Wilt versus Roach

This is not a HealingWell debate. It is about an hour and a half of discussion on the PSA controversy in regards to screening and I am simply the messenger.

At the PCRI conference was an interesting debate between Dr. Tim Wilt from the USPSTF and Mack Roach from UCSF. Guess what the topic was?

It started pretty funny, both men were given boxing robes and Moyad introduced them like Michael Buffer. With the theme from Rocky playing he introduce both and flipped a coin as to who would go first. Wilt won and chose to defer.

Screening with PSA versus the USPSTF recommendation to end all screening. This was very similar to ASCO in June (plus the Moyad theatrics)

Roach:
Screening saves lives. Patients get to know and that is paramount. Roach dismissed the US PLCO trial as invalid and flawed sue to contamination. Harped heavily on the ERSPC and stood firm on active surveillance being an option to curb over treatment.

Wilt:
Said screening does NOT save lives that while the ERSPC data indicates a very slight life saving capability, the morbidities of treatment, particularly due to mortality in treatment and side effects of biopsy and treatment out weighed any benefit reported in the ERSPC trial. Wilt said that the ERSPC was also a very uncontrolled multivariate retrospective reposting of trials from several countries in Europe. That if you took two of the countries out of the equation ~ The Netherlands and Sweden ~ that the ERSPC data would support the PLCO trial findings. He said that makes the two trials suspect.

After a couple Q&A from Moyad, Roach would received the support applause at each mention that PSA screening saves lives. There were no "booers" in the crowd and both men received a warm applause at the end of the 45 minute session.

All was good in the general assembly. It was in the after debate session that both men took the podium in the public facing Q&A...that's when the more fireworks began.

Wilt was first and he stated that the USPSTF would reconsider the screening recommendation if better data became available. Roach stood fast and hard that the USPSTF recommendation would kill men. To that Wilt stated, at the ratio of benefit treatment extensively would also kill men and that for every 100 biopsies 1 man man would be hospitalized for days with sepsis and be fighting for his life. Roach responded that without clear data the USPSTF made a foolish recommendation. This is where it gets sharp. Wilt told Roach that UCSF and all of the multivariate institutions were asked for better screening data that the two trials in Europe that showed clear benefit. Roach started to restate that "you'll be killing men" and Wilt responded "why not you Dr. Roach? Why don't you start a trials that proves the benefits?" To that Roach threw his hands up and walked off the stage and out of the building.

Wilt stayed and took more questions from unhappy patients until the next speaker was to come to his QA.

I think all points are as expected. And familiar to all here whom took sides in the matter. It was proof that this discussion will not go away soon, and the sides are entrenched with the patient community quite largely siding with the pro-screening side.

Peace. And be nice.

Tony

yeah, don't kill the messenger for constantly bringing up the same message...

I actually thought this was about Wilt Chamberlain and Tony Roach. I've spent my life playing and following sports, not following urologists :)

I don't think it's fair to categorize the naysayers as "the patient community". That's like a default setting. Guys who are not facing PCa directly or even indirectly have no reason to contemplate screening for PCa.

Thanks Tony.

I was there too and you presented an accurate picture.

Despite Davidg's comments, it was worth mentioning that the debate was one of the features at the Conference

Mel

It's important to note that Wilt is only one doctor in the VA and certainly not a consensus representing the VA. He is free like many of us to represent his own opinions and he does not have the ability to establish the screening protocol for the VA. No man exposed to Agent Orange should forego screening based on Wilts position though he might not agree. I truly don't know his position in that way.

The topic I posted here was a key session at the PCRI event where attendance was high and so were emotions. It was good that the PCRI staff felt that this topic was appropriate as it is a huge topic nationally for any prostate cancer patient forum and group.

My hope in all this is that it raises awareness among men and causes discussion that leads to education.

Tony

Post Edited (TC-LasVegas) : 9/9/2013 10:26:23 AM (GMT-6)

Tony - thanks for posting. It sure sounds like it was a lively discussion.

Every time I listen to these arguments pro and con, it seems the same things happen. Those who oppose over diagnosis rationalize that view with an over treatment case.

I would hope that over time the guidelines stay the same as they were for the diagnosis portion but that if warranted the over treatment is tightened up.

LupronJim