I think the only thing the "Federal Task Force" cares about is cost, not mortality. Next will be non curative medications.

Yes Tony -- but back when the DRE was the main way to discover PC, we had many more men dying of the disease because many had progressed too far for cure.

It makes NO sense at all to ignore a potentially life saving test that can be performed at no extra inconvenience -- because it can be part of the standard blood test associated with the annual physicals that people are supposed to be taking anyway.

Not doing an annual PSA test is like cooking a great feast and then deciding not to eat it. Makes no sense at all.

Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

One thing is an absolute certainty. The USPSTF was not concerned about my health in the least when coming up with their recommendations. I know this because Otis Brawley himself told me that men my age and even older played no part whatsoever in the decision making behind their recommendation.

I don't recall seeing too many urologists agree with their recommendations and I recall only one person on this entire forum agree with them.

We know screening plays a significant role in the 40% mortality rate decline in America.We also know that some people think the people who potentially face some degree of a potential side effect related to treatment is a bigger problem than the number of men who would die as a result of no screening because there aren't potentially as many. We also know that there are people who flat out think that America cannot afford the treatment that results from this screening. We also know that there are people who stand to benefit from promoting AS and use this issue to that purpose.

I will add one thing. If we followed the current AUA guidelines we would not see a total train wreck that would result in 40% more deaths by PCa. The number would be small and probably barely measurable if at all measurable. Prior to the "baseline at 40" model announced in 2009 the screening that was in place resulted in that 40% reduction in mortality. And back then and the decade before it was 50yo/45 with high risk factors. We have not seen any improvement as yet with screening a baseline at 40 standards and it will take decades to see any.

Tony

David,
I do hear you loud and clear on being the 40 something guy. I really do. After all I am one of them that was diagnosed with late disease. I do know there is no perfect answer. Someone is always left out of guidelines. At least you had some family history where I had none. You were covered in the latest AUA guidelines by not being standard risk (but not in the pre-2009 guidelines). I was not covered by any guidelines and quite possibly not by a baseline at 40...

Tony

Hey Guys,
I think we are all on board in opposing the Task Forces "Not Recommended". Our main differences revolve around who and when to screen; my views are known. Probably with the advances in medical technology and other factors my original questions will not be able to be answered.
I do have 1 question that can be answered: "In the absence of screening and testing.g/diagnosis of PC only when symptoms occur, is the PC not considered to be cure able or can it be staged as intermediate also vs advanced; maybe it's an automatic death sentence"?
As my advocate, I am asking Tony to put it on his agenda at one of his meeting to ask what federal medical facilities subscribe to the "recommendation" and which do not. Of course, he could be "" with verbiage also--lol.
Bill

gunfighter said...
Hey Guys,
I think we are all on board in opposing the Task Forces "Not Recommended". Our main differences revolve around who and when to screen; my views are known. Probably with the advances in medical technology and other factors my original questions will not be able to be answered.
I do have 1 question that can be answered: "In the absence of screening and testing.g/diagnosis of PC only when symptoms occur, is the PC not considered to be cure able or can it be staged as intermediate also vs advanced; maybe it's an automatic death sentence"?
As my advocate, I am asking Tony to put it on his agenda at one of his meeting to ask what federal medical facilities subscribe to the "recommendation" and which do not. Of course, he could be "" with verbiage also--lol.
Bill

Hi,

If you do no screening at all (such as PSA testing as part of regular physicals) and the doctor performs a DRE & feels a bump, it would depend on the Gleason Grade. If a man experienced this and a biopsy showed a Gleason 6, he probably would be okay.

But just imagine if a man had not been checking his PSA over the years and a positive DRE led to a biopsy revealing Gleason 9 or 10? I think what follows is probably self-explanatory because, when a highly aggressive prostate tumor has reached the palpable stage, chances are greater that it has already metastisized.

I would feel really bad if such a man had listened to those new guidelines and refused PSA testing in the years prior to his diagnosis -- testing that could have alerted him to the disease BEFORE it reached beyond the prostate.

The so-called experts, who made that recommendation, would be nowhere to be found if our fictional victim wanted to ask why they made such a recommendation in the first place.

Anyway, that's this person's humble thought.

Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

Post Edited (HighlanderCFH) : 9/1/2013 12:48:37 AM (GMT-6)

davidg, my position on screening is very similar to yours. However, I was struck by one sentence in your latest post that said, "Tony, I honestly have never been asked by any doctor if I had a family history of cancer."

The reason I was so surprised is that I think that EVERY new doctor to whom I have gone in the last 20 years has asked that question, either personally or via the patient questionnaire that is filled out by new patients. That includes PCP's, urologists and dermatologists. I know that Dr. Samadi was your surgeon and I really find it hard to believe that he would not solicit that information. Maybe I'm wrong. Maybe I'll just start a poll for the fun of it.

Jim

In regard to the original question,
If doctors do not find 50,000 indolent cancers each year and the number of deaths remains about the same (a little higher), then the percentage of cancer patients who die goes up mathematically. (The number of patients go down by 50,000).

If doctors do find 50,000 indolent cancers then the percentage of "cures" go up substantially.

(I'm for PSA testing and only thinking theoretically.)

If the USPSTF's recommendation of "no screening" was to be adhered to, how would diagnosis when symptoms occur affect the mortality rate?

more guys would die, fewer would be "overtreated" and insurance companies would save money.  like it was pre-PSA testing.

ed

 

Just a thought,
Can you call a person "cured" of a diseased that would never have been a harm to them?

I know the question is an invalid question because we would have difficulty ever proving there was or was not a threat. But cured?

Tony

Hey TC, Your thought and question... (while standing on my head this morning) resonated with me.
Yes, you can (call a man cured of a disease which may not have harmed him). There are many G6 or probable G6 men whose trajectory I follow. These include men from 25 years ago, who, whether or not they had it, certainly seem "cured". Who knows what the outcome may have been otherwise? That's what I question too.

Similarly, who knows what may have happened otherwise if they had not chosen their course or non-course of action? We know of people here who have chosen no treatment, as well as those who have had different treatment with similar stats. Some use the word "cure" if they have no further problems or remain stable. Others don't but live well, and some with great difficulty from side effects but feel "cured". Some of us have to use the idea of a "cure" however, as the word "cure" is often synonymous with "hope" - realistic or not, I don't think it matters. Some use the idea of cure (to facilitate great hope) over time, although in their hearts they know this is actually a lucky remission which will hopefully last forever ... (My hubby and I fall into this category in light of his G7 contained 6 years ago) but we still like to think he is "cured" and he is in the category of men who would not be tested under new recommendations. hmmmm.....

Its an interesting question you ask though. But I think if one tries to answer it, this is probably why the medicos think they have it all sorted out. They think they can generalise and predict what would have been the future. The fact is, no one can. Its often the luck 'o the draw so to say.

That's all my noggin can come up with from this "heady perspective" (upside down) this morning. Love ya! Lana