Over Diagnosis is an oxymoron - ANYONE, please refute this. . . . . .

Some have suggested that I create a thread for this topic of OD / OT - and I decided that I would. NOT that we need yet another thread as there are a few already active on this topic - but yes I will put this out there because after multiple attempts at getting anyone to refute my (and other's) position - I have NOT gotten a direct rebutal.
So then here it is - out in the open, fair game - someone, anyone, reply DIRECTLY to this:

You know, this junk continues to amaze me. THE ISSUE IS NOT about OVER-DIAGNOSIS - that phrase, in itself, "Over Diagnosis" is an oxymoron. Somebody - anybody - please provide me with solid, scientific data that correlates the two.

I honestly, truly cannot believe there is even discussion about this - While I personally and completely agree with "Over-Treating" going on - somebody please explain to me how being due-dilegent about testing has anything to do with over-treating. Sorry to be harsh and to the point here, but if a man makes a decision to be over-treated, then he has made a mistake - and because of that why should other men suffer from not being tested.

I simply cannot fathom this entire series of arguments - I really can't............

But at the end of the day I will still stand here and wait for someone to challenge my position on this whole ODOT thing - it is simply not about over diagnosis, it is what each of us does with the information we are presented with - like any other decision in life - the difference being this one is a potentially life altering if not life saving decision, which absolutely demands that I become educated and knowledgeable to make the right decision - on choice of treatment, or to be treated or not.

To not avail me of the opportunity to do so, is wrong - and I have yet to hear a counter-point to what my position is.

All I can come up with is if there is less diagnosis, then by default there is less treatment.

If you don't diagnose, then there is nothing to treat.

So over diagnosis = a higher percentage of over treatment.

Do I understand the concept? Yes.

Do I agree? No.

I'm with Allen here. Since that is the absolute definition in the medical field.

My version is:

Overdiagnosis is defined by the detection of a cancer, through screening, that would otherwise not be detected or cause harm to a patient during his lifetime.

But same thing.

This is not term for the diagnosed patient to fret over. But to deny this exists was a big mistake I repeated until I fully understood how it is used. This is not a term to look at our fellow members to say you were over diagnosed because we cannot define it on a case by case basis. It is an epidemiological recognition that when you look at the statistics and see way too many men diagnosed versus the quantity of men that actually die or experience adverse oncological side effects.

Sorry it is not an oxymoron. It is a fact.

Tony

Yoop,
"Hell yeah" we are in agreement with you! See my comments in Clock's thread about my beliefs on screening, od & ot. I really get perturbed when I hear other members comments about screening only those at risk or those that need screening or non-routine or less screening to help eliminate od & ot. Anyway, we haven't been disinvited to the chi-town get together-lol. My spell checker indicates that that wasn't a word but I will let it stand.. See you in October.
Bill

Yoop, I think you got several answers to your question - both technical and common sense. I happen to like the answer you got from Mrs. WW, that is the common sense notion that if you don't diagnose you don't treat. Hence, less diagnosis means less over treatment...simple math. I don't happen to personally subscribe to that approach of dealing with OT but it's a pretty clear explanation.

I think the problem you are having is that you just do not agree with the notion of restricting diagnosis in order to reduce overtreatment. Unfortunately the medical community has not - to this point - come up with a better solution. I hope they do.

In the meantime the debate continues, here and in the medical world. It will likely not be solved on this forum...

Jim

halftrack - very well put! I was having those same thoughts reading the posts leading to yours.

What we need are better detection technologies to clearly distinguish the potentially lethal cases. My history with it is quite aggravating, and plopped me into a pretty unhappy diagnosis.

Halftrack:

"Do we really have to restrict a patient's right to know in order to keep him from treating something that does not need to be treated?"

Even here there are nuances that medical professionals will point out two men, one 70 and one 40 with the same exact PCa will probably require a different path. With my disease at 70 I would have waited and monitored, but at 40? not a chance.

davidg said...

Even here there are nuances that medical professionals will point out two men, one 70 and one 40 with the same exact PCa will probably require a different path. With my disease at 70 I would have waited and monitored, but at 40? not a chance.

It's a tough call, David.

Suppose the experts come to you and say, "Let's hang off for X years, you have time for technology to catch up with better ways to treat this if it goes rogue. For that matter, it may never go rogue, but our crystal ball is off line right now, so we can't give you any concrete answers on that."

I don't argue with AS per se, but the human body will defy our logic and numbers and studies. Sometimes it just doesn't behave according to our best prognostications.

30 years is a long time for rogue cells to decide how to misbehave.

Let's face it; some of us made a decision and took our chances that we wouldn't end up with undesired results. We won that round, but others have not been so fortunate. I really do empathize with that, and that is the heart of the over treatment argument. Any compassionate individual would like to help somebody avoid that if possible.

In keeping with the thread: at least we were afforded the opportunity to make that decision, which would not have been ours to make without screening.

Medicine is still an inexact science.

Hi A Yooper, how ya doin’? I read your repeated question.   You’ve already gotten a clear detailed response from Tall Allen plus Tony's reply, plus the common sense response from MsWW, which are similar in aggregate to what I might have written, but the thought in my head is “why is he burning all this energy over this rat-hole?”   There are important issues here, but another definition of “over diagnosed” is not one of them. The important issues are 28,000 men in the US dying from PC, and the need for better treatments for high-risk disease to extend quality and quantity of life of these men.   The important issues are the need for better PC prevention.   Better knowledge of which environmental and lifestyle factors “feed the cancer,” and which “fight the cancer.” The important issues are the gross over treatment and maiming of men in the current “scorched earth” protocols which trigger emotional, even hysterical, responses to the tiniest biopsy findings just because it carries the “big-C” word, without even allowing the element of “time” to determine whether treatment is needed or not.   Men get so hysterical that we often hear them say (something like):   “I was diagnosed with low-risk PC at age 40, and if I hadn’t been screened without my knowledge and quickly treated I’d be dead at 42.”   That’s pure emotion with no science.  In the words of Virginia Moyer, "we can do better than that."  The status quo needs to change. So why are you jumping up and down about the definition...you passion seems misdirected.  (Hope that you take this in the spirit in which it was intended.)   “Over diagnosed” is not oxymoronic.   In today’s environment, over diagnosis leads to over treatment.   We can help motivate change.   We need to aggressively treat men that need treatment, and not aggressively treat men that don’t need aggressive treatment. Post Edited (Casey59) : 8/22/2013 8:15:01 AM (GMT-6)

Hey Casey, I'm doin' good - how's the newly-wed thing going?  Have you two been able to settle back in to the day to day stuff yet?

So then why am I burning all of this energy - because it's something I believe strongly in - fundamentally broken down to this - it is wrong to deny individual men screening because of a population of men making mistakes and being over treated - that's why.

 

I take it personal - "I" am not willing to be part of the collateral damage because of "other" men making uninformed and uneducated decisions in their lives.  Every man has the option to either panic and make a bad decision or become educated and make an informed decision - that's why.

Other than first half of your last paragraph that I'll get to next, your post is spot on to what I also believe = the need for better treatments for the high-risk guys for length and QOL, prevention, knowledge and lifestyle decisions, gross over treatment - all extremely well put!

I must not be very clear in my posts - I'm not "jumping up and down" about the 'definition.'  I am incensed however about trying to equate OD to OT, even Tony agreed that they are mutually exclusive. . . .  So then, TO ME, OD is indeed oxymoronic when applied towards an automatic OT - because FOR ME, OD does not, and will not, lead to OT.

For clarification - when I state "I", or "For ME" - what I am really saying is "Newbie", I am trying to stand up for them. . . . my sole focus of remaining on this site and being as active as I am elsewhere in the world of PCa is to help give the new guys that will follow a better chance at understanding PCa, as well as the various treatment options - and that they DON"T have to be either over or under treated.

Your last two sentences really, truly sum this all up extremely well - "We can help motivate change.  We need to aggressively treat men that need treatment, and not aggressively treat men that don’t need aggressive treatment." 

If you don't mind, I'll use those words from time to time!

Hi, again, A Yooper, Please do use those words again…you’ve certainly seen me use them at least a few times, and I’m pleased the numerous times I’ve seen others re-use them word-for-word.   Just send me a nickel each time… Back to the day-to-day next week.   I (finally) got some more wedding pics from a friend (professional photographer will take a couple weeks).   I will post a couple later today if I get back online again, or else maybe this weekend. Gotta run…

Tall Allen, in response to MsWorryWart, you said, "Because the PSA-screening detection of the prostate cancer would be irrelevant in those men -- something other than prostate cancer would have caused their death before they ever experienced any of the clinical symptoms (e.g., skeletal events, kidney failure) of prostate cancer."'

She had said, "I just don't understand how they could know that it would not cause harm in their lifetime, if they are not screened."

I understand what you are saying, and I'm sure it's statistically and probably true in most cases (you yourself use the word "typically" later in your response).

But her question was about "knowing," not guessing, or thinking, or wishing, hypothesizing, or relying on statistics or someone's model of how things should happen. Unless someone has a crystal ball, or a direct connection to the Almighty, isn't it true that there is now way of KNOWING that it will not cause harm in their lifetime? How can we KNOW that something other that prostate cancer will cause these men's death, and why is it being made to sound so unreasonable that a man would want to take action right now to reduce the likelihood of that ever happening.

Yoop,
You have a rational point of view. Looking at it another way; We know by autopsy data that the prevalence of PC is roughly equal to your age. So we already know that the majority of men over 50 will have prostate cancer. Only 3 will eventually die. Out of 100 men over 50, 50 have PC and 3 will die and 47 will die of something else. 2 will die regardless of treatment or early detection so only 1 out of 100 will be affected by screening or treatment. Mass screening would affect 47 men and impact only 1. This is not a wise use of the resources available. 50,000,000 men multiplied by $100, cost of test, is $5,000,000,000. Could this money be better spent to save more lives?