Now screening and treatment reduces mortality by 20% in younger men.

I feel like a ping pong ball or I am starting to get wip-lash based on all the different opinions about screening.

http://www.medpagetoday.com/HematologyOncology/ProstateCancer/32549

then where do you really draw that line? I was 56 when dx, and it has acted agressive, should i not have been screened and treated because i was over 50?

Personally, I'm glad I asked for a PSA test. I can only imagine what would have happened if I had of waited until I was 50. As a side note, I changed Gp's midstream. I had a long sit down talk with my new family doctor last month. She said she would have discouraged me from the inital PSA test because that is what is pushed now by the medical community. Needless to say she is rethinking her stance on the issue.
Also, when I read results from a study (medical or political) I always try to find out where the study originated. More often then not, studies are skewed by where the funding came from.

Who said prostate cancer was a "20-year disease?" I was 65 at dx, in great shape. If I had never had a PSA test (12.2), a biopsy (G7) and then RP, who says I'd make it another 10 or 15 years without dying of PCA? And even if so, how many of those "survival years" would have been spent suffering radiation, hormone, or chemo treatments in the battle to try to stay alive? As it is now, there's a great chance I have put it behind me completely, other than dealing with the comparatively minimal side effects, which I'll gladly put up with in return for a cure of my cancer. Nobody will ever be able to convince me that I'd have been better off had I never had a PSA test.

Casey59,
Not in disagreement with anything you said, but you know the statement "We need to focus on aggressively treating those who need aggressive treatment, and not aggressively treating those who need monitoring rather than aggressive treatment" is beginning to sound like a broken record. You are not the first person to make that statement. It has been made 1,000 times over by people all through out the industry. But.......the fact still remains that there is absolutely no way to determine definitively the agressive cases vs. the non-aggressive cases. There is no test out there that can tell us that. Everyone beats the "we need to treat only the agressive cases" drum, but none of those people can tell us how to determine who those people are. Yea, it makes logical sense to do that. It's a great idea, but again nobody anywhere can tell us who has aggressive vs. non-agressive cancer and guarantee it. So......just to be safe practically everyone is going to want to treat it somehow, since they can't tell you for sure that your case is agressive or non-agressive. And if you can't tell them apart, then yes you have overtreatment.........That's what happens.

I have a lot of great answers for some problems to, but they aren't technically possible either.....Again, Casey this is not anything against what you posted. It's really just something I've wanted to say everytime I hear someone in the news media make the same statement you did. It's like stating the incredibly obvious to me. I mean you might as well say "Oh yea, we need to cure cancer to stop this from killing people. That's what we really need." Duh........

Again, not a personal attack on you Casey..........Please don't shoot me........

Chris,

THanks for sharing that piece.

It's real simple in my mind, the whole subject.

All men should still be tested. If no PC in the family, and if caucasion, then starting at age 50. If African-American, or if there is strong family history, at age 40. Or perhaps sooner, if there are other prostate related problems at an early age.

PSA screening has saved lives, I will never buy into what is pushed now by the "experts". It is a simple, inexpensive, non-invasive blood test.

What should be done with the results of a PSA test, should be well thought out. Rule out infections and enlarged prostate matters for starters. If it's a question of rapid PSA velocity (as I experienced), then get a biopsy sooner, rather than later.

The PSA is just a tool in a long and complicated process. If the PSA leads to a biopsy or biopsies, and there is a positive diagnosis, then treatment or non-treatment should be seriously reviewed, looked over, and consulted about. A second opinion on a positive biopsy, should almost be a requirement prior to any treatment in my opinion.

AS should always be offered to any man with a positive dx, if all the safe criteria is met. AS shouldn't be avoided, denied if warranted, or hidden away as a treatment in it self.

Until there is that "perfect" test we all would agree upon, to know the variant and aggressivness of a PC dx, until that is available, we have to work with what we work with.

PC is not the good cancer, no cancer is good. But having PC shouldn't mean making rapid, drastic, invasive choices unto the best facts can be discovered about a particular diagnosis.

I don't like where the "industry" is going with testing, I think it's short sighted at best. PSA testing does, and will continue to save lives, regardless of what some carefully worded study or group thinks or states otherwise.

I also don't like, or remotely agree, with this new notion of calling low-grade PC something other than "cancer".  If the cells have mutated to be viewed as cancer cells by a qualified pathologist, then cancer it is.  Telling a man, in the case of a PC dx, that it is anything else but what it is - cancer, is deceptive and I would dearly question the true motivation for doing so.  Again, having the correct diagonois, is no excuse to panic and race out for immediate treatment, if treatment is not warranted.  But let's call an apple, and apple.

As long as I am alive, I will continue to inform as many men as possible in my natural path, the need for regular PSA testing.

David in SC

Post Edited (Purgatory) : 5/8/2012 1:14:08 PM (GMT-6)

ChrisR said... Again, not a personal attack on you Casey..........Please don't shoot me........ On the contrary, Chris, thank you for your comment because it is an opportunity for dialogue and learning. I will respectfully point out that contrary to the comments made here, doctors who practiced conscience-based medicine and doctors who are versed in an understanding of the AS protocols advocate a good-sense blend of curative treatments and active surveillance…NOT a treat-everybody-no-matter-what approach. First of all, doctors do separate aggressive from non-aggressive PCs (your question from above) very quickly. What is less immediately obvious is the non-aggressive from the mildly aggressive cases, and that requires the patience and wisdom of time . Time is used as an important prognostic guide, and it is unavailable at the time of diagnosis, and with time and added trending the confidence grows and multiplies. This is why, of course, conscience-based practitioners plead with low-risk men to not rush their decision…and why we often do the same to newly-arriving low-risk men, too, but we often forget the real reason behind the reason not to rush. As Dr James Eastham, well known prostate surgeon at MSK, has said that he typically tells low-risk patients, “Let’s see what this case is going to do,” Don’t rush into surgery—in other words, don’t aggressively treat cases that don’t need aggressive treatment . It's not just words...the knowledgeable doctors are putting it into practice. How do we help push that knowledge down to the community urologist level quicker than is happening now? Of course, many of the proposals to change the name of low-risk PC are rooted in helping allow men who have time to take the time. Along the lines of Dr Eastham's comment, it might be better referred to as "something that needs watching," but could be cleared-up with lifestyle changes, based on the commitment of the patient. added later as an edit: It is important for men to be informed that some low-risk prostate tumors may remain indolent without any symptoms or pr opensity to spread, and treatment of these tumors can be more harmful than beneficial to a man's QoL. On the other hand, high-grade tumors appear to present the greatest risk of spreading and the greatest likelihood of prostate cancer related death. Therefore, in the "informed dialogue" clinicians should stress that the risk of high-grade disease, rather than the overall risk of having prostate cancer , is the important reason for proceeding with a prostate biopsy . In other words, the urologists should be counseling patients before their biopsy, "Most men your age already have some low level of abnormal cell growth that used to be called prostate cancer, but let's see if the indicators are such that you may have the the frequently occuring low-risk kind that often doesn't need aggressive treatment, or something else." This might be less apt to trigger the "get it out, now!" response which is problematic.

I think that the NCCN has published the most common-sense approach to PC screening...which has more details that I described, but my description is based on their guidelines

Casey,
Prostate cancer deaths did not decline BEFORE PSA testing became "wide-spread" as you mention. The data says otherwise (see below). There has been a 44.1% PCa death reduction between 1994 and 2009. Not something that can be ignored, but it is...

Here is the SEER data:
SEER Cancer Statistics Review, 1973-2009

Table 23.6
Cancer of the Prostate (Invasive)
Age-adjusted U.S. Deatha Rates by Year, Race and Age

Male - All races

Year of Death/Mortality rate*

1985 33.91
1986 34.93
1987 35.11
1988 35.88
1989 37.10
1990 38.56
1991 39.31
1992 39.22
1993 39.34
1994 38.54
1995 37.29
1996 36.00
1997 34.15
1998 32.63
1999 31.56
2000 30.31
2001 29.17
2002 28.19
2003 26.57
2004 25.51
2005 24.70
2006 24.06
2007 24.04
2008 22.82
2009 21.99

*US Mortality Files, National Center for Health Statistics, Centers for Disease Control and Prevention. Rates are per 100,000 and are age-adjusted to the 2000 US Std Population (19 age groups - Census P25-1130).

Source:
tinyurl.com/7wdr4jx

RalphV

There is nothing wrong with PSA testing. How the result is used matters most. My PSA was going up gradually from the age of 65. At the age of 70, I was disgnosed with Gleason 3 + 3 T1C cancer. I asked the urologist about AS. He said would have reommended that if I were 80. He suggested brachytherapy (not all urologist recommend surgery) because he thought at my age surgery may be too risky. I had successful brachytherapy with no SE. So I am glad my PC was discovered and got treated. I don't care what the pundits say about PSA testing. Very soon there will be better test and PSA will be history.   

So I was diagnosed at my current age of 44 with a PSA of 6.5 and it was then that I found out that 3 years earlier I had my PSA checked along with my cholesterol and my PSA at age 41 was 3.8. I'm very glad it was checked this past year again but not sure why I wasn't told 3 years ago. I guess from what I was told, if it's not 4.0 they don't throw any red flags.

My brother (41) went to get checked because of me and the doctor still told him he was too young to be tested. My brother said.....Look, my brother has pc, I'm getting tested and I'll pay you for it on the spot! He tested 1.5  and I told him he really needs to get a DRE done also.

So I was a 4+4 at biopsy and after surgery 4+3, no positive margins. I had ZERO symptoms and felt great... not sure I want to think of where I might have been 6 years from now at age 50.

More and more younger guys with pc.... I say get checked at 40, it's a simple blood test and get the DRE at the same time. I could be wrong on this but my neighbor is Air Force and when we were talking about this he said they get checked on a regular basis and not at age 50.

Thanks to the nurse at my family doctors office that said see a uro now (psa 6.5) the doctor wanted me back in 3 to 6 months.... glad she took the time to call me while reviewing my charts and voiced her opinion!

            Jeff

David,
The only way to test for a varient is having certain tests run by a pathologist on the biopsy sample. Dr Bronkhoff has a paper on all the tumor markers that he uses that I can send to you if you wish.
Scans, such as CDU, MIRS, and multiparametric MRIs are the best way to verify that you are a candidate for AS. As I have mentioned before, personally I would never go on AS without having a Color Doppler Ultrasound. Franchot, who used to post here, was very successful in using CDU to establish his eligability for AS and has successfully used it to monitor his AS program.
Time is still one the best methods. You are checking psa every 3 months and at the first signs of it rising you get another biopsy or go for treatment. In every study conducted delayed treatment has the exact same statistical results as immediate treatment. Most progressions are identified within the first 3 years and treated.
I always looked at AS as a risk reward situation. The risks are that 30% of the time it will progress and you get treated with the same results as immediate treatment. Given that treatment involves at least a 60% risk of permanent side effects the reward is 70% that you live free of SEs. According to Klotz and somewhat verified by the European studies, if you are never treated there is a 5% differential in mortatility at the 20 year mark. Which means that 95% of patients with low risk PC are still alive at 20 years with doing nothing. I'm not suggesting this as some European doctors are, and believe that all patients should get treated on any signs of progression. I guess it's all relative; In Viet Nam I had a 20% chance of dieing in a 12 month period; so I think 5% over 20 years is a smoking deal especially when there is a 100% chance of living 10 years. I'm pretty sure that I will die from a heart attack before I'm 87, so I would take those odds any day. Others may feel entirely different.

A comment on the ORIGINAL poster's thread title, " Now screening and treatment reduces mortality by 20% in younger men ," it is relevant to note that the scientist who first discovered the prostate specific antigen marker, Dr Richard Albin, wrote that he has come to believe that widespread deployment of screening for men over 50 constitutes "a public health disaster."   (Many people have improperly paraphrased his comment more widely to include all ages.)   ARTICLE I like the NCCN screening guidelines better than any others I've seen... but if we are going to screen younger men, we have to FIRST get better at having the "informed discussion" which will lessen the "cancer hysteria" which occurs even upon finding irregular prostate cells (currently called low-risk "prostate cancer").  Did you realize that autopsies of boys/men between ages 20 and 30 found 10% incidence of what we currently call PC!?   For the sake of our sons, we have to get a better handle and reverse the trend of overtreatment of low-risk PC.  I'm honestly surprised and disappointed that there is such a level of resistance to change among a portion of the HW members, and the level of satisfaction with the overtreatment which is happening today, especially in light of the strong evidence and knowledge that we can safely weed out many low-risk cases (I would acknowledge that we will probably never eliminate all overtreatment of PC), and today we aren't weeding out nearly enough. edit :   I revised the segment “… between ages 15 and 25…” to be “…between ages 20 and 30…”, and I underlined and colored that sentence to place emphasis on this important point.  Thanks, Ralph, for drawing attention to this and helping emphasize the importance. Post Edited (Casey59) : 5/9/2012 2:33:40 PM (GMT-6)