PCa in CA Reading Material

Color me ignorant, but the solution is right there in front of us: we are so worried about "over diagnosing" indolent G6 cancer that we are engaging in behaviors that work against diagnosing men with clinically significant PCa while it is in the early stage.

For example, a recent study advocates for target-only biopsies (cores in the target zone(s) only) after the MRI, so as not to find insignificant cancer elsewhere in the prostate by combining the targeted biopsy with a systematic biopsy (i.e., including random cores taken in the other prostate zones)*. We don't want to screen men because--heaven forbid--they have indolent PCa and will shout "treat me!" So what if diagnosing x number of men with serious cancer means identifying y number of men with indolent disease? IMO that's wrong-headed public health thinking. But if we continue with this Chicken Little philosophy, we shouldn't be surprised at the consequences.

We are paying the price by not educating both PCPs and the public about the value of screening and the value of active surveillance. As they say, this isn't rocket surgery

P.S. We also know that a good percentage of men diagnosed with G6 PCa actually don't have indolent disease and harbor undiagnosed higher-grade lesions.
___________________________
*This is after a consensus of research in recent years advocating for targeted+systematic biopsies for the very reason that they find more cancer.

Djin

The USPSTF figured a lot of money would be saved by shutting down the bonanza created by the screening campaign of the 2000s. Too many greedy doctors willing to unnecessarily remove or radiatiate prostates, and too many hysterical men screaming about having an indolent cancer they want out. Very expensive.

The USPSTF knew they were throwing men under the bus by essentially halting screenings, but no big deal. When these guys finally came in with advanced cancer it would be more or less 2 to 5 years of Lupron and that was about it. Not very expensive.

But what happened after 2012? ARPI combinations with Lupron, Pluvicto and its analogues in development, and who knows what else in the pipelines. The USPSTF killed a lot of men. At least some of the guys the USPSTF abandoned are starting to live for kind of a long time -- at an extraordinary expense to the healthcare system. They shoulda left it alone.

I saw this article last night and was going to post it this morning but you beat me to it. Alas, many men and doctors were taken in by this wrong headed thinking that big brother should protect us from ourselves. The premise seemed somewhat reasonable at the time -- avoid unnecessary treatment. But the logic was flawed and the cost was many lives lost to a terrible disease.

If the medical community could ever get their **** together and offer some common sense guidelines about what tests to take, when to take them, when to treat and when not everyone would be better off. "Discuss with your doctor and make individual decisions" is a noble and lofty goal but ignores the fact that docs today barely have time to pee during their busy days. The USPSTF has failed men big time. I'm with Halbert in thinking that insurance companies have had undue influence over this for way too long. Money talks.

My advice to anyone I know is to continue to get screened and then make a smart decision if and when you get unfavorable results.

Jim