The never-ending screening debate

From the New York Times:

http://www.nytimes.com/2011/10/09/magazine/can-cancer-ever-be-ignored.html?_r=2

I agree with Fairwind completely. As to serious side effects, ED and incontinence, while serious, ain't nothing compared to have those pesky cancer cells travelling around and settling in somewhere else. Just ask any one of our members who have gone through surgery and radiation, only to have the beast raise its ugly head again.

about 7 years ago, my dermatologist told me that I had a good-sized patch of basel cell skin cancer and that it needed to come off. Would the cancer have killed me - probably not but the possibility existed that it could spread and there was just no way I was going to take that chance. I'm not saying that BCC is anything like PCa ... certainly I have experienced no side effects other than a lovely 2 inch scar on my collar bone.

There are so many cancers that are not "curable" by surgery or radiation. I'm sure there are many who would welcome ED and incontinence if they could rid their bodies of their cancer.

It's articles like the Times' that lead the public to think that PCa is "no big deal."

This is a topic I'm currently wrestling with. Of course, I don't want to die an early and painful death from metastasized prostate cancer. But I've never been a direct male relative who has been diagnosed with prostate cancer. Does this mean that I'm the first one? Or have several had it and blissfully never knew and eventually died from something else?

Then how young is too young to begin testing?

"Two years ago, John MacMahon went in for a routine physical. During his checkup, his doctor drew blood and sent it out to have his prostate specific antigen level, or PSA, measured to screen for prostate cancer. Mr. MacMahon was 29, in great shape and had no family history of prostate cancer. His doctor said he just wanted to see what was normal for Mr. MacMahon, to measure future tests against."

http://online.wsj.com/public/resources/documents/SB110350121947304355.htm

I think Geezer has this right; it is a tough issue.  Anyone who is absolutely certain they have the right answer has probably under-thought the issue.  One important point (at least to me personally) is the distinction between population screening (for example, give every man age 40 and older and annual psa test and a DRE) and targeted screening for those in a special risk category -- family history, African American, or elevated baseline psa score if they ever had a psa test -- or for those who are otherwise anxious about the risk of prostate cancer.  I am an example:  my father died of prostate cancer, and my psa tests -- since age 40 -- have been higher than normal for my age, though not high enough, say expert doctors, to justify a bx.  I watch this like a hawk -- getting psa checked every 6 months.  But that is not what I would normally call "screening."  The NY Times article raised important questions about the benefits, and downsides, of population screening.  But I hope it does not discourage anyone with elevated risk from getting regular psa tests and DREs. 

I think everyone is missing the main point. It is not the screening, but what is done with the information from the screening. There is a lot of evidence that there is no survival benefit from treating low risk cancer at 20 years and the majority of cases Dxed by screening detect these low risk cancers. There is no disagreement that all intermediate and high risk cancers should be treated and the only way to do this is through screening. The issue is what to do when low risk cancer is detected and does the treatment of low risk cancer outweigh the benefits, if any, of treatment. The patients that have little of no side effects from treatment are in the vast minority and does this outweigh the chance of metastisis or death which is estimated at less that 1%, which is exactly the same risk that a patient has AFTER receiving treatment.
It's not screening, but the determination if the cancer detected is indolant or occult.
I still cannot get by the undisputed fact that only about 3% of men die of prostate cancer while autopsies indicate that 50% to 80% of all men over 50 have detectable prostate cancer. This can only mean that most prostate cancer that is detected through screening will never harm anyone and the vast majority of deaths occurr in men that have been treated.
Screening does save lives as is indicated by the drop in PC related deaths, but the other side of the equation is that many men will have their quality of life affected by treatments that will not have added one day to their lives, and many of those that were treated will still die of this disease.
JT

JohnT's thoughts, as usual, are thought provoking. I have two thoughts, in response. First, to say "screening is not the problem; the problem is what you do with the information" ignores human nature, to a large extent, and particularly -- for whatever reason -- in the United States. The reality is that the overwhelming majority of men who have a positive bx WILL get treated, even if it the bx shows what appears to be low or very low risk disease. We can question whether individuals with very low risk disease SHOULD get treatment. But the reality is that (with very few exceptions) they WILL. So, in the real world, screening leads to treatment. Second, until there is a better way to distinguish aggressive from indolent cancer -- or to determine that what shows up on the bx path report is really what's in there -- I am not sure the treatment decisions are all that unreasonable. Many of us who have seen someone die of metastatic prostate cancer would very much like to avoid a three percent chance (or whatever) of it happening to us.

In time and not that far into the future that these days will be looked back in horror. As the days of massive over treatment and needless lower quality of life side effects.

Too many still panic at the mere mention of the C word. But we all know that not all cancers are alike and not a prostate cancers are either. That is why I still feel disheartened observing men rush into surgery 6 weeks after dx with low risk PCa. Or those who I feel needlessly subjecting themselves to radical surgery in their 70s. Some do take their time before committing to such an option but too many still do it in a panic.

Can't tell from this set of information, but a test to tell if it was a rare, aggressive type or PC or not [as was suggested by the article contributor I mentioned in the post further above] may one day be very meaningful to someone in your shoes or similar. But what we do know today is that the most aggressive, deadly form of PC does not typically throw off much PSA into the blood. There are many different forms of PC; mostly not aggressive.

Fairwind said... If the death rate was 3%, only 5800 would die every year... 3% of the approximately 1,000,000 annual male deaths in the US are from PC.  (I thought that we had previously addressed this question...?) Here's some other interesting facts: PC ranks 7 th in the list of causes of death for all men (all ages) in the US, using CDC data.   Among some specific age groups of possible interest here: ·          31 st most frequent cause of death in my age group (45-54) ·          17 th in the 55-64 age group ·          7 th in the 65-74 age group ·          5 th in the 75+ age group PC, and all other causes of death, are dwarfed by the number of deaths by coronary heart disease.   --------------------------------------------------------------------------------- this note added later as an edit:   Another interesting note from the causes-of-death data...  In the 55-64 age group, death by colon-rectum cancer was 2.4X as frequent a PC death.  You guys who are eating a lot of red meat oughta watch it!  Cutting down or eliminating fatty red meat not only will reduce your likelihood of PC progression , it may also save you from other more deadly cancers!   Post Edited (Casey59) : 10/6/2011 2:47:39 PM (GMT-6)