THANK YOU CASEY59 FOR: HW Mo Bros support MOVEMBER!!

Yeah, a big "THANKS" from me too Casey!  You challenge others to "Be a Do'er" - and you set the example for that.  Also nice to see you put your money (and your stache!!!!) where your mouth is!!!!

Hey guys, I appreciate that!

I definitely had some fun with it.  But prostate cancer awareness absolutely went UP as a result of 2013 Movember participation...and that, my friends, is a good thing.

The 2014 (4th Annual) HW PC/Aerobic Challenge is next...!

gunfighter, thanks for your note here, and also for copies of your recent editorials which addressed both BC and PC.   You are doing a lot of good for a lot of people, and most here know nothing of your efforts.  I particularly liked your editorial during BC month which paid homeage to BC but encouraged the ladies to also look out for the men in their lives. I don’t have the printout you brought any more, but the VA system, to me an outsider, seems to send mixed signals/messages.   If I remember it correctly, you had an example of some VA staff actually discouraging PSA testing…but it doesn’t seem like this is how it operates across-the-board. The VA is a huge organization, and perhaps decentralized by design (I don’t know), but THIS article from last year cites several disturbing examples, but one of the clear points is that there is a lot of PSA testing going on in the VA system.   On a national basis , an average of 45% of men over age 85 or with four or more serious other diseases were given a PSA screening test.   Looking at some individual VA medical centers, that screening rate went as high as 79%.   The study specifically found that the frail, ill men were screened at the same rates as the healthy older men with longer life expectancies.   I don’t care whether you are at a VA or where you are at, that’s just bad medicine at those medical centers .   While I would strongly say that any man deserves care decisions on a more individual basis, I can’t frankly see any cases for continuing to screen an 85 year old who has never had prostate problems. So that article was all about men over 85, which is a unique and small sub-set of all men.  Based on what I’ve read, and on what you’ve reported, there seems to be a wide range of variation in the individual man’s experiences, based on which VA hospital one goes to.   HERE was an article of a pilot program at the nearly VA hospital in Milwaukee on a PSA screening “decision-aid” to improve knowledge/education…this is very much state-of-the-art thought in urology outside of the VA system, so this example seemed very positive and forward-looking. When I looked at the VA/DoD website for their PSA guidelines, their policy seems to be following the generally accepted approach of “counseling men annually regarding the risks and benefits for screening; screening may be performed if desired by the patient.”   The most significant part of the online guideline that I personally had a problem with is that it appeared to be left to the individual facility or clinician as to whether the doctor would recommend screening to a patient at increased risk …to me this is a no-brainer that someone with increased risk (including Agent Orange exposure) should be recommended for screening .   I don’t understand why the VA is decentralized to this extent…especially with the known Agent Orange risk factor.   Off the topic of PSA screening, the VA has done monumental work in other parts of the PC arena.   The PIVOT trial, for example, was led by the VA.   This trial confirmed that after at least 15-years there was no difference in survival between men with early stage PC who had surgery and those who did not have any aggressive treatment whatsoever.   VA Press Release   keep up the good work!        

There is no doubt that the PIVOT trial could have been better but there has been a lot of unjust debunking of that trial. There has been plenty of time to debunk that trial with another trial but no one has produced better data. I don't think it's fatally flawed but I do not have a vested interest in it either.

To date we do know that there is a lot of controversy surrounding the PIVOT trial but it's mostly in the patient community.

For those asking what the PIVOT trial is, see below:

www.nejm.org/doi/full/10.1056/NEJMoa1113162

Tony

Not sure it is mostly in the patient community, Tony. My guess is that 99% of PCa patients don't even know about it.

This was a good link about it

www.cancer.gov/ncicancerbulletin/053111/page2