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Posted 7/17/2012 5:53 PM (GMT 0)
Prostate Cancer screening and male life expectancy
http://www.huffingtonpost.com/2012/07/17/prostate-cancer-screening-test-man-life-expectancy_n_1679499.html
Posted 7/17/2012 5:56 PM (GMT 0)

how about this steaming green apple..........

The guide makes clear that before men decide to have the PSA test, they should think about how they'd react to a suspicious result, and all the testing and treatment decisions that would entail.

Posted 7/17/2012 6:01 PM (GMT 0)
Everybody and their brother has already come out and said that PSA testing on men with less than 10-years life expectancy is a complete waste...this is not new news.

Nor was it the main point of the ASCO news release.

The ASCO news release emphasized that oncologists believed that men with GREATER than 10-years life expectancy SHOULD have a discussion with their physician about screening DESPITE what the USPSTF published. In fact, the ASCO article title (published today) is: "ASCO Expert Panel Concludes Evidence Supports Physician Discussion of PSA Testing for Men with Longer Life Expectancies"


horse dung?   Maybe the way the mass media has chosen to report it...
Posted 7/17/2012 6:15 PM (GMT 0)
i guess warren buffett didn't get the memo.

ed

Posted 7/17/2012 6:21 PM (GMT 0)
Maybe I completely missed your point, Ed....which part do you think is "horse dung"?

I believe that ASCO is highly respected.  (They are in my book)

[The title of the article you posted, I would point out, is:  "Prostate Cancer Screening Depends On Man's Life Expectancy, Doctor Group Says"]

Posted 7/17/2012 6:52 PM (GMT 0)
Uh, Ed,
I agree with this article 100%. let me explain...

1> We are finding that 99.8% of men live longer than ten years after diagnosis with early stage non-symptomatic prostate cancer. If such is the case then we should not screen non-symptomatic men with ten year or less life expectancy.

2> My contention has been to screen men earlier in their lives to establish a baseline PSA or to find high risk men. If we can find them earlier then they are less likely to have symptomatic disease at their later ages since they can be treated earlier. This recommendation is falling into what I have believed for years now.

3> If guys like me, Jerry L, David Emerson, and many more, were screened earlier in our lives there is a good chance we are not late stages at discovery. It has been proven the longer a man lives with prostate cancer the risk of dying of prostate cancer is exponentially higher.

4> The conundrum then is what to do when PSA's are suspicious at earlier ages. This we need to keep looking at but I agree that education is key. And men can be educated. A PSA os 2 at age 40 should not result in treatment unless other factors other than PSA are measured such as doubling time and free PSA. Some will also say PCA3 tests and a genetic T2-ERG test. I have no problem with that.

Thanks for this post, but I agree with the article and find it to be very informative. We used to say screen at 50, 45 with risk factors. I think the correct age to start the screening process is 40/35 but without educating the person being screened we are running huge risk of over treatment. It's very important to educate men BEFORE initial therapies in these cases and we need to get the doctors to participate more closely with that thought process.

We do a great job of educating men here, and also in live forums such as the support group I run. My problem has been that the diagnosing doctors view my group as adversaries and it affects their business. But it's the right thing to do and many doctors will send these patients out to a support group ~ just not enough of them...

Tony
Posted 7/17/2012 7:03 PM (GMT 0)
Here is a non-biased commentary on this from Mike Scott's blog...

prostatecancerinfolink.net/2012/07/17/asco-issues-new-guidance-on-psa-testing-and-prostate-cancer-risk/#comment-24439

I sure wish that this was known when I turned 40...

Tony
Posted 7/17/2012 7:33 PM (GMT 0)
F8 LOL! :)

...and the only other thing that should accompany this carefully designed and conducted study with and its precisely defined result of 10-years life expectancy as a cutoff for PSA testing, is a card reader or a crystal bowl from your local witchcraft store.
Posted 7/18/2012 7:52 PM (GMT 0)
Great advice from the American Society of Clinical Oncologists' new guideline on PSA screening:

The guide makes clear that before men decide to have the PSA test, they should think about how they'd react to a suspicious result, and all the testing and treatment decisions that would entail.

Posted 7/18/2012 8:27 PM (GMT 0)
Taken literally, don't you find that to be a bit insulting to men?  Can you imagine saying to women, "The guide makes clear that before women decide to have the PAP test, they should think about how they'd react to a suspicious result, and all the testing and treatment decisions that would entail."

 

You'll never see a statement like that. 

Why this special treatment of the PSA test?  All medical tests have potentially serious outcomes and implications that can change lives. I say to the average guy, get tested.  Chances are you'll find out you're fine.  If the results are suspicious, find a really good urologist and make smart decisions about what to do, or not do, next.

It sounds as if the Clinical Oncologists are really saying, "Men, you probably don't want to get PSA tested because you may get a 'suspicious result' that's gonna take you some places you really don't want to go.

This is not a neutral piece of advice.

Posted 7/18/2012 9:37 PM (GMT 0)
Is there a similar cervical cancer overtreatment issue?....or, if not, are you suggesting that "one size fits all"?


By the way, I believe that cervical cancer is significantly less overtreated, particularly since the name of the lowest stage of what used to be called "cancer" was changed in 1988. Cervical cariconoma in situ was renamed cervical intraepithelial neoplasia.



An additional "by the way" note, the PAP testing guidelines are a great example of how screening has gotten "smarter."

At age 30, in the absence of other risk factors, women with 3 consecutive negative tests are recommended to move to an every-3-year test cycle. This is very similar to the structure of recommendations being put forward for "smarter" PSA testing.
Posted 7/18/2012 9:51 PM (GMT 0)
Tony,
You can include me in your point #3 list. My very first PSA, was at age 56, after having 2 "thorough" physicals at age 50 and 55. I had the PSA done as a requirement for life insurance. The result was 17, and 22 on the retest. Had my doc ticked the box when he was checking off the other blood work items maybe my biopsy wouldn't have been 7/12 with up to 70% involvement. Maybe, just maybe, the surgeon would not have had to "cut wide" to get it all. Maybe I would not be sitting here with a bottle of Quadmix in the freezer.

We know that ejaculation, stimulation, DRE all affect PSA screening results. Rather than avoiding the test how about telling patients to abstain for 48 hours before the test. That would reduce the number of false positives.

Jeff
Posted 7/18/2012 11:01 PM (GMT 0)
"The guide makes clear that before men decide to have the PSA test, they should think about how they'd react to a suspicious result, and all the testing and treatment decisions that would entail."

Who could possibly be fooled by such a ludicrious remark as that quoted above? Why not take this same piece of nonsense to every single medical test. Gee, don't get tested for anything, because it might come back negative or the patient might not like the answer. There has to be another motive behind such a statement, and not one in the best interest of the patient. I loved the part, "how they'd react to a suspicious result"????

Time to end this academic approach to testing, reagardless of the underlying motives, and let's go back to what is best for the patient.

All men need to be tested for PSA, period, in my opinion. If there is no problem there is no problem, if there is a problem then the sooner that information is available to see if treatment is needed. Avoidence is just another form of being in denial. What a great message to send to men, who historically, don't take good care of themselves, this just gives that mindset another excuse to ignore what could be a critical sign.

Geez, when is this nonsense ever going to end?

David in SC
Posted 7/18/2012 11:16 PM (GMT 0)
"The guide makes clear that before men decide to have the PSA test, they should think about how they'd react to a suspicious result, and all the testing and treatment decisions that would entail."

Sorry--- I ain't no expert and probably not the most articulate....but that is horse dung...

Posted 7/18/2012 11:48 PM (GMT 0)
Can I ask why men shouldn't think about how they'd react to a cancer diagnosis and the treatment decision?

Tony
Posted 7/18/2012 11:54 PM (GMT 0)
not saying they shouldn't, but what we think about cancer and SEs prior to a biopsy is very different to what we think once cancer is confirmed. Not to mention how different our attitudes are. Furthermore, understanding and adjusting to this crap can be a lengthy if not life long process for some/many.

Just knowing you are having a biopsy leads you to consider the potential results. The mind won't stop at cancer, it'll go on through consultation with doctors, family and friends and a lot of internet research, ost of which probably harmful.

Being told you have cancer is a whole different book than speculating whether you might have it and what you would do if you have it. I'd love to be back in that place.
Posted 7/18/2012 11:57 PM (GMT 0)
Tony,

The point is that they should, but will they? And why this level of concern about a PSA test as opposed to the other tests they do without warning? After I posted about the myriad of tests they do, I looked at some of them.

Some dire indications that I could get from one of those tests:

- thyroid cancer

- liver failure

- kidney failure

Does the task force suggest that I be educated on what a lifetime of dialysis would mean before I get my blood test?

(And no, Casey, I'm not sure if dialysis patients are over-treated, but I'm sure someone pays for those machines too.)

Just the point that education is great, but where does it start and stop? 

Posted 7/18/2012 11:58 PM (GMT 0)
So Tony, are ready to agree that you would have rather not known that you had PC, so that you wouldn''t have to know how serious a state you were in? Looks like you have really changed your approach to testing in a big way.

Seems like many on HW that agree with this new thinking, gee, have already been diagnosed and treated, so its easy for them to say they agree, since they have already been taken care of.

david
Posted 7/19/2012 12:12 AM (GMT 0)
Tony, I just find that statement and many of the other of the "new" thoughts about screening, testing, overtreatment, and so forth demeaning to men.

When my family doc ordered a blood sugar test recently, I didn't hold it against him that he failed to take me aside and warn me that a high number could mean a lifetime of insulin shots, daily needle pokes, possible kidney damage, eventual amputation of limbs, impotence, and so on.

.

Just as when he did the yearly PSA tests beginning at age 50, I didn't hold it against him, nor would I have welcomed it, if he had given me a statement like the one quoted in this thread.  If he had said something like, "You should think about how you would react to a suspicious result, and all the testing and treatment that might entail," I would have run, not walked, out of his office.  That verbaage just sounds like utter nonsense to me, something produced by a government bureaucrat perhaps.

Posted 7/19/2012 12:20 AM (GMT 0)
Where do you get that from, David?

In my post above I mention that I wished I had been tested at 40...

@142,
This isn't a task force. They are a consortium of physicians specializing in the treatment of prostate cancer. Some of the top PCa docs in the world. I think the recommendation is reasonable and it gives a chance for guys like me to be diagnosed earlier by being tested earlier. They're trying to prevent advanced case diagnosis in this recommendation. The recommendation is not just a don't test when patients have less than a ten year life expectancy, it a recommendation as to when PSA screening may be at it's most valuable point. It covers younger men which I applaud. And in older men it says ok to test when LE is greater than 10 years giving them a chance to find it before it's advanced into the years when they will have less that 10 years LE. It's all encompassing. It states that men should understand the tendency for patients and doctors to overreact which is a fact.

I dunno, I thought that was a good one...

Tony
Posted 7/19/2012 12:28 AM (GMT 0)
Or my doctor saying, "Oh, yes Jerry...before I give you your cholesterol numbers, think for a bit how you might handle having to go through a series of tests to see if there are any blockages and then bypass surgery.  Rehab will be intense.  Are you sure you want those numbers?....or we might just want to put you on a statin...but think about how you would react to any and all of this...". 

Ok doc - I think I'm ready for the numbers.

 

Posted 7/19/2012 12:31 AM (GMT 0)
way to go jerry, that's the same point i am trying to make out of all this. just what is "the other side" really after in all this? if men aren't freely tested, then they won't get diagnosed, then they won't be treated.....smells like the trail ends only in money-motivations to me. i am not willing to short other men's lives in this vain attempt to deceive men about testing.

david
Posted 7/19/2012 12:34 AM (GMT 0)
But Jerry,
We don't have the same reactions to high cholesterol and hang nails as we do a cancer diagnosis. Simply put, most men have that deer in the headlights look when a doc tells them they have prostate cancer. But since you mention it, if a doctor tells you you have borderline LDL and HDL the first attempt should be dietary to correct it as opposed to a lifetime of Lipitor. But some men would rather have the lipitor than change the bacon supply...

:-)
Posted 7/19/2012 12:44 AM (GMT 0)
Tony,

Sorry, I am mixing the discussions.

I agree with testing earlier, but I don't agree that we can expect the pre-testing education process to get much better. I also think that not testing when LE is less than 10 years is weak. At year 1 of those 10, if I have an issue that will kill me at year 5, I want to know. I tend to side with the "test everyone, treat smarter" idea.

I was poorly saying that if the real Task Force can cause so much chaos here, we should extrapolate to the situation that you have to go to school for a day before you get a common blood test.

Posted 7/19/2012 12:44 AM (GMT 0)
Tony,

That's not exactly true about high cholesterol.  I have familial hypercholesterolemia, which means that my elevated cholesterol (300+ without Lipitor) cannot be controlled, or even significantly lowered,  by dietary changes.  But, that's beside the point.

When I was first told my cholesterol was over 300, I think I was as dismayed and discouraged as when I got the prostate cancer diagnosis.  When I was told a month ago I needed an ultrasound to look for a kidney tumor, I wasn't very happy about that, either, and I certainly have been thinking about the implications of a positive diagnosis from that testing.

If we're really interested in developing reasonable recommendations, I think we should avoid formulating statements that will be off-putting to men who might need the testing.  It's a given that any medical test for a serious disease like prostate cancer will cause a man to "think about" the implications of a positive diagnosis.  Do we really need to put it before him in a way that makes THIS test stand out from every other?

 

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