"Screening Saved My Life" — a popular sentiment, but how true?

Casey

I think here on Healing Well we have a community of brothers where PSa did in fact save / extend their lives.

The article is balanced and well written.

Bud

I agree with this article. And Mike's post on the Infolink. In another post there that now has over thirty replies to it, Mike (the InfoLink writer) single's David Emerson and myself out by stating that we need to find guys like us as opposed to the general population being screened. To that I replied this:
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Mike,
I want to find guys like me too.
But the truth be told we truly had no reasonable way of knowing that I was a high-risk probability at the age of 44. David Emerson and I were detected when our cancers were Stage 4 and Stage 3B respectively. David at age 42 had metastatic disease at Dx. We weren’t sure with my case after surgery but we have been able to keep it at bay and it is in remission. I feel it’s because a doctor checked the PSA box on a lab blood test sheet without telling me during a routine physical. There is no metric that would have made sense to do that for me even if provisions were added to the USPSTF prostate cancer screening statement concerning risk groups. Again, I had no high risk family history and I was otherwise healthy and asymptomatic.

I hate to wonder what would have happened in my case if this task force released this recommendation in 2005....
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Would I be dead today if I had not been screened? Probably not. At least probably not yet. But another thought has to be considered ~ we are all going to die of something. In reality we are only considered saved if we die of something else and there was no eminent threat danger of dying from prostate cancer. I believe that we need to look at screening as a way of extending lives. So then this is a better question than did screening save my life:

Did finding prostate cancer before it had progressed any further add quality years to my life?

Even still I can't answer that factually but rather presumptively. I think yes. Had my disease progressed any further we have scientific data that shows a less appealing prognosis for metastatic disease that has spread to bone and/or other organs. But our friends here in Todd and David are both six years into a diagnosis that indicated a poor prognosis.

We know factually that treating cancers in the early stages results in better prognosis. But we do not know that precise cutoff point that this takes place. Are there a lot of men here saying that PSA screening saved their lives ~ yes, including me. Are there men here where that simply is not true? Yes.

Take you own guess as to whether I should have not been screened. The USPSTF says no...

Tony

Suppose you have an identical twin brother who is diagnosed with PCa at the same time as you, and you have treatment while he does not. If he dies of PCa and you do not, then you could say that "screening saved my life".

In my case, with no twin brother, a PSA of 5.7 and Gleason 8, at first I thought that I would have been in the 25% group where screening did save my life ~ after 3.5 years, what happens to a Gleason 8 with no treatment?

I suspect I might be in a worse state than I am now, but even so PCa might yet get me at the end. So if I can't say "screening saved my life", I might instead say "screening lengthened my life".

Statistically it might have, but as you said Casey, impossible to tell exactly.

My wife found an aggressive hormone driven breast cancer at age 45 (15 years ago) through her regular annual screening consisting of mamogram and physical exam.   The almond sized tumor was removed with clear margins and no spread to lymph nodes, but was judged as high risk due to the DNA and expected doubling time.   Surgery, chemo, radiation, and hormone drugs resulted in a clear path.   Her tumor was doubling every 90 days so clearly the screening saved her life as she no doubt would have been metastatic by the next annual screening and probably would have had very poor 5 year survival probability let alone the 15 years cancer free that she has experienced.

In 2010 she finds another tumor in the same breast unrelated to the first and this is under the watchful eyes of her doctors that have managed her screening on a semiannual basis for 15 years.   This time a masectomy, chemo (the oncotype had a high probability of recurrance) radiation, and more hormone therapy.   It is far too early to say whether this was a life saver.

At the same time I get PSA screened and find a prostate full of potentially agressive cancer that requires treatment.   If I live another 15 years treated versus 10 years untreated, did the screening save my life?   At year 10 and one day I would certainly say yes.   Until then the jury is out.

I think this has nothing to do about screening and everything to do with treatment.   In my opinion, many men are overtreated, particularly with surgery, and suffer considerable decline in quality of life without significantly extending longevity.   For the truly higher risk men there is no question that treatment is extending life and in most all cases is well worth the QOL issues. 

Who will be the one to tell the person that we think has intermediate grade prostate cancer not to pursue treatment that has shown such high efectiveness at 5, 10, and 15 years out?    Surely the doctor won't block the treatment and risk the liability or go against his science and the large amount of studies that confirm the results.

JNF said...
"In my opinion, many men are overtreated, particularly with surgery..."

I think this road goes in all treatment directions equally. We have to remember that there are many men subjected to radiation, cryo, surgery and a long list of unnecessary supplementing ~ all of which can have more side effects than monitoring an indolent cancer. The warnings from the USPSTF, and statements in this article, and the concept of over treatment is not treatment specific. They are all treatment modalities inclusive.

Tony

 

I had some really awful pain. That was dx as prostatitis, several times. I went on several regimens of cipro...and finally a biopsy. A fairly high cancer content. The doc that did my biopsy was a radiologist...he was looking at the stuff he was aiming at on his screen...I still remember the talking between him and the tech... 

Post surgery path showed an EPE.

As far as I'm concerned, and IMHO, I could be far worse off today if it hadn't been for a few PSA tests...and PSA velocity those tests showed. Many are worse off than me.

Did the PSA tests do something for me? Yes, I believe they did.

Was I overtreated? Maybe. Maybe not. I think it was right for me and what I was comfortable with.

I certainly feel I got the short end of the stick in many ways...(nope, no puns intended, implied or expressed). But, that I'm dealing with successfully.

BTW, I often wonder if it hadn't been for a few PSA tests, where I would be today?

I'm pretty much certain it would not be good and...I'm sure it would not be better.

JMHO

 

Post Edited (mikey1955) : 10/26/2011 3:54:14 PM GMT

Why would I allow Dr. Gil Welch, who has been against screening for as long as I can remember, to tell me that I am wrong in thinking that PSA saved my life back in 1992? Yes, PSA saves lives and don’t let them tell you otherwise.

RalphV

Perhaps the progression of my case would be different had I begun screening at age 50. I initially declined the PSA test when offerred. But after some discussion with the urologist decided it could not do any harm to have a test. After all, I was healthy and had not one symptom. Rang the bell on the first and only screening test. Do I feel that it has "saved my life"? I will let you know on my 78th birthday if I get that far. :)

Don

TC-LasVegas said...
Personally I have probably heard over a hundred men with a G6 diagnosis say that screening saved their lives. I know that for most that was possibly not true.

That's a great example, Tony.  One thing has become increasingly apparent thorough this “teachable moment” (brought to us by the USPSTF)…it’s going to take a heck of a lot of “educating” before we see the needle move on overtreatment.

 

Here’s why I say that.  I would think that many of the men here are generally among the more “educated” (school of hard knocks) laypersons about prostate cancer.  But there is very surprising little uproar here about the extent of overtreatment.  There appears to be very little concern about the next guys coming through the door…instead, we hear mostly about the defensive rationalizations essentially in support of overtreatment!  Very few here urge newcomers with low-risk cases to move cautiously.  One would think this group could impart a little more “hard knocks” wisdom, but we get lots of “you should do what I did” suggestions for the new guys more than anything.  If we can’t educate patients better, I don’t know how the doctors (who you’d be incredibly naïve not to understand have a financial stake in keeping the machine going) will step-up and start suddenly practicing conscious-based medicine.

 

off soapbox

It's like trying to live in parallel universes.
You want to feel certain that you've made the right decison, but the only way to know that would be to live for 20 years then meet the other you in the parallel universe who hadn't had any treatment and find out if the PCa had killed him.

In my case I reckon that a 3+3 at biopsy that became a 3+4 after surgery plus SVI, suggests that my PCa was not the nice kind. For me a crucial "number" is that the distance from the prostate to the end of the seminal vesicles is more than the distance from the end of the seminal vesicles to the spine. Doesn't take a lot of thinking to work out what might have been going to happen to Parallel Alf.

If real Alf had however still been 3+3 and no SVI after surgery, then I would still have been a lot happier with the Prostate removed than with cancer lurking in me and, as yet, no way of telling if I was one of those with nasty PCa or not.

Alf

Casey59 said...
TC-LasVegas said...
Personally I have probably heard over a hundred men with a G6 diagnosis say that screening saved their lives. I know that for most that was possibly not true.






<span style="FONT-SIZE: 9pt; FONT-FAMILY: Verdana">That's a great example, Tony. One thing has become increasingly apparent thorough this “teachable moment” (brought to us by the USPSTF)…it’s going to take a heck of a lot of “educating” before we see the needle move on overtreatment.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

<span style="FONT-SIZE: 9pt; FONT-FAMILY: Verdana">

<span style="FONT-SIZE: 9pt; FONT-FAMILY: Verdana">Here’s why I say that.<span style="mso-spacerun: yes"> I would think that many of the men here are generally among the more “educated” (school of hard knocks) laypersons about prostate cancer.<span style="mso-spacerun: yes"> But there is very surprising little uproar here about the extent of overtreatment.<span style="mso-spacerun: yes"> There appears to be very little concern about the next guys coming through the door…instead, we hear mostly about the defensive rationalizations essentially in support of overtreatment!<span style="mso-spacerun: yes"> Very few here urge newcomers with low-risk cases to move cautiously.<span style="mso-spacerun: yes"> One would think this group could impart a little more “hard knocks” wisdom, but we get lots of “you should do what I did” suggestions for the new guys more than anything.<span style="mso-spacerun: yes"> If we can’t educate patients better, I don’t know how the doctors (who you’d be incredibly naïve not to understand have a financial stake in keeping the machine going) will step-up and start suddenly practicing conscious-based medicine.

<span style="FONT-SIZE: 9pt; FONT-FAMILY: Verdana">

<span style="FONT-SIZE: 9pt; FONT-FAMILY: Verdana">off soapbox

Casey give up already. There were a few of us who use to advise newly diagnosed low risk PCa men to take their time, educate themselves. blah, blah, blah. But the fact we have such an extraordinary group of men here who by god were all saved from certain death by radical procedures with surgery being the most common. Their anecdotal evidence reigns supreme here and trumps any Cancer group of doctors who after all are all in a conspiracy. So I suggest any more of these new fangled over treatment less PSA announcements be forbidden to ever be seen here again or even linked to. Because if just one man here had ever believed them and took their advice he'd be dead. I for one don't want that on this forums collective conscious. Now I need to make amends to my first urologist who when asked said I'd be dead within 7 years with my low risk initial dx if I refused treatment. . I doubted him, such was my arrogance. I even admit my TFT may not have been needed. Oh forgive me, for if I had not taken action I know now I'd be soon dead. But no, now I know the truth all who come here with low risk Pca and are treated will live long lives, see those grandchildren graduate etc. If they don't of course it's a no go to ever attend little Johnnies graduation. I thought it was only my having a much less invasive procedure with few SEs that made it easier to admit may not have been needed. It's only other men who never appear here who may be over treated. Also you should ban those few guys who back AS here , they could cost lives after all. Away with them let this tsunami of truth wash them out to that sea of conspiracy and lies. Ok now back to more inspiring unquestionable anecdotal evidence. Down with facts and statistics..

This site is totally regressing. Bye all this may be it for me.

clocknut said...
So, unless we agree with the USPSTF recommendations and renounce the American Urological Position on PSA testing or the position of our personal physician we should shut up and stay off this site? Really?

Can't we discuss this reasonably and without sarcasm?

Of course not. It's only those who believe that massive over treatment is occuring should be gone from this site.