more on prostate screening....

Tony,

Ahhhhhh bacon....now that's music to my ears.  I haven't had a strip of bacon in years.

but seriously --- I don't have the full report.  Can you point me to where it talks about early testing to catch a guy like me?  If it sounds good, I might have to take back some of my horse dung comments....

thanks

Here ya go, Jerry...
jco.ascopubs.org/content/early/2012/07/16/JCO.2012.43.3441.full.pdf

Tony

The report isn't intended for the patient. It's intended for the doctors for practical application. Whether the patient listens or not is not relevant to what doctors should try to do. Basically if any man wants a PSA test, or they recommend such a test they should first examine the individual and not the class of the patient. All men with a life expectancy greater than ten years are considered eligible for the screening but the doctor should take the time needed to explain the pros and cons. If the patient wants to proceed they will be screened. If the patient does not want to be screened that is their prerogative. This can be done long before a patients life expectancy is less that ten years or if life expectancy is unknown. But if it's known that they do in fact have a shorter life expectancy this recommendation does not eliminate the test if the patient wants it anyway.

I used the calculator at the JCO website and my life expectancy at age 50 is 36.1 years. I would qualify for screening but the recommendation is for the doctor to tell me the pros and cons first then proceed. The explanation should probably include the earlier still in effect recommendation still in effect by ASCO to get a baseline at the age of 40. If I had not had a prior PSA at this age then this would be my baseline.

The only things to consider "controversial" here are the following:

1> If the patient should receive the discussion on the Pros and Cons
2> It appears that some think that placing a life expectancy criteria is wrong.

But when you compare to the USPSTF recommendation to doctors that says no man EVER should be screened ~ I think these controversies pale in comparison...

Big difference...

@Jerry at this time, the news is all over the place and there is no way to put the toothpaste back into the tube. What a man hears in the news, in the office, from their brother who was diagnosed, from whatever ~ this recommendation attempts to urge the doctors to clear it up as best as possible first. The Average Joe will hear what they are hearing now anyway. And if Joe wants to use this to avoid a screening ~ Joe gets his way anyway we change things.

Tony

Post Edited (TC-LasVegas) : 7/18/2012 11:09:40 PM (GMT-6)

I've been following this thread and abstaining. I'm glad I did initially because I misread the intent of Casey59's first post and got a little pissed. Now I understand where he's coming from and am in complete agreement. It's good to wait until reason sets in.

In this vein, I was doing a little news scan and came across yet another article ("Surgery for early prostate cancer doesn't save lives") in USA Today (I'm not a reader of this newspaper, but I followed the link). I'll throw in the link below, but my real intent here is to post a couple of comments, both from doctors, who hit the nail on the head:

Thanks for the excellent article. As both a cancer biologist and young prostate cancer survivor myself, I think the Task Force erred and "threw the baby out with the bath water". Stopping PSA testing entirely is a sloppy, heavy handed recommendation. What makes a great deal more sense to adopt a new, more focused plan of PSA testing. I outline just such a plan on my lab's website: bit.ly/JOgSEM.
Paul Knoepfler PhD.
Associate Professor
UC Davis School of Medicine.

Dr. Knoepfler hit one nail on the head with the phrase tossing the baby out with the bath water. Another adage to add to this is "don't confuse the message with the messenger". The fault, dear "Brutus" lies with us and now we use the results of PSA testing--at any instance in the historical timeline of the man with PC (prostate cancer). I have been in the field of PC since 1983, prior to and during PSA use from everything from screening for diagnosis, to determining response to treatment. The PSA is the most valuable biomarker for the most common malignancy afflicting men. Moreover, whoever said that a diagnosis of PC itself does not have major health ramifications in that such a diagnosis is tied into other co-morbidities, such as osteoporosis, metabolic syndrome, diabetes mellitus, CVD (cardiovascular disease), major abnormalities involving inflammation. Additionally, a diagnosis of PC does not equate or mandate performing an invasive procedure. AOS (active objectified surveillance) for many men finally is now a reasonable and logical approach thanks to the fine work of Lawrence Klotz et al. Secondly, the morbidity associated with the various invasive procedures are fundamentally related to the skill of the physician technician performing it. All men or women are not created equal; some have exquisite talents while others are frankly dangerous.

There are many important issues tied into this glib decision by the USPSTF. Perhaps, the harsh reality is that the level of medical/surgical care is so horrendous for men at large with PC that the most expeditious approach is to stop being aware that the problem of PC exists. There's no PC. A late diagnosis of PC has no ill effects. The emperor really is wearing clothes, and my doctor really knows what he is doing because he drives a Mercedes. Of course I am being sarcastic. But given what I have seen in the trenches for almost 30 years focused on one form of cancer, I do feel that the air must be cleared.

Stephen B. Strum, MD, FACP
Board Certified: Internal Medicine, Medical Oncology
Member: ASCO, ASTRO
Member: International Strategic Cancer Alliance (ISCA)
Ashland, OR 97520

I have to add that what these doctors say is common sense. This kind of reasoning does not require an advanced degree or even a Mercedes, but common sense and some reasoning skills. I don't get how a whole industry of supposedly bright people can be thrown into a tizzy over this. They should be able to poke holes in the USPSTF's findings and roundly denounce it for the sham that it is.

Link to USA Today article: yourlife.usatoday.com/health/healthyperspective/post/2012-07-19/prostate-cancer-surgery-dentist-visits-rory-staunton-obesity-and-olympics/806797/1?csp=34news

Looks to me, like the reverese is more likely true.

Just a quick note: Those two quotes that I included have been removed by USA Today in the comments section. Instead, there a couple of other comments that add nothing to the debate (though, the health insurance industry looms large in my mind in terms of this whole pile of dung).

Yup, that's USA today!

Just posting to link these two discussions together. One spurned the other.

www.healingwell.com/community/default.aspx?f=35&m=2465463&p=2

tony

blownsideways said...
I'm not sure which side is which, Tony, or if it matters, but I'm not here to get into a pissing match with anyone (pun intended). I have disagreed with the USPSTF finding since it came out and am not familiar with the alphabet soup of other organizations or which one is superior.

Thanks for your contribution to this important discussion, blownsideways.  I realize that perhaps you've bowed-out of this discussion, but I will add these comments for the benefit of those who may reference this thread in the future.

I don't believe that there is a single person to have ever posted here that agrees with the USPSTF recommendation...so you have joined the crowd.

The ASCO recommendation under discussion here was published this week; it is new.  The ASCO is the American Society of Clinical Oncologists..."clinicians" are the docs that meet with patients in the medical offices. 

USPSTF and ASCO recommendations are different...very different.  The ASCO recommendations are getting wide support among physicians treating PC patients (like Dr Strum), while the USPSTF never got much support in that community.

Sometimes, some of us spewing the alphabet soup forget that not everyone is equally intimate with them...sorry for the confusion, but I hope this explanation is helpful to future readers here.