Pratoman said...
"The groups agree that PSA-based prostate cancer screening should not occur in the absence of an informed, shared decision-making process, and that the decision to initiate or continue PSA screening should reflect an explicit understanding of the possible benefits and harms, as well as patients' preferences and values."
I understand that this statement was the joint opinion expressed by 3 professional organizations. And I may not be one of the more informed members here, I don't do as much reading of white papers and research as I did earlier in my journey, because frankly, I'm tired of thinking about it.
And I want to emphasize, no disrespect meant to anyone here, I want to go out of my way to say I respect the individual and collective intelligence and thoughtfulness of the members here, especially all of those who have participated in this thread.
With that said, I just have to say, with all due respect to the intelligence of the members of the organizations that put out the above statement, ITS DUMB.
Everyone should get screened. The reason its dumb, is that it should go without saying that before screening is performed, the doctor should have an obligation to explain to the patient that PSA is a tool, and just one of many, to determine whether other, more involved testing should take place. But every man should get screened. Just like every woman should get screened for breast cancer and every person should get screened for colon cancer. (i know, those cancers are different. Really? Only if you aren't a G9)
Screening and overtreatment are not cause and effect. Lack of education and overtreatment ARE cause and effect.
I've often criticized my PCP for being overcautious and overtesting. Turns out, he's saved my life twice with his tests.unneeded tests.
I don't really care if I am 1 in 100 people in that situation. I care that I had grade 4 cells at the apex, initial intraoperative margins that were positive in that area, and my life was saved by a lot of testing.
There is a big difference between over testing and overtreatment. The testing should be done, then the shared decision making can begin
Please understand, I'm giving my opinion, and i respect the right of others to have and offer theirs.
I'm pretty much with you on most of that, Prato. As I said in the last post, I wish I had more early testing- and also that I had paid more attention to it, not less. True, I am a bit of a strong AS proponent, and I think there is a ton of over treatment. But a PSA test does not have to lead to over treatment. OT is the problem that needs dealing with, seems to me, much more than does getting the info from a PSA/DRE.
Still, I guess the argument can be made that if we didn't do the PSAs then UROs would not be offering the BXs and then offering aggressive treatments on the many cases for which it is not needed. The other thing is the patients: I have a friend who went to a free screening, ended up getting a BX, was told he had PC, and said "get it out of there now". Who knows what his Gleason or staging was, I doubt he knows. He was told they got it all. He had many months of incontinence, who knows about
his ED. He never considered anything else for even a minute. It would have been him pushing the surgeon(even if it wouldn't take much pushing). He had a severe shoulder injury during his 6 hour surgery that caused him trouble for months.
So it will probably take a ton of education to keep low risk folks from panicking when they hear "cancer", not to mention many surgeons who will encourage the RP. But that is not the fault of the PSA. In my case, with an SV+ G9, I don't see how I could have benefited from less testing and in fact may have benefited from more, and earlier. My past or future treatment might not save my life, but I don't see how I could have better off with less testing, do Y'all? (not that anyone is even necessarily advocating for less testing, I am not sure) Man just think, in my stubborn case, a Bx and surgery a few years earlier and maybe no SV+ and no positive margins! Who knows, maybe a little earlier than that and my nerves could have been spared! Or, maybe just some RT and no surgery. And, I think I would have felt much less rush to decide on treatment if I had not waited until my PSA was rising rapidly.