Fewer men estimated to die from prostate cancer

Let's be clear; screening has nothing to do with incidence. It has only to do with detection before the cancer becomes symptomatic. With less screening we all know we will have less detection, but the PCa cells didn't stop developing and proliferating just because we turned a blind eye to them.

It continues to amaze me that we routinely screen for so many things, many of which lead to serious over treatment by prescription drugs; but we now balk at screening for two of the most prevalent and potentially lethal cancers; breast and prostate?

Best advise continues to take control of your health, educate yourself, and choose the providers that are in line with your objectives. There is so much great information readily available to everyone in America that this really should not be the issue it has become. And before you say that so many people don't have a computer or smart phone, remember there is a huge network of public libraries reaching most every community that do have computers and skilled people that will assist in their use.

Jack I understand that. I am pointing out that the language is misleading. When we purposely confuse incidence with detection we enter the realm that if we want to reportedly wipe out cancer, all we have to do is stop diagnosing it. Of course we know that is a bit Orwellian. But, so is saying that because we are "detecting" less cancer now that we aren't screening that it isn't "occurring" as often as it did when we detected more of it because we were screening. Again, occurrence/incident is different than detection.

In my opinion, and that of many others, by screening fewer people we will assuredly fall back to the days when we didn't find the cancer until the advanced stages with resultant limited treatment success. When that occurs in the next generation (our sons) then the new smart movement will be that we need earlier detection to be better able to treat and extend lives with less morbidity and........start screening again!!

To your point, thankfully about two thirds of the men with PCa need no treatment and will die with, not from, the cancer. But of the other third that have serious cancer it is a very different story. In my opinion, effective screening and appropriate treatment protocols should mean that the low risk men don't have the problems of overtreatment and get to die with PCa, and the high risk men get the appropriate treatments that have proven to extend lives and even provide cures for many so that more of them can also die with, not from, the disease..

JNF, I agree with most your comments.

Since you are using a microscope on the wording, however (and please don't take this wrong, I also think using the correct wording IS important), I wish to clarify this comment:

JNF said...
To your point, thankfully about two thirds of the men with PCa need no treatment and will die with, not from, the cancer.

No, that's just the ratio from those diagnosed/detected/reported (pick your favorite word). My point was that there are MANY more "with" PC besides those diagnosed which skews that ratio much more...many unreported cases which never affect the men in their lifetimes. The autopsy data proves this.



Please accept this clarification in the spirit in which it was offered...and I hope you will also agree with this point.

I am absolutely 100% "with you" on understanding everything you wrote in your prior post, JNF, and I agree with everything you said (minor exception of the "G7's" not worth quibbling about here is that a large number of the 3+4's, but not the 4+3's, can fall into the not-needing-immediate-treatment and maybe-not-ever category, but in the big picture your 2/3 and 1/3 ratios are definitely in the ballpark).

HOWEVER, this ballpark overlooks the point you made (I agreed with) earlier that this ONLY represents those diagnosed/detected/reported (pick one). The point YOU made (if I understood correctly, and again, I agree with) is that there are many others who have an "incidence" of PC who are un-diagnosed. The way you put it was:

JNF said...
...because we are "detecting" less cancer now that we aren't screening that it isn't "occurring" as often...

We can do an easy, quick back-of-the-napkin calculation to figure the real ratios using two readily available data sets. FIRST, we have the fact (from autopsy studies) that roughly 50% of 50-year olds have "detectable" prostate cancer (mostly undetected), and about 60% of 60-year olds, etc. SECOND, there are several sources for population data in various age categories; I'll use WHO's U.S. poplulation of males alive today. There are, for example, roughly 21 million males alive in the U.S. in the 45-55 age category. Roughly 50%, or about 10.5M, have prostate cancer (mostly undetected). Let's extend that over more age groups (let's see if I can get this table to line-up close):

....AGE...#U.S. MALES..%w/PC...Count w/PC
...45-55.......21M...........50%........10.5M
...55-65.......19M...........60%........11.4M
...65-75.......12M...........70%.........8.4M
....75+..........8M...........80%.........6.4M
................................................36.7M = rough total of U.S. males with PC (diagnosed + undiagnosed)

This is a back-of-the-napkin calculation of the true "incidence" of prostate cancer in the US (or, using the term in the quote I pulled down from your earlier post, JNF, the true "occurrence" of PC in the U.S.)

SEER reports what they call the "prevalence" of PC as the total number of men living with prostate cancer in the US, but this is only the cases diagnosed/detected/reported (pick one). The 2015 prevalence for PC in the U.S. was 2,795,592. This is the number to which your 2/3 and 1/3 ratios appropriately apply. [This is also the data which experts use to say that more than 1.5M men alive today have likely been "overtreated" for prostate cancer and living with the consequences...that 1.5M count is roughly 2/3 of the 2.7M.]

Most men today are "detected" via a process beginning with the PSA test...but clearly this method only identifies a small percentage of the actual incidence...let's estimate that 2.7M/36.7M=roughly 7% of all "detectable" cases are actually detected (mostly by PSA testing).

Perhaps more significantly is the fact that despite detecting only a small fraction (7%) of all the cases of PC which occur in the U.S., the mortality rate for PC continues to go down (which was, of course, the subject of the original poster in this thread). What does that tell us...(rhetorical question)?


JNF...how we doing with this?

Post Edited (JackH) : 2/24/2016 2:52:26 PM (GMT-7)

JackH said...


....AGE...#U.S. MALES..%w/PC...Count w/PC
...45-55.......21M...........50%........10.5M
...55-65.......19M...........60%........11.4M
...65-75.......12M...........70%.........8.4M
....75+..........8M...........80%.........6.4M
................................................36.7M = rough total of U.S. males with PC (diagnosed + undiagnosed)

Oh my gosh, I knew the number was big but had never done that back of napkin add-up.

That's staggering. How would we ever handle all those new diagnosis?

-Norm

Good questions, Jim. There's actually been a number of studies all of course with similar results. One of the objectives of the studies is simply to understand the real prevalence of prostate cancer, and I believe they were looking for other things too. The most well-known one is called the Detroit Study because it was done by the Wayne county corner which is where Detroit is at. I've posted the link for the report at this site before, you could Google something like Detroit autopsy prostate cancer and probably find it. It is staggering to think of what would happen if the diagnosis rate shut up 14 times the current rate.