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do you consider ignored guidelines failed guidelines?

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Posted 5/12/2013 3:53 PM (GMT 0)
I do. But I suspect some will get left behind in the confusion and uncertainty created.

"As Dr Smith editorialized in the Journal of Urology following the publication of the ERSPC and PLCO trials in 2009, “Treatment or non-treatment decisions can be made once a cancer is found, but not knowing about it in the first place surely burns bridges”. It is clear that many urologists consider these new AUA PSA Guidelines to be in danger of burning these bridges. However, rather than burn bridges, it is likely that urologists and others will ignore these guidelines and continue to counsel men in a more balanced fashion about the pros and cons of PSA testing. The AUA will then need to consider whether ignored guidelines are failed guidelines."

www.ncbi.nlm.nih.gov/pubmed/?term=19524982
Posted 5/12/2013 6:33 PM (GMT 0)
David the ERSPC trial is precisely the one used in the AUA analysis that 1000 men need to be screened to save one life. In that trial of men screened 4 out of that thousand died. In the non-screened arm 5 out that thousand died. The charts are in the new guidelines.

Tony
Posted 5/12/2013 6:54 PM (GMT 0)
Author is saying that it is likely that nobody is going to follow these dubious guidelines.

And I agree with this part:

"Treatment or non-treatment decisions can be made once a cancer is found, but not knowing about it in the first place surely burns bridges”

Like Ed was saying, you think the member of the AUA will skip a baseline test at 40 and have their boys skip it? I doubt it.
Posted 5/12/2013 7:17 PM (GMT 0)
i think to use the term "nobody" is non-scientific. There will be no problem finding a doctor whom will ignore it entirely. And there already are doctors that have ignored all five options in my poll. There's enough doctors out there to definitely all aspects of the harms involved to render the justification that no man should be screened as having merit. It's the no restraint mentality that caused the USPSTF to react.

Tony
Posted 5/12/2013 7:19 PM (GMT 0)
But to finish another point, many urologists will abide. And they will still do tests at insistence from the patient.

Tony
Posted 5/12/2013 7:27 PM (GMT 0)
well since men our age get completely screwed by these new guideline (according to many prominent urologists) I'd hope many to actually ignore them.

Like Otis Brawley personally told me in an email exchange I still have, young men my age weren't even part of their findings and recommendations. He admitted to me in writing that yes, perhaps men my age were getting screwed, but that we weren't the focus of their recommendations. Same seems to be true now.
Posted 5/12/2013 7:54 PM (GMT 0)
big time fail.

look at how much time and energy Tony has put into clearing up "misconceptions" about the new guidelines.

what the guy on the street hears is PSA testing does not save lives and puts you at risk of being overtreated  -- i.e., possibly permanent ED and incontinence.   some doctors will hear the same thing.

ed

 

Posted 5/12/2013 8:07 PM (GMT 0)
LOL, Fair enough Ed,
I have put a lot of energy not just in clearing up the perceptions. Here are some of the perceptions I think were expressed:

1> The AUA is ending all screening in men aged 40-54.

2> The AUA is in cahoots with the USPSTF

3> There's a big time conspiracy in the medical industry to comply with the insurance companies and that's why these changes are being made..

4> The guidelines would killed me.


I can keep going on. But I won't. As an advocate I fully want every man saved that is possible and practical. As an advocate I also will represent the men that have been affected which is also an important part of being passionate.

According to the ERSPC trial...

1 in 48 have to be treated to save a single life.
1 in 1000 have to be screened to save one life.
48+ men will claim to be the one that was saved making at least 47 incorrect.
230+ will suffer morbidity without facing good odds at being saved.
48 of those men will claim to be the one that was saved making 47 incorrect.

Who is supposed to advocate for those men? We all are. It just seems that few care about them

Tony

Post Edited (TC-LasVegas) : 5/12/2013 2:50:57 PM (GMT-6)

Posted 5/12/2013 8:20 PM (GMT 0)
I haven't seen perception #1 and 2 Tony.

#4 can be real and is serious.

Hope none of you are ever that "single life"
Posted 5/12/2013 8:21 PM (GMT 0)
On Tony's post above, #3, not so much from conspiracy angle, but I was going to comment that not only do the urologists have to be willing to ignore a guideline, but the insurance company may not pay by citing the guidelines as their explanation or benefits, or not benefits as case may be.
Posted 5/12/2013 8:55 PM (GMT 0)
Davidg,
You are right on not seeing #1 I mistyped the numbers. I revised it. I have seen USA Today saying that the AUA is saying to no longer test men at 54 and under and that the AUA has stopped recommending the test altogether. Please look at the headline, and know that this was the post that started this whole discussion.

www.usatoday.com/story/news/nation/2013/05/03/urologists-psa-screening/2130971/

Now I ask since I believe that you read the statements and the paper ~ is that accurate?

Tony
Posted 5/12/2013 8:58 PM (GMT 0)
I have very little trust in the media here. I follow NPR who reported it like this.

www.npr.org/blogs/health/2013/05/03/180871950/urologists-recommend-less-psa-testing-for-prostate-cancer
Posted 5/12/2013 9:06 PM (GMT 0)
David,
I don't believe that the doctors will ignore the AUA guidelines..As an example, currently my major medical facility abides by the AUA guidelines and every patient is screened at age 40..My civilian doctor is bound by current guidelines. My VA doctor won't do a psa test on anyone without symptoms since he abides by the USPSTF recommendation..Another younger doctor at the same facility offers the test. Maybe he had one himself..Currently, the guidance at my VA "silo" seems to be that "the test is highly discouraged but it's at the doctors call". Who knows??
Bill
Posted 5/12/2013 9:07 PM (GMT 0)
Great post, david. Did you see the update from Otis Brawley? LOLOLOL. That I agree with?

Update at 3:55 p.m. ET: Dr. Otis Brawley, the American Cancer Society's chief medical officer, and a longstanding critic of PSA testing, praised the urology group's work in an email to Shots:

"I believe that the American Urological Association should be commended for a very careful evidentiary review and developing a statement that is truly consistent with the state of the science.
"The past 20 years represents some of the worst in public health in that we widely disseminated a screening intervention before adequately assessing it. I welcome any effort to explain to men the uncertainty, potential harms, and potential benefits of PSA screening. Use of this test should be a decision made by the individual patient in collaboration with his healthcare provider. The American Urological Association statement combined with the American College of Physicians statement of last month should mean the end of mass screening for prostate cancer.
"Now the American Cancer Society and five other independent organizations are calling for shared or informed decision making regarding use of this test."

Oh man. Casey is rolling over in his grave.

Tony
Posted 5/12/2013 9:16 PM (GMT 0)
i still don't agree with him. I'm glad my PCa was found in the last 3 years and not 25 years ago as it likely would have been an advanced case.

In my emails with Brawley he said that none of this was about 40 year old men like me. I explained to him repeatedly that young men like me get PCa and that given our age and frequent ability to rebound well vis-a-vis potential SEs it makes sense to find it early. He just keppt repeating that this was for men well over my age group. We exchanged about 15 emails.
Posted 5/12/2013 9:18 PM (GMT 0)
Guide lines are suggestions, not rigid rules to be followed, so NO, they couldn't be considered failed if not utilized.
Posted 5/13/2013 3:53 AM (GMT 0)
I think the observation that guidelines can't fail because they are not obligatory is quite valid.

I voted to test every man every year. Why? My company REQUIRES on pain of immediate termination that I (and all other employees) be frequently and randomly tested for drugs, nicotine, and a myriad of other situations. They walk in with a form, and I had best be at the testing center within the day, at my cost for the gas. Why should there be so much emphasis and pain of termination with cause about some things that are, well, let's just say less than significant, but no one tells or expects me to test for something that can (and in my case probably will) kill me? Yeah, my PSA test was because an observant nurse who had a case in her family thought to suggest my first one at age 56.

Argh.

Posted 5/13/2013 12:43 PM (GMT 0)
This topic is the never ending story debate. . . .  posted my position on all of this in the thread Tony started about voting on the different guidelines:

https://www.healingwell.com/community/default.aspx?f=35&m=2728059&p=2

 

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