem. I regret having PC and having to go through surgery and the side effects, but I'm glad I had the PSA test done.  

Dear realziggy:

Once again, in my opinion, I think your post is unduly harsh concerning the opinions of our fellow PC brothers on this forum.  I have carefully read the many posts of men commenting on the recent studies and I do not reach your conclusions, i.e. that "most here can't" logically read the studies correctly and that people here are sticking their fingers in their ears.  In fact, I think some of your comments are arrogant and disrespectful.  Just because someone disagrees with your opinion does not mean they are unable to interpret things logically.

Yes, this may be an era of overtreatment.  However each of us is entitled to view our own cases individually and decide whether or not we were overtreated.  You chose to be treated.  With a low PSA, a small prostate, a low gleason and 1 out of 45 cores at 2% some might argue that ANY treatment for you was overtreatment.  However, you chose a specific treatment and I have not seen any overt criticism of your choice.  I certainly respect your decision as you obviously thought it was a good idea to do something.  I weighed my options and decided on a protocol.  Am I overtreated given my stats?  I don't think so and, frankly, I don't really care whether you or anyone else thinks I was. 

Here is my position on testing (and you can feel free to accuse me of being unable to interpret the studies or sticking my fingers in my ears because I have a thick skin).  I personally think routine PSA testing for men over 50 is a good idea.  I will continue to recommend it to my friends who may value my opinion.  I have stated the reason for this before...knowledge is power.  By KNOWING information about one's health, one can make informed decisions.  No one forced me to get treatment.  I was aware of the "slow growing, etc" arguments well before these studies...however, in MY particular case, I am glad I had the opportunity to learn more about my health and make a decision.  That's why I get annual physicals and get the other routine tests that I feel are essential to my health and decision making.

In most of the posts on this forum, I think the men have made logical, informed decisions about their treatments.  Did some men jump to a treatment without enough infomation?  Maybe?  But who is to say in any specific case whether TFT is an overtreatment or if RP is overtreatment?  Each specific man who has the treatment is my answer.  Whatever the overall stats show, I believe that each of us is entitled to make informed decisions. Getting PSA scores, however fallible, is part of the critical information gathering that allows this informed choice.

Tudpock

Diagnosed at age 52, gleason 4+2=6.  Our sex life? Like teenagers in the back of a 57 Chevy (thanks to Bupropion).  The first time my uro asked about my sex life I replied, "I'll bet we get it on more times a week than you do".  There were several interns with him, male and female.  Hell, I made them all blush.

Several months post op my uro asked if I would do it over again?  NO!!!  Now I know why prostatectomy is accompanied with the word "RADICAL".