Prostate Cancer Taskforce Finding

[meierlde]

The question being asked by the panel is simple does the benefit outweigh the harm for society as a whole. Clearly it does for some folks, and not for others. Ultimately if you are spending societies money either thru insurance or medicare cost effectiveness becomes an issue.
It is just like one could build a car that would take a 200 mph crash and you could walk away, look at the formula 1 cars. However it would be prohibitively expensive, as carbon fiber bodies are built by hand.
As donheff says it partly depends on our attitude to heroic care versus hospice treatment.

[JOHNNIE36]

Quote:

Originally Posted by Zero Rereading that article, I really wish Rich-In-Tampa would address this assertion. "The problem is that even with staging and grading of tissue samples, there is no way to know for sure which cancers detected through screening are likely to kill a man and which could be left untreated and unnoticed for decades." I cannot believe that is true.

I woulld like to hear from Rich also. Haven't seen (heard) from him in a while. It always seems like he can put an understanding to the situation. I just like way he always answered the posts.


Editing to add a thought. I have read and reread the posts and can't get over the idea from some of you that it's better to not know about a health care concern. Why? Because information may be more harmful than helpful. Why? Because the information can't be trusted. I guess I am missing something. I'm thinking, "why would my doctor prescribe a blood psa test if the information might be harmful"? I have a lot of faith in my doctor and for now I'll put my trust in him and not some writings by so called experts in the various fields. I've asked my doctor about these reports and he tells me he has read them also. He has always led me in the right direction. As for now, everything goes through him.

[Mulligan]

Quote:

Originally Posted by Zero Hey, you must be talking to my best friend, he asked me the same question yesterday. His question was; "5 years of blissfully unaware life doing what you like, versus 15 years of knowledge of health issues and fighting to stay alive one more year."

This may in part be a reason for me not wanting to get tested. Otherwise, I would feel like John Wayne in one of my favorite movies, "The Shootist" as he didn't hang around for his painful death from cancer. Except that wouldn't work for me because I am no gunslinger and have no scores to settle

[TromboneAl]

Doctor A is smart and well-educated and opposes PSA testing.

Doctor B is smart and well-educated and is for PSA testing.

One of them is right, and one is wrong.

If you have blind faith in your doctor, you are essentially rolling the dice with your life, because what your doctor recommends is based on which doctor, A or B, you happened to end up with.

[Nords]

I should start off this post by promoting cheerful good news: studies have shown one of the best ways to avoid prostate cancer appears to be frequent sexual intercourse.
prostate health and ejaculation

I've told my spouse that she's welcome to do her share to help me rise (so to speak) above my family history...

Quote:

Originally Posted by tjscott0 First there is no family history of colon cancer.

Every time I read a "not in my family" comment, I'm perversely relieved that my family medical history sucks.

Genetics loads the gun, but the environment pulls the trigger. If your family never pulled the trigger, then you've learned nothing about your genetic susceptibility. In addition, I've been exposed to dozens of environmental hazards over the years, and the reason I know this is because battalions of government agencies and litigious lawyers have told me about asbestos, ionizing radiation, atmosphere-control chemicals, and their ilk. But if you've never had that "benefit" of being informed, either, then how are you going to know when your life is at hazard?

I'd rather continue to have testing and seek knowledge.

When I need a decision, I'll "rational"ize it by subjecting it to a poll of the posters here.

Quote:

Originally Posted by Zero One certain way to cut healthcare costs is not to do healthcare. Cutting our mammograms, PSA, PAP smears, Diabetes testing, blood pressure testing and colonoscopies would certainly reduce testing costs. Now the next logical step would be to reduce healthcare costs is to let everything just progress naturally, not treating either. The message is essentially: "the number of lives lost by not PSA testing is not worth the cost of the testing.".

This sounds like it would raise the costs of hospice.

But I'm not sure. Let's try it on someone else's family members first...

Quote:

Originally Posted by donheff It doesn't. It makes the whole process more expensive but more likely to be done.

So right now, we're carrying out selective evolution for people who are more likely to inflict colonoscopies on themselves, and the "demand" for virtual colonoscopies should literally die out in a few generations...

[meierlde]

Here is an article from CNN reporting that hospitals used free prostate screening to drum up more business. Prostate cancer screening's false promise - CNN.com
The hospital in question used the free screenings because they found that the 135 men who had the second stage payed for the screenings. I wonder how much much of the screenings, in particular the expensive ones are motivated by the fee for service system? Of course fee for service in principal is a conflict of interest.

[meierlde]

Quote:

Originally Posted by Nords I So right now, we're carrying out selective evolution for people who are more likely to inflict colonoscopies on themselves, and the "demand" for virtual colonoscopies should literally die out in a few generations...

Of course the question is the age of the person involved beyond the age of reproduction? when you die after that age it has no effect on evolution, your genes have either passed to offspring or not. May diseases that occur say after 50 have little evolutionary impact directly because the individuals affected have already reproduced. There might be a secondary effect in terms of helping or not helping the offspring, but is only secondary.

[lightspeed]

There seems to be the myth that treatment is life altering and leaves men impotent and incontinent on a regular basis. Everyone knows somebody that had a terrible time with treatment, but in reality most patients who undergo treatment are happy with their decision, whether it be surgery or radiation, and most would even choose the same treatment again when asked a year after treatment. The reality is, treatments are much better and safer than they were even 5 years ago. Permanent seed brachytherapy is an outpatient surgical procedure, patients are back to work in a day or two. IMRT is daily 10 minute appointments that patients can drive to every day. Robot assist prostatectomy requires 1 night hospitalization in most cases, and some surgeons are now considering sending patients home the same day. The terrible complications come from choosing the wrong treatment for a certain pt. Some are better suited for one type of treatment than others, and if treatment decision is individualized, there is very little risk of long-term, permanent life altering consequences. For example, for someone who is most concerned about sexual function, surgery may not be the best option. For someone with a large prostate and trouble urinating to begin with, I would not recommend seed implant, which causes a lot more long-term swelling. The problem is some doctors recommend only what they do.... usually they have a vested interested in their equipment, and that's when you get in trouble-- when you use one tool to fix all problems. Which is why second opinions are so important.

[Nords]

Quote:

Originally Posted by meierlde Of course the question is the age of the person involved beyond the age of reproduction? when you die after that age it has no effect on evolution, your genes have either passed to offspring or not. May diseases that occur say after 50 have little evolutionary impact directly because the individuals affected have already reproduced. There might be a secondary effect in terms of helping or not helping the offspring, but is only secondary.

Ooh, good point.

I keep forgetting that the Darwin Awards should be restricted to those who have not yet (knowingly) managed to procreate.

[Buckeye]

Although the annual PSA test is not recommended, isn't the annual DRE recommended?

Did we get to the annual PSA only because men don't like the annual DRE?

Is this a skill that has been lost or was never really good in a GP?

[Zero]

Quote:

Originally Posted by Mulligan This may in part be a reason for me not wanting to get tested. Otherwise, I would feel like John Wayne in one of my favorite movies, "The Shootist" as he didn't hang around for his painful death from cancer. Except that wouldn't work for me because I am no gunslinger and have no scores to settle

Hey, start a blood feud! Get a pistol, a big one.

Last evening I got a call from a friend to let me know that a friend's mom, who "cared" about me when I was a teenager and kinda parentless , had died at 87. For a few moments I "re"-felt her kindness.

Woke up this morning and don't gives a ratsass about PSA.

[donheff]

Quote:

Originally Posted by Zero Hey, you must be talking to my best friend, he asked me the same question yesterday. His question was; "5 years of blissfully unaware life doing what you like, versus 15 years of knowledge of health issues and fighting to stay alive one more year."

You friend's question is far off the mark. Was he just being snarky to dismiss people who don't agree with him? There is nothing in the facts behind the recommendation to indicate that people who forgo the test are shaving years off their lives. Nor is the choice to not aggressively fight a stage 4 lung cancer to extend a painful demise by a few more months anything like blissful unawareness vs knowledge of health issues.

[Zero]

Quote:

Originally Posted by donheff There is nothing in the facts behind the recommendation to indicate that people who forgo the test are shaving years off their lives.

Can you present those "facts"? Can you give the evidence that not testing for PSA gives a person the same longevity as annual testing?

Not being SNARKY, just asking for your evidence.

[donheff]

Quote:

Originally Posted by Zero Can you present those "facts"? Can you give the evidence that not testing for PSA gives a person the same longevity as annual testing? Not being SNARKY, just asking for your evidence.

I am simply accepting the statements of the panel. Turn the request around. You read the article and show us how anyone can possibly say the test extends average life by any significant period at all, let alone 10 years (as per the quote - 5 vs 15).

[eytonxav]

It seems to me for many years the virtues of early detection/preventative care have been espoused by the medical/insurance community. Now a panel comes up with a conclusion that prostate cancer screening does more harm than good and some folks are quickly accepting that conclusion without question. I'm not sure we can rely on anything these days for certain, even if family histories are clear, but personally I would prefer to continue getting tested and then dealing with something I know vs something I do not know is lurking. Of course if I was > 80 yo, I probably would not care.

[JOHNNIE36]

Quote:

Originally Posted by Buckeye Although the annual PSA test is not recommended, isn't the annual DRE recommended? Did we get to the annual PSA only because men don't like the annual DRE? Is this a skill that has been lost or was never really good in a GP?

As I mentioned in a post yesterday, my doctor strongly recommends both the psa test along with the DRE. Each "test" on it's own is not is not conclusive (?).

Edited to add the story of my golf buddy. Eight years ago, based on tests performed, had his prostate removed. Also, had chemo. Then last September the cancer reappeared on the stem(?) of the prostate. Not sure how they found this reoccurance. He had to undergo eight weeks of radiation, once a week for a 15 minute treatment. I don't know what to think about that situation.

[Zero]

Quote:

Originally Posted by donheff I am simply accepting the statements of the panel. Turn the request around. You read the article and show us how anyone can possibly say the test extends average life by any significant period at all, let alone 10 years (as per the quote - 5 vs 15).

Yeah, I did not see any evidence either, just a "government" funded study that relies on future "governemnt" funding giving a recommendation to stop charging testing to insurance.

[Buckeye]

Is this recommendation an example of "evidence-based medicine?" We're not used to that! Isn't evidence-based medicine Rich's specialty/passion?

[tjscott0]

What are the facts? Or what are your chances of dying from prostate cancer?

What are one's chances in the population at large?
source:Journal of National Cancer Institute 2008
# of men out of 1000 that will die in next 10 years
age 50=1
age 55=2
age 60=3
age 65=6
age 70=12
age 75=19

So at age 60 [I'm choosing age 60 because I'm age 61
& IT IS ALL ABOUT ME!]; 3 out a 1000 men will die from prostate cancer in 10 years or 450000 out of 150000000 US men. That work out to .3% chance of dying from prostate cancer.

One should weight that chance vs potential complications from prostate cancer treatment or biopsy complications.

Obviously if there is a family history of prostate cancer that tosses the above calculation on its ear. I suppose there must be some data somewhere on how likely prostate cancer will occur in one that has a family history of prostate cancer.

Place yer bets gentlemen. Hey its only a life.

[donheff]

The Harvard Med Blog has an article worth reading this morning. PSA screening for prostate cancer: a doctor's perspective.

One quote is relevant to the fears mentioned above by the black helicopter aficionados:

The USPSTF is made up of volunteers from a variety of fields, including internal medicine, family medicine, behavioral health, and preventive medicine. None have financial interests in tests or treatments.

The article also notes that the panel looked at many studies but focused on two randomized clinical studies -- "the gold standard of medical evidence." A European study found:

In the outcome that mattered the most—death—there was no difference in overall mortality among men who had the PSA test and those who didn’t, though there was a small decrease in prostate cancer deaths over the 11 years of follow in the screened population. The researchers calculated that 1,410 men would need to be tested, and 48 additional cases of prostate cancer would need to be treated, to prevent one death from prostate cancer. PSA-based screening slightly reduced the rate of death from prostate cancer, “but was associated with a high risk of overdiagnosis,” the authors concluded.
The second trial was the U.S.-based Prostate, Lung, Colorectal, and Ovarian Screening Trial. After 13 years of follow-up, the cumulative death rate from prostate cancer was 3.7 deaths per 10,000 person years in the PSA screening group and 3.4 deaths per 10,000 person-years in the control group. Again, no difference. In contrast to the European study, and in keeping with the practice of medicine as currently practiced here in the U.S., there was no difference in the death rate from prostate cancer in the screened group compared to controls.

Those stats certainly don't tell us that forgoing PSA tests is a tradeoff between ignorant bliss and long lived knowledge. As to the question that since we have been relying on these tests for years why change our practices based on a few studies, I would ask why not take advantage of better medical evidence?