Lies, darn Lies And Statistics

A lot of stuff Samadi says doesn't make sense. The 16% of those DXed with PC eventually die from it is a correct number. These include treated and not treated.
It is also true that 98% of those DXed with low risk cancer will survive at least 10 years.
Theoretically if all cancer was caught very early it could have a 98% chance of survival, but this is unrealistic as it would involve testing starting in your early 40's and psa test at least yearly from then on. It also assume that everyone would get tested, which again is unrealistic. This also means that every cancer, lung, breast colon ect would also require a much increased testing rate, because it makes no sense to early DX PC only to die of another cancer that wasn't detected.

"But if found early there is a 98.9% survival rate."

That is why even on facebook I tell every person I know If your a man over 40 or if you know a guy over 40 please tell them to get a quick blood test for psa. It could save their life.
Two guys did the test and both found cancer in very early stages.
I will never stop tell men about the test.

There is a BIG difference between testing and population-based screening. Two entirely different things. In your case, with a family history of PC, the AUA and USPSTF recommend talking to your doctor about testing. Screening means everyone gets it regardless of risk factors and discussions with doctors.

Screening at 40 would be an unmitigated nightmare.

I started getting tested annually in my 40's . My company included it in my annual physicals. PSA never went above .4 but I was diagnosed with BPH at age 58. Went on finasteride and tamsulosin for 12 years then PSA started to climb at age 67. At age 69 I had Gleason 9 PCa. I was told my PCa was always Gleason 9 and probably started at age 60. So I was tested but still had no evidence of cancer until it was too late and had left the prostate. One of the unluckily 10% . At least I got it treated before I had distant mets. And when lymph node mets were found at age 71 I treated them aggressively with RT. And I Just had SBRT to a single bone met and am back on ADT3 and on xgeva.
So early detection doesn't stop cancer for some of us.
Bob

I had a normal DRE and a normal PSA at around age 52 when I was with a large HMO in California, as part of a requested personal Health "testing" as opposed to an entire patient population "screening". I was healthy and had no prostate type symptoms thereafter. More focus was put on a melanoma scare and treatment about 5 years later, and annual colon health "screenings", thereafter.

At age 65, after experiencing severe lower back and abdominal pain, I was diagnosed with advanced metastatic prostate cancer to many, many bones and lymph nodes, and a ridiculous PSA of 5,006.

Did I personally "fail" to manage the "testing" aspect of my health? Was the HMO's "patient education" and Prostate "screening" program lacking? Did the oncologists and primary care physicians whom I saw during those 13 years bear some responsibility? Perhaps it is some mix of all of the above.

Regardless, "it is what it is", and since I was diagnosed 3 1/2 years ago, I have had to learn to deal with the new Reality, and to do my best to Live each day in the Present moment, rather than to continue to ruminate over the Past, or to fear or despair about a Future which is not yet real.

At first, there were many days when I had very fearful and sad thoughts about how I was "dying". As time went by, I've learned to have more thoughts about how I can be "living" in the present day. Some days it is nice to know that I can awake and choose, ... "Am I dying today, or am I living today?" and then go about it.

Charles

Annie-

You misunderstand the policy. The current task force guidelines do not "withhold" testing (not screening - they are different) from anyone who, understanding the risks, wants to be tested. But a man under 50 would be crazy to get tested without having any risk factors. If he does so, he is highly likely to slide down the slippery slope of biopsy, early treatment, and half a lifetime of living with horrific symptoms. If he does so, the odds of it saving his life are vanishingly small. Because PC is a slowly progressing disease, there is small benefit to early detection. You and I can both cite exceptions, but they are exceptions, not the rule.

Screening has been horrible in the US - countless men were given unnecessary biopsies and maiming treatments who should never have been diagnosed with their low grade PC in the first place. How many men is it necessary to maim in order to save one life?

An individual can make that judgment for himself. National policy, however, has to do what is best for the population as a whole.

PC does not result in death for most men who get it. What the AUA called for is a rational screening policy. Where does your "logic" take you? If any amount of harm to any number of men is justification for saving just one life, then why not prophylactically remove all men's prostates at age 40? After all, 1 in 6 men will be diagnosed with PC at some point in their lives, and if a man lives long enough, almost all men will have some prostate cancer even if he never gets diagnosed with it. Screening all young men is a dreadful idea - can you imagine the many years of suffering that would cause compared to the comparatively infinitesimal number of lives saved? We have to have quality of life too.

Guess I stirred the nest on this one.

Best of luck to Naples, Ddyss, Annie, Curious, Break.

There is no perfect response. Testing is not a perfect indicator and will not catch all cancers, and mass testing at age 40 seems unwarranted. But with a family history a first test at 40 doesn't seem unreasonable to me, as does testing in response to symptoms. And without risk factors there is still an age to start testing. Is that 50, 55, 60? There are enough guys on the forum in their 50's or early 60's diagnosed and requiring treatment, without any family history or any symptoms, for me to believe that 60 is too late. Is 50 too early? To me it makes sense.

So, from what I know of a few members who were in their 40s.

Todd - 42 at dx, still with us, but not really in any PCa risk groups, I think
Me - PSA 4.0 at 49, still with us, pT3bn1 , not in any risk group
JPenn - 45 at time of death, RIP Jordan, I don't think he was in any risk group either

Where would we be without screening? We know Jordan's fate. RIP

damm works...so silly yeh? ...yes it is a hypocritical existence...and will continue to be so in this dimension... " be ye there fore perfect " Transfigure and understand perfection in that...Light....


" Hypocrisy is vice's homage to virtue" " a little silver...a little gold "

Guys,
Early screening causes over treatment of low grade prostate Ca at very young age. The younger you are at time of treatment especially surgery for removal of the prostate, the longer you will be suffering SE which greatly are changing QoL. QoL will never be the same after surgery.
In the era where urologist are hungry for money and money is always on their mind not the patient best interest, you will be easily sucked in into veri intrusive life changing treatment which most guys are not ready for SE at very young age.
I am not against treatment when necessary but we all get easily scared when we hear word Cancer and we commit for treatment that lives some of us with life long regret.
I am one of those who regretted having surgery at age 51 that change my QoL.
I wish I stayed on AS even agains medical advice.
Surgery left irreparable damage on my body and man's function.
MK

Tall Allen,

Sorry to be so slow in responding to your post. The subject upset me so greatly that I didn't return to the thread.

You wrote:

You misunderstand the policy. The current task force guidelines do not "withhold" testing (not screening - they are different) from anyone who, understanding the risks, wants to be tested.

I'm afraid that is NOT the policy in Canada. The Task force policy in Canada is simply that screening is not recommended- at any age. An informed discussion, or the "offer" of screening is not necessary. The PCP can opt to withhold screening- not mention it at all- to reflect his/her experience and values. canadiantaskforce.ca/guidelines/published-guidelines/prostate-cancer/

Such was the case for my husband. His physical exam at the age of 56 did NOT include any mention of a PSA test.

So I wrote to the PCP, who is now retired. Incidentally, the PCP who replaced him also didn't offer screening and didn't seem to realize that prostate density and not only nodules, was an indication of PCa. We had to do battle to obtain an urgent consult when my husband had PSA of 28 and symptoms.

Here is what the PCP wrote in response to my email in which I informed him of Tim's cancer.

I used to offer PSA's to all men. Then these studies came out which showed that we were not helping men who had the test religiously, live any longer than men who never did. That raised eyebrows especially of doctors who were seeing the patients with unnecessary prostatectomies and damaging radiation treatment, men who ended up on daily Viagra and went deaf because of it etc.
The top specialists ( I remember dr. Klotz a famous Toronto urologist) were recommending 'watchful waiting' approaches but our patients were not very patient . They were anxious and they wanted their cancer gone even if it 'likely' posed no serious threat to their lives. So quite a few of my patients ended up with aggressive treatment for something that was likely not going to harm them.
In the end it became a matter of whether the Hippocratic Oath applied here, as you know it says 'Primum non Nocere' : first and most importantly: don't do any harm
What I was seeing was that we were in fact harming the innocent and had no justification for it. We could no longer promise the unfortunate impotent fellows they were going to live any longer.

Yes, I totally understand that a man might opt not to be screened and that is his choice. But my husband (and many Canadian men) who are at risk due to age have no choice at all.

It feels like my husband's life was sacrificed to protect the sexual function of other men.

In Canada, there are no repercussions for PCPs who opt to withhold screening from ALL men, regardless of age. Heck, it makes their job easier because they don't need to counsel or be knowledgeable about slightly elevated numbers. Furthermore, with emphasis placed on saving money, they are likely deemed by the government to be the heroes of the system.

So screening is not recommended in Canada at any age. But an individual doctor who believes in it can still opt to offer it?

My younger brother lives in England and I believe screening is not generally done there - if any English guys are reading this and I am wrong pls advise. At my urging my brother is having PSA tests and DRE's.

I realize I don't know my pcp's general philosophy on screening. In my case it was always understood that with my family history I needed annual PSA's from about the age of 50. Which eventually went to twice a yr as I got older. I suspect my pcp starts screening all guys past a certain age. But I will ask at my next exam.

The issues are complex and whether to screen and when to screen can be debated. But I do believe that any guy who specifically wants to be screened should have that right. But most guys are looking to their doctors for guidance and unless the doctor/national health board, etc. are recommending screening it's not going to be done. Which is the case for Canada, and probably lots of other places.

Annie88 said...
Tall Allen,

Sorry to be so slow in responding to your post. The subject upset me so greatly that I didn't return to the thread.

You wrote:

You misunderstand the policy. The current task force guidelines do not "withhold" testing (not screening - they are different) from anyone who, understanding the risks, wants to be tested.

I'm afraid that is NOT the policy in Canada. The Task force policy in Canada is simply that screening is not recommended- at any age. An informed discussion, or the "offer" of screening is not necessary. The PCP can opt to withhold screening- not mention it at all- to reflect his/her experience and values. canadiantaskforce.ca/guidelines/published-guidelines/prostate-cancer/

Such was the case for my husband. His physical exam at the age of 56 did NOT include any mention of a PSA test.

So I wrote to the PCP, who is now retired. Incidentally, the PCP who replaced him also didn't offer screening and didn't seem to realize that prostate density and not only nodules, was an indication of PCa. We had to do battle to obtain an urgent consult when my husband had PSA of 28 and symptoms.

Here is what the PCP wrote in response to my email in which I informed him of Tim's cancer.

I used to offer PSA's to all men. Then these studies came out which showed that we were not helping men who had the test religiously, live any longer than men who never did. That raised eyebrows especially of doctors who were seeing the patients with unnecessary prostatectomies and damaging radiation treatment, men who ended up on daily Viagra and went deaf because of it etc.
The top specialists ( I remember dr. Klotz a famous Toronto urologist) were recommending 'watchful waiting' approaches but our patients were not very patient . They were anxious and they wanted their cancer gone even if it 'likely' posed no serious threat to their lives. So quite a few of my patients ended up with aggressive treatment for something that was likely not going to harm them.
In the end it became a matter of whether the Hippocratic Oath applied here, as you know it says 'Primum non Nocere' : first and most importantly: don't do any harm
What I was seeing was that we were in fact harming the innocent and had no justification for it. We could no longer promise the unfortunate impotent fellows they were going to live any longer.

Yes, I totally understand that a man might opt not to be screened and that is his choice. But my husband (and many Canadian men) who are at risk due to age have no choice at all.

It feels like my husband's life was sacrificed to protect the sexual function of other men.

In Canada, there are no repercussions for PCPs who opt to withhold screening from ALL men, regardless of age. Heck, it makes their job easier because they don't need to counsel or be knowledgeable about slightly elevated numbers. Furthermore, with emphasis placed on saving money, they are likely deemed by the government to be the heroes of the system.