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New, expanded work by USPSTF to examine evidence of PSA harms/benefits

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Posted 5/4/2016 9:16 PM (GMT 0)
I hear where you're coming from, and yes it's a valid question for investigation. And it still begs the question of whether PSA is a valid screening tool, and absent PSA, what OTHER screening tools would find the high risk cases while they are still treatable?

The key to all of this, it seems to me, is figuring out how to identify the high risk cases. And I don't see anything in this write-up that is aimed at answering THAT question.

So, I guess I'm suggesting that while the list of questions is valuable to ask (with the exception as noted above of question 5--which I suggest is moot), they're not asking the right ones.
Posted 5/5/2016 5:22 AM (GMT 0)

halbert said...
The key to all of this, it seems to me, is figuring out how to identify the high risk cases. And I don't see anything in this write-up that is aimed at answering THAT question.

... they're not asking the right ones.




OK. Thanks for your comments.


So, your "gripes" (as you called them back then) seem to have shifted from what they were back in November when you posted this in my thread about the USPSTF draft plan seeking inputs. www.healingwell.com/community/default.aspx?f=35&m=3525362

Back then your issue was not about identifying high risk cases, as it is now. Back then it was about the definition of overdiagnosis (I just posted your earlier tonight about the definition of over-/unnecessary treatment), the perception that biopsies fell into the "treatment" category (they don't), and going from high PSA to a quick treatment.

I guess that this shifting around shows that you're still finding your footing with respect to PC's complexities...that's understandable.

A decent PC education takes TIME; that's well understood.

You definitely have/had time.

Did you end up sending in your inputs to USPSTF on your question was at the time, as you suggested in that November post, to steer their process?
Posted 5/5/2016 10:50 AM (GMT 0)
Yes, I did send in comments, and no, my thinking really hasn't changed all that much. What bugs me, as someone who really does know a little bit about research project design, is that careful reading of the questions reveals a great deal about the presuppositions of the researchers, and points clearly towards the outcome they are aiming to prove. Remember the adage that 'all data that does not fit the hypothesis is to be discarded'.

I can't find on the USPSTF website the draft plan they were working on last fall--maybe it's there and I just can't locate it--but my comment about 'biopsy as treatment' was pretty clear, but perhaps truncated in my comments. They were certainly clear about the idea that a biopsy is an unnecessary intervention in many cases--so it still raises the question in my mind: if you're not going to use PSA (which we all know is NOT a cancer test, it's an activity test) to identify people who need more examination--and you're not going to biopsy those you're suspicious of, then how in the heck are you going to find anyone until they exhibit frank symptoms when it's too late to do anything.
Posted 5/5/2016 12:40 PM (GMT 0)
Well said, Halbert. This is the problem many of us have seen for a long time.

If one is determined to prove that the PSA test causes harm, well by golly we can construct an argument to prove that. If it means that thousands of men will present with advanced, symptomatic prostate cancer, well so be it.

This idea that the PSA test is the enemy seems to morph into a fixation, and all reality is then filtered through that perception. It's really quite strange.

Here's a loose analogy: If I present with an A1C of 7.2 and my physician immediately puts me on insulin or recommends some even more drastic treatment, is that the fault of the A1C test? Hardly. It's just poor medical practice. Yet, in the case of prostate cancer, if the PSA test comes back high and the physician immediately orders a biopsy and urges surgery, that's somehow the fault of the PSA test.

This subject keeps rebounding here on HW, and nearly everyone seems to agree that the fault is with poor interpretation/reaction to the PSA result, not the fault of the test itself, but a few doggedly insist that the PSA test inevitably leads to over-diagnosis and overtreatment. There's nothing inevitable about it. It's a fixable situation, and indeed I think most minds have already been changed.

Post Edited (clocknut) : 5/5/2016 6:47:48 AM (GMT-6)

Posted 5/5/2016 4:37 PM (GMT 0)
Ah…a mind is to be changed…a promise is to keep… Rare a promise to surmise…rarer still... one kept…I advise.. Ok surfs down…off to gym…some protein…to dismem… a rest for you and them…nail the hammer to the limb..

Damm it Bones…let Me pilot my ship!!!
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