Why don't we hear more about this?

In countries in which the PSA test is more used to detect PCa, the rate of
PCa mortality and trend are down and fewer men are dying of the disease.

U.S.A.'s rate now is 19.8 men per 100K population
In 1994 it was 27.5 per 100K population

Canada's rate is 23.3/100K
In 1994 it was 25.0/100K

On the other hand, where PSA use is low, the trend is flat or even
increasing and more men are dying.

Sweden's rate is 54.8 men per 100K population
In 1994 it was 49.3/100K

Cuba’s (Michael Moore’s medical paradise) rate is 40.1 per 100/K population
In 1994 it was 29.4/100K

U.K.'s rate is 34.4 men per 100/K population
In 1994 it was 33.7/100K

Finland’s rate is 31.6 men per 100/K population
In 1994 it was 26.6/100K

We constantly hear about the widespread use of PSA testing in the US. Well, that “widespread” use amounts to a some 55% of men at risk admitting to being tested. That means that 45% do not get tested and are at a higher risk of an advanced diagnosis.

In the countries mentioned above where PSA use is low, PSA testing is in the range of 20% to 7%.

In spite of all this, experts can’t determine that the reduction in mortality since the commercialization of PSA testing is related to its use. As this debate goes on, many men at risk do not get tested, have a higher risk of an advanced disease diagnosis and many more die unnecessarily. Sad but true…

RalphV

David - could you elaborate? what do you think this motivation is?

Is this a quiz show question?

If a simple PSA test is discouraged, then less men would be diagnosed with PC, and if they don't know they have it, then they won't seeking treatments, and thus saving millions upon millions of dollars in primary and secondary treatments. That's my opinion. Why else would they be afraid of men having a simple blood screening test?

Over diagnosis and over treatment are currently possible because it is not easy to separate kittens from tigers. That said, with our current diagnostic capabilities along with better and knowledgeable information by both doctors and patients we could reduce this situation. Active surveillance is a possibility for men who are diagnosed with low PSA, low volume of well differentiated cancer. The current situation, in my view, is under detection which results in more advanced disease at diagnosis and potentially worse treatment results. Not many talk about this or explain why a good percentage of treatments for seemingly localized disease fail in a good percentage of men.

RalphV

Personally I'm glad I insisted on a PSA test starting when I got my new Dr just after moving here and every time I had my "annual" (actually 16-20 months)

My Dr didn't think it was worth doing, (false positives) I insisted, she didn't bother to tell me when the PSA more than doubled in 18 months, said my prostate felt fine at my last exam (uro 2 weeks later felt 1.5cm lump) and is no longer my Dr but that's another story.

Let's face it, PSA saves lives, maybe only 1 in 50 or 500 men is saved by a PSA which doesn't seem like much 'till your that one.

We could pretty much wipe out prostate cancer if we simply surgically removed the prostate of every man at age 40...

As it turns out, a fairly significant percentage of men at age 40 have PC (based on autopsy results of men dying in car accidents, for example)...

Hi Casey,
That would result in overkill. Most of those autopsy cancers in younger men are far from clinical cases. They tend to be insignificant in volume and differentiation. It is better tor males to have an eight-grade education about PCa risk at that point in their lives to avoid being railroaded...

RalphV

the other 99 are making a decision to do whatever they do.

the value of the life of the 1 cannot be measured.

Besides, those numbers are dubious at best.

So we are already surgically removing the prostate of many young men with clinically insignificant prostate cancer who would never otherwise be affected by it in their lifetime...and the PC incidence statistics show that younger and younger, and less significant and less significant PC is being looked for (and therefore discovered) year over year, why not wipe prostate cancer completely out by getting surgically proactive...?

Yes, I'm separating the overtreatment epidemic from PSA testing. The PSA test is a lousy test...it is prostate specific, but it is not prostate cancer specific. I have no real issue with testing because we don't have anything better. I think the real shame, which is too slowly changing, is the overtreatment of younger and younger men with less and less significant cancer.

PSA testing saves lives.

We need to give people the information they need so that they can make sound personal decisions.

As with everything else, people need to be empowered to make such decisions for their own benefit.

In populations that are heavily screened, the incidence figures increase dramatically...but again, I have no real issue with testing.

The problem, as I see it, is that patients hear the word “Cancer” and want definitive treatment. The word “Cancer” evokes a response which is disproportionate to the natural history of prostate cancer. It is a communication challenge to overcome this…to explain why an aggressive treatment might not be the best choice. There are still too many doctors who are dragging their feet to avoid this, and sticking with the gravy train by rushing their patients into treatment before they get properly educated.

Low risk patients have a significant "window of curability"...basically, plenty of time to see if they really need treatment or not. Studies have specifically been conducted to see if deferred treatment is as good as immediate treatment, and using reasonable trigger criteria they are basically indistinguishable. Don't think the "window of curability" is large? Check the nomograms for low risk patients...

...which is why we now see the good ones speaking up publicly about slowing down and not rushing.