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Studies Find Declines in Screening and Early Detection of Prostate Cancer

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Posted 11/17/2015 9:12 PM (GMT 0)
Article from the NYT should get our weekly debate about screening going again.......

www.nytimes.com/2015/11/18/health/prostate-cancer-studies-find-declines-in-screening-and-early-detection.html?_r=0

From the story.....

"Fewer men are being screened for prostate cancer, and fewer early-stage cases are being detected, according to two studies published Tuesday in the Journal of the American Medical Association.

The number of cases has dropped not because the disease is becoming less common but because there is less effort to find it, the researchers said......"

FG
Posted 11/18/2015 2:34 AM (GMT 0)
Thanks for the link.

I'm not sure what to make of this info, which is hardly new to those of us closely monitoring this disease.

Until such time as there's a test which can tell us which PCa is indolent and which isn't, it's a crap shoot I'd rather not play when I've been told by 7 specialists that I'm low risk but not a good candidate for AS because I'm not "very" low risk; that treating low risk disease leads to better outcomes mortality-wise than the higher risk levels; that I can have my pick of all the treatments now; and that because I can expect to live another 20-25 years, the disease will most certainly have advanced over the next 10-15 years making treatment necessary at some point.

If I roll the dice and defer treatment for say, 5 years, maybe the cancer stays the same. But if it doesn't, then my treatment options will be more limited than they are now, and I seriously doubt that any "new" treatments offered then will have sufficient long term data behind them, which means the insurance companies may not pay for the treatment and I won't be confident the new treatment is better than the tried and true for addressing what will then be a more serious situation.

So for me, early detection is a good thing, all things considered. I think.......
Posted 11/18/2015 2:56 AM (GMT 0)
Insurance companies would rather ALL cancer victims remain ignorant of their condition until they are stage 4 and terminal. Overall, the cost of treating such patients is much less than paying for a protracted battle that can go on for years requiring therapies and drugs that can cost untold amounts of money...

"The task force, an independent panel of experts picked by the government, found that risks outweighed the benefits of routine blood tests for prostate-specific antigen, or PSA, a protein associated with prostate cancer." What "risks" ?? There is NO RISK AT ALL in having a PSA test.
Posted 11/18/2015 3:37 AM (GMT 0)
But what if there is no "protracted battle" ? You are saying that finding cancer early means years of therapies and drugs. Most likely with poor quality of life..so who cares if it is found early? A protracted battle of PSA every 6 months isn't too expensive..for example....and yes, there is no risk of the PSA test per se but what patients feel compelled to do with the information.
Posted 11/18/2015 7:09 AM (GMT 0)
Fairwind,
I am a cynical kinda gal..Okay, I'll admit it. But on this one, it makes no sense for physicians and insurance companies to WANT to treat end stage PCa over conducting routine PSA screening. I just don't get it. Sheep has a point. NONE of the arguments against PSA testing make ANY sense to me.

After thinking it through, the only thing that I can come up with is that not screening means not having to keep the GPs educated, and not having to worry about malpractice if somethings missed on a DRE, or someone "drops the ball" on either ordering or failure to follow up on the PSA test, as that seems to happen a lot.

More cynicism...the makers of these expensive tx therapies ( zytiga, xtandi, Provenge)should see a big spike in use of their drugs in next few years due to the lack of screening.
I should invest.

Beth
Posted 11/18/2015 3:24 PM (GMT 0)
Palliative care is likely less expensive than trying to cure the disease itself.
Posted 11/18/2015 4:17 PM (GMT 0)
Dcd55
Certainly treating low risk PCa has better outcomes than high risk. That's because low risk is curable; but treating high risk early while maybe not curative can dramatically extend life. Even treating high risk late can extend life meaningfully.
I see no downside to early detection except that some men get treatment who don't need it and that's the argument that's being made.
Bob
Posted 11/18/2015 4:53 PM (GMT 0)

NYT said...
Promising new imaging techniques and blood tests for biomarkers that would reveal cancer are in the works, they said. “But they’re not ready for prime time, so we’re stuck with the hand we’ve been dealt, the PSA test, which is an imperfect test,” Dr. Penson said.

New tests are coming in, e.g. see
www.healingwell.com/community/default.aspx?f=35&m=3531690
so screening for PCa will be the standard in a not too distant future.
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