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Posted 7/19/2016 4:59 PM (GMT 0)
This is preaching to the choir but saw this today.

"Number of Advanced Prostate Cancer Cases Soars...
Increase may be due to lax screening or more aggressive disease, experts say"

"The number of these cases was 72 percent higher in 2013 than it was in 2004, the researchers found."

"The report was published July 19 in the journal Prostate Cancer and Prostatic Diseases."

Link to the article....

www.webmd.com/prostate-cancer/news/20160719/number-of-advanced-prostate-cancer-cases-soars-us-study

TG

Post Edited (Fuelguy51) : 7/19/2016 11:02:23 AM (GMT-6)

Posted 7/19/2016 5:14 PM (GMT 0)
I would think that in either case, lax screening or more aggressive disease, less lax screening would be called for. Could there be other reasons for the apparent rise in aggressive PC cases?
Posted 7/19/2016 5:33 PM (GMT 0)
But, hey, we're only talking about 24,000 men per year...... with advanced metastatic disease..... that could have been found much earlier.(says Bill sarcastically).
Posted 7/19/2016 5:45 PM (GMT 0)
Add my sarcastic remark: But guys, don't you know that there is a straight line from screening to unnecessary treatment? So what if a few men get caught too late to do anything about it, we're saving all these men from horrible, unneeded treatments and side effects? And besides, these advanced untreatable cases are going to save us so much money going forward, don't you know.
Posted 7/19/2016 5:52 PM (GMT 0)
And now my sarcastic remark: typical....you guys only read the headline, and not the article, right?

Check in with Dr D'Amico
Posted 7/19/2016 6:08 PM (GMT 0)
Read the headline and the article, and they sort of confirmed what my crystal ball has been saying since the USPSTF recommendations. But, I'm sure it's only a matter of minutes before it will be explained to us that this is all wrong, and that even if tens of thousands more men aren't screened and end up with advanced metastatic disease, it's really a good thing, because hundreds of thousands of others can still get erections while all this is happening unbeknownst to them inside their prostates.

These tens of thousands of guys diagnosed late are just cannon fodder in the war against PSA testing, and it's time they realized that and accept their fate.
Posted 7/19/2016 6:50 PM (GMT 0)
You are only allowed one sarcastic comment per day.
Posted 7/19/2016 7:01 PM (GMT 0)
Oops. Sorry. :) You're right about the sarcasm, but my focus has always been on the guys who aren't diagnosed in time, since that nearly happened to me.

My family doc included a PSA test with every annual physical. One year it was in the 2 range, then the 3 range, then the 4 range, then the 5 range, and finally about 6.2 if I remember correctly.

I should have seen the uro several years before the PSA numbers finally convinced me to do so. My doc had been urging me to do that, and when it went beyond 6 he refused to even do the DRE. He said I MUST see a uro ASAP. I thought I was bulletproof...cancer proof...but the PSA number is what compelled me to see the uro. His DRE found a tumor, which was confirmed by a biopsy, and the rest is history. It was Gleason 7, all six positive on the left side (and more found subsequently on the right) and I'm just really fortunate that the PSA results overcame my obstinacy and hardheadedness before the cancer became metastatic.

So, I feel strongly about testing and am supportive of the PSA test, which much be followed up appropriately, which might mean AS, or possibly more serious intervention. But, knowing how many men ignore their health, I view the PSA test as an important weapon in the war against prostate cancer....one which can save tens of thousands of men from having to deal with metastatic disease.
Posted 7/19/2016 7:50 PM (GMT 0)
Just a thought. I had annual physicals and PSA screens every years since age 45. No family history. Less than a year before diagnosis my PSA was 1.9 and stable. And less than a year later I was metastatic. I did everything a person is supposed to do and still got hit. Not sure what any of that means other than sometimes it just happens...
Posted 7/19/2016 7:53 PM (GMT 0)
PSA, by itself, is a tool. That's all it is. Used properly, it can help save many lives and much suffering. Used improperly, it can wreak havoc. Finding the line between those two uses is the maddening challenge.
Posted 7/19/2016 7:55 PM (GMT 0)
also see: /prostatecancerinfolink.net/2016/07/19/a-rise-in-the-incidence-of-metastatic-prostate-cancer-from-2004-to-2013/

a quote from the article:
"These findings cannot be explained completely by reactions to the USPSTF recommendations alone, as increases in metastatic prostate cancer began in the years before its release."

Let's not overreach until needed.
Posted 7/19/2016 9:13 PM (GMT 0)

InTheShop said...
Let's not overreach until needed.



hahaha...good one!

Reserve the right to overreach when needed...
Posted 7/19/2016 9:25 PM (GMT 0)

john16 said...
Just a thought. I had annual physicals and PSA screens every years since age 45. No family history. Less than a year before diagnosis my PSA was 1.9 and stable. And less than a year later I was metastatic. I did everything a person is supposed to do and still got hit. Not sure what any of that means other than sometimes it just happens...



john16, I'm really sorry to hear about your case, but what you described is the nature of prostate cancer and a prime example of why mass "screening" programs for PC are highly ineffective...due to both lead-time bias and length-time bias (your case), which are little understood by the general public.
Posted 7/19/2016 9:55 PM (GMT 0)
Before we go down into the hole of our standard argument (no I won't grace it with the label of debate) about screening/no screening, might I suggest a different question:

How can we, as participants in the system that exists today, who have experienced the reality of PC, move the process forward in a way that does two things: Keeps the 6 of 7 men who will never get diagnosed with PC from the anxiety and stress of getting checked AND locates the 1 of 7 who do need to get diagnosed early enough to be treated effectively? (I'm not interested in a quibble about whether the number is really 1 in 7 or whether it is more or fewer than that, that isn't the point of the question).
Posted 7/19/2016 10:21 PM (GMT 0)
That system of mass PSA routine screening has created overtreated of favorable risk cases like mine and yours, halbert, and over a million others, as well as john16's missed case due to length time bias. So the answer, in part, is that it will not include the PSA test. PSA is highly ineffective for PC.

Post Edited (JackH) : 7/19/2016 4:24:53 PM (GMT-6)

Posted 7/19/2016 11:00 PM (GMT 0)
Jack, so take a stab at the question: What does the solution look like? For me the solution, which again has to be based on current understandings and current methods and materials, has to somehow include some form of "screening" to identify the real risk factors. What are those methods and materials? It's not enough to say "no" to everything. There is no solution there.

Oh, I'll say it again. I may have been treated early, but not unnecessarily. My post surgical pathology certainly suggests that a subsequent biopsy could well have come back with 50% positive G7 cores, ending any AS run at an early point. And I don't want to argue about it. I have my opinion about it, and you have yours. Can we agree to disagree on necessity and overtreatment in my case?
Posted 7/19/2016 11:10 PM (GMT 0)

JackH said...
That system of mass PSA routine screening has created overtreated of favorable risk cases like mine and yours, halbert, and over a million others, as well as john16's missed case due to length time bias. So the answer, in part, is that it will not include the PSA test. PSA is highly ineffective for PC.

And yet, as I said in my post above, it was the PSA test results that finally convinced me to see a urologist. Without the PSA test, without those several years of increasing PSA results, I would have never seen a urologist. I would certainly, by now, be dealing with an advanced case of prostate cancer. I am not wrong about this, and I am certainly not making it up.

I suspect there are many, many men like me for whom the PSA test results were THE motivating factor that led to successful treatment of prostate cancer.

You say you were "overtreated." I don't know if that's a subjective judgment on your part, or if it's medically and objectively definable. I can only speak for myself, and I refuse to acknowledge that the "answer" does not include the PSA test. That's just wrong.

This horse has been beaten to death and I don't intend to add anything further in this thread. There's no point. But these are my thoughts.
Posted 7/19/2016 11:12 PM (GMT 0)
But, are the majority of those cases discovered by PSA testing subject to the biases mentioned? I'll bet not, but maybe.
Posted 7/20/2016 2:03 AM (GMT 0)

clocknut said...
Oops. Sorry. :) You're right about the sarcasm, but my focus has always been on the guys who aren't diagnosed in time, since that nearly happened to me.

My family doc included a PSA test with every annual physical. One year it was in the 2 range, then the 3 range, then the 4 range, then the 5 range, and finally about 6.2 if I remember correctly.

I should have seen the uro several years before the PSA numbers finally convinced me to do so. My doc had been urging me to do that, and when it went beyond 6 he refused to even do the DRE. He said I MUST see a uro ASAP. I thought I was bulletproof...cancer proof...but the PSA number is what compelled me to see the uro. His DRE found a tumor, which was confirmed by a biopsy, and the rest is history. It was Gleason 7, all six positive on the left side (and more found subsequently on the right) and I'm just really fortunate that the PSA results overcame my obstinacy and hardheadedness before the cancer became metastatic.

So, I feel strongly about testing and am supportive of the PSA test, which much be followed up appropriately, which might mean AS, or possibly more serious intervention. But, knowing how many men ignore their health, I view the PSA test as an important weapon in the war against prostate cancer....one which can save tens of thousands of men from having to deal with metastatic disease.

Clocknut, my story mirrors yours in several ways. Except, when the PSA finally drove me to a URO and BX, I came up with a G9, and later realized I also had SV+ after post op path report. I might could have caught this several years earlier if I had listened to what the rising PSA test was telling me.

Post Edited (BillyBob@388) : 7/19/2016 8:14:09 PM (GMT-6)

Posted 7/20/2016 3:31 AM (GMT 0)
Good grief, I cannot believe we are having this conversation. If the problem is overtreatment work on that through education of doctors and men. Don't advocate doing away with the test that properly educated doctors and patients use to see when to test more.

Education is the answer, not the one non invasive cheap test that identifies when a man needs more expensive or invasive tests.
Posted 7/20/2016 4:03 AM (GMT 0)

clocknut said...

You say you were "overtreated." I don't know if that's a subjective judgment on your part, or if it's medically and objectively definable. I can only speak for myself, and I refuse to acknowledge that the "answer" does not include the PSA test. That's just wrong.

This horse has been beaten to death and I don't intend to add anything further in this thread. There's no point. But these are my thoughts.

Clocknut, I agree that we need the very imperfect psa test as a gateway indicator of something needing further testing. Now there are several other blood and urine tests available for greater precision. And, of course, the latest MRI scans. Beyond the biopsy, there are now the Prolaris and OncotypeDX tests which analyze the genomics of the cancer slides.

BUT, the main variable in the "overtreatment" debate is the face-to-face doctor who makes the recommendation.

The guy who told me of my positive diagnosis was a surgeon; but, he was also part of the Johns Hopkins Urology team, and had to submit my pathology to a board of review. They said AS. He had to agree, and that was that. This contention will not be settled for a few more years, when imaging and genomic tests became absolutely reliable.
Posted 7/20/2016 12:06 PM (GMT 0)
Halbert, picking up from yesterday afternoon, you missed my point which was response to your question: mass routine PSA screening does not get us to the place you described. Not even today's "smart" screening, which is the best we've got. That's the answer to your question...you can't get there from here...not with the highly ineffective PSA test.
Posted 7/20/2016 1:16 PM (GMT 0)
And Jack, you missed my point. What IS the solution? If not PSA, then what gets us "there"?
Posted 7/20/2016 2:20 PM (GMT 0)
No, you missed my point! hahaha, we could do this all day

So I'll repeat, more slowly this time for you...the place you described included (i) use of the PSA test to (ii) not overtreat millions of men like you and I on one end of the spectrum, but also (iii) detecting john16 and others earlier than he was found despite annual PSA tests. You cannot get there from here using the PSA test, which was your constraint. Mass routine screening makes matters worse, but "smart" screening which I and every medical society on the planet endorse today, is pretty much all we have today for the use--which was your constraint--of the PSA test. I want you to keep in mind that nobody, not even the USPSTF, says to stop all PSA testing. Nobody.

The PSA test is a highly inefficient screen for prostate cancer.

I've given the same answer multiple times now, and in many threads in the past, which is unusual because I never, never repeat myself.
Posted 7/20/2016 2:27 PM (GMT 0)

ShinytopPC said...
Good grief, I cannot believe we are having this conversation.

Hang around, this wackiness pops up from time to time.

eventually the mods end up locking the thread because some can restrain themselves.

Peace,
Andrew
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