Dana Jennings on Invasion of the Prostate Snatchers

>>I wish I had had this book back in 2008.<<

huh? PSA and surgery saved Dana's life. indecision or complacence may have killed him.  i've read every one of jenning's essays on prostate cancer but he really looked like he forced it here.

F8

I have enjoyed Dana's articles on PCa and everyone has an opinon. Look at the comment section from 82 yo Charlie who obviously likes to tell it like it is, as he sees it.

Michael

this article was already posted in another thread today, the one about the book in question

"Yet radical prostatectomy is still the treatment recommended most often, even though a recent study in The New England Journal of Medicine suggested that it extended the lives of just 1 patient in 48."

I was unable to find this "study" in the link posted...But even if there is such a study, does anybody here believe this claim??

My own investigations have shown that in first time positive prostate biopsies over 50% of these biopsies reveal aggressive Gleason 7 or higher tumors that require treatment. If we all took Blums and Scholz advice, the annual deaths from PC would over 100,000..

Somebody said...
“Out of 50,000 radical prostatectomies performed every year in the United States alone,” Dr. Scholz writes, “more than 40,000 are unnecessary.

Even assuming this is correct, I still would have the surgery.

How would I be certain before the surgery if I am one of the 80% where the surgery was unneccesary or I am one of the 20% who would eventually get an advanced if it wasn't treated soon after diagnosis.

I have read too many times patients going into surgery a 3+4 and finding out after the prostate is sliced and diced that that were a 4+3 with more tissue involvement than expected.

Yes, overtreatment is a problem, but the big problem is not yet being able to accurately diagnosis the severity of the PCa prior to treatment

Dan

At a 3 physician Boston consult this past spring one oncologist gave us the same Blum etc. study; "1 in 48 with stats like yours will never die of the disease" he said to my husband. We'd decided on AS til we read the May 11th AUA article entitled "Delayed Surgery Boosts Prostate Cancer Risk" which suggests patients delaying surgery for low risk prostate cancer for six months or more increases the risk of adverse outcomes. Gray is gray with this disease and thank God that although I've been second guessing as a result of his post surg loooong recovery, my husband says it's a done deal, don't look back and refuses to hear it. That's as black and white as we have right now. It's also why no one else but those who've walked through the Gray Valley knows what it's like. Has anyone done a Rex Morgan style thread on the comments, well meant but exasperating, from fam and friends when you tell them about the PCa? Sheesh.

Blum etc. didn't do a study.

If you go here you see the study and all the names.

http://www.nejm.org/doi/pdf/10.1056/NEJMoa0810084

Dr. Walsh said the European study conclusively proved that screening saved lives. That is not in question.

The question raised by the study, and apparently by Blum and Scholz-- and by Dana Jennings in his blog-- has to do with over-diagnosis. To this point Walsh wrote:

"In the European study it is estimated that to prevent one prostate cancer death at ten years, 1,400 men would need to be screened and an additional 48 men would need to be treated. Ten years is the earliest time at which one would expect any benefit and if one looks at a 50 year old man who is going to be alive for another 35 years, those odds would be entirely different. Also, with longer follow up in the European trial these odds will improve. However, if screening for prostate cancer is ever going to receive popular support, it will be necessary to avoid over-diagnosis in men who are unlikely to have a survival benefit (men who are too old or too ill to live longer than ten years) and to avoid over-treatment in men over age 65 who have low volume disease. Most of all, it is imperative for us as physicians to continue to improve the quality of treatments to reduce their morbidity. If one day it were possible to reduce these side effects to a minimum, the debate would end."

(Source: Brady Urological Institute: http://urology.jhu.edu/prostate/PSA_controversy2.php)

Walsh also wrote that in the ESRPC study only 85% of the men in the screening group actually got screened, and if you adjust for that, then the reduction in PCa deaths jumps up to 27%, even with such a relatively short followup.