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Prostate Cancer Taskforce Finding
Old 05-22-2012, 12:23 AM   #1
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Prostate Cancer Taskforce Finding

New Data on Harms of Prostate Cancer Screening - NYTimes.com

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a government task force published its final recommendations against regular prostate cancer screening, concluding that the harms of the simple blood test far outweigh any potential benefit.

the task force found that, at best, one man in every 1,000 given the P.S.A. test may avoid death as a result of the screening, while another man for every 3,000 tested will die prematurely as a result of complications from prostate cancer treatment and dozens more will be seriously harmed.

The task force found that up to 43 men per 1,000 tested will face serious harms. Thirty to 40 men will develop incontinence or erectile dysfunction, or both, as a result of treatment. Two more men will have a serious cardiovascular event, like a heart attack, due to treatment, and one man will develop a life-threatening blood clot in his legs or lungs.
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Old 05-22-2012, 05:55 AM   #2
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Thanks for this link. Personally, it is hard to accept no more screenings for something after having heard for so long that they were so important. OTOH, a person close to me was just treated for PC and is now one of the "43 men per 1000" referred to in the paragraph quoted.
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Old 05-22-2012, 06:55 AM   #3
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I have not met a man treated for PC who did not have unfortunate side effects. Also, note that this is a government agency making this recommendation, and there is not a urologist or oncologist on this board. I believe it is the same board that recommended that annual mamograms are not necessary before 50, previously it was 40. Having had PSA scares and a biopsy (was negative), I am familair with the whole PSA and PC treatment event. I also question since the governemnt pays a huge portion for PC treatment, if this is a follow-the-dollar event in part. Nonetheless, PC is usually a different type of Ca; it does not spread as fast as most cancers do. I would want to know if I had PC and then once the anxiety subsides, there is adequate time for each person to make a decision they are comfortable with, or to be re-biopsied in the future to see if it is aggresive or not. Just like with various investments, it is important to not let fear be the determining factor, but a rational and well thought out decision that you will not regret.
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Old 05-22-2012, 07:30 AM   #4
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My PSA is very high (9). Dr. is comfortable with a 'normally' high reading.

I contracted sepsis after a (negative! negative!) prostate biopsy.

Damn near killed me so it'll be a while before I go for another biopsy...still, I like to track my progress (or lack thereof) with annual PSAs.

Or could this be another 'you don't need mammograms' situation?
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Old 05-22-2012, 07:34 AM   #5
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I discussed it at length with my doctor in January and he still espouses screening with a watch and wait approach to treatment (i.e., watch for signs of an aggressive cancer before considering treatment). What bothers me is that I don't have a good feel for how effectively they can test for aggressive cancers without doing a biopsy. That is what I want to hear more data on. If they can focus their tests and identify a subset of biopsy candidates that change the statistics dramatically then the benefits of biopsy may outweigh the risks (i.e. the watch and wait approach would have merit). If not, a watch and wait approach would seem to foster anxiety with little or no benefit.

In the stats above, the 1/1000 saved vs 3/1000 injured would be a misleading stat if 75% of the 1000 with a high PSA don't proceed to biopsy until some other markers emerge. Then the numbers would be altered to 1/250 saved with 9/250 injured. As I write that I am not sure its better.
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Old 05-22-2012, 07:39 AM   #6
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I thought this revolation came out over a year ago. Nevertheless, it makes me wonder if this is simply a feeble attempt by the Gov't to control costs. Next, I suppose we'll hear that colonoscopies are dangerous and no longer needed.
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Old 05-22-2012, 08:01 AM   #7
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Today's MSNBC article on sigmoidoscopies rther than colonoscopies:
Simple scope exam cuts colon cancer deaths - Health - Cancer - msnbc.com
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Old 05-22-2012, 08:17 AM   #8
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Originally Posted by Richard4444 View Post
Today's MSNBC article on sigmoidoscopies rther than colonoscopies:
Simple scope exam cuts colon cancer deaths - Health - Cancer - msnbc.com
I saw a recent article that shows a new virtual colonoscopy (VC) procedure that was quite interesting. VC uses MRIs to explore the colon. Unfortunately, any contents in the colon obscure the image so people still have to drink the awful antifreeze clearing fluid that is the biggest negative to colonoscopies. With the new technique, patients drink a bit of dye that colors the material in the colon and a photoshop like subtraction removes the tagged contents from the image. Voilla - polyps, etc emerge like magic. No more colon clearing. But it sounds expensive.
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Old 05-22-2012, 08:22 AM   #9
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I saw a recent article that shows a new virtual colonoscopy (VC) procedure that was quite interesting. VC uses MRIs to explore the colon. Unfortunately, any contents in the colon obscure the image so people still have to drink the awful antifreeze clearing fluid that is the biggest negative to colonoscopies. With the new technique, patients drink a bit of dye that colors the material in the colon and a photoshop like subtraction removes the tagged contents from the image. Voilla - polyps, etc emerge like magic. No more colon clearing. But it sounds expensive.
The problem with this is then the polys need to be removed, so how does this save money.
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Old 05-22-2012, 08:35 AM   #10
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The problem with this is then the polys need to be removed, so how does this save money.
It doesn't. It makes the whole process more expensive but more likely to be done.
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Old 05-22-2012, 09:25 AM   #11
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Quote:
Originally Posted by donheff
I discussed it at length with my doctor in January and he still espouses screening with a watch and wait approach to treatment (i.e., watch for signs of an aggressive cancer before considering treatment). What bothers me is that I don't have a good feel for how effectively they can test for aggressive cancers without doing a biopsy. That is what I want to hear more data on. If they can focus their tests and identify a subset of biopsy candidates that change the statistics dramatically then the benefits of biopsy may outweigh the risks (i.e. the watch and wait approach would have merit). If not, a watch and wait approach would seem to foster anxiety with little or no benefit.

In the stats above, the 1/1000 saved vs 3/1000 injured would be a misleading stat if 75% of the 1000 with a high PSA don't proceed to biopsy until some other markers emerge. Then the numbers would be altered to 1/250 saved with 9/250 injured. As I write that I am not sure its better.
I personally believe that the confusion and controversy of this procedure will continue until they can properly identify the difference between a slow growth non life threatening cancer vs. the fast growth. Many people have said that early detection of PC has saved their life. But some medical people counter that if it hadn't been diagnosed they never would have known they had it and lived a full life anyways. I personally will probably dodge the test because PC has not been in my family and probably Im looking for a justifiable reason not to do it which this study has conveniently provided for me.
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Old 05-22-2012, 09:32 AM   #12
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Originally Posted by DFW_M5 View Post
The problem with this is then the polys need to be removed, so how does this save money.
a very well rated HMO here in WA recently said that routine colonoscopies were not needed, recommended instead annual stool occult blodd testing, to be followed by colonoscopy if indicated.

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Old 05-22-2012, 09:35 AM   #13
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Originally Posted by Mulligan View Post
I personally believe that the confusion and controversy of this procedure will continue until they can properly identify the difference between a slow growth non life threatening cancer vs. the fast growth. Many people have said that early detection of PC has saved their life. But some medical people counter that if it hadn't been diagnosed they never would have known they had it and lived a full life anyways. I personally will probably dodge the test because PC has not been in my family and probably Im looking for a justifiable reason not to do it which this study has conveniently provided for me.
I had one PSA test, it was low. My Doc never suggested it again. Since I really don't like all these tests anyway, I think that is where it will stand.

And urologists? The PSA is their farm team finder.

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Old 05-22-2012, 09:59 AM   #14
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What bothers me is that I don't have a good feel for how effectively they can test for aggressive cancers without doing a biopsy.

That's just it. First, aggressive prostate cancer [as well as breast cancer]is a very small % of total cases. Second, aggressive prostate could have spread significantly between screenings.

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 far I [age 61] have declined a colonoscopy. First there is no family history of colon cancer. Second the odds are negligible IMHO.

number of persons in a thousand dying from colon cancer in next 10 yrs
source-Journal of National Cancer Institute-2008

age 50=2
age 55=3
age 60=5
age 65=8

Then there is a chance of a perforated intestine.

Dr Hadler in one of his books told of a study where 183 patients with positive fecal test under went back to back colonoscopies by experienced colonosopists. The first doctor removed all polyps & adenomas. 289 in total. The second doctor discovered an additional 89 missed by the first doctor.

The risk/reward ratio doesn't appeal to me. To each his own though.

I now will prolly stop having the PSA test done also[been having it done annually in my 60;s & every other year in my 50's]. I did have one relative that died from metasized prostate cancer. My father's brother. He was 94.He eschewed chemotherapy. He was dead within 2 months of when his psa skyrocketed to 25 from last test.

I've thought long & hard about this. My father died from pancreatic cancer @ 82-dead 10 days from discovery. My mother died from a stroke @ 72. My paternal grandfather lived to 95[heart attack] & father's brother 94[prostate cancer. I didn't think much of the quality of live of my relatives in their 90's. IF by refusing tests I die early--so be it. It will be shaving years at the end of life. The positive side is that I will avoiding sitting in doctor's offices waiting on he/her to have time fer me.

You will note I've also posted the "Good' cholesterol doctrine may be flawed: study" post

'Good' cholesterol doctrine may be flawed: study

I'm beginning to think much of what we think is true medically ain't.

You might wish to view my post on this thread:
Any New Info on PSA Screening?

you will note I have changed my view on having the psa test.
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Old 05-22-2012, 12:54 PM   #15
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I discussed it at length with my doctor in January and he still espouses screening with a watch and wait approach to treatment (i.e., watch for signs of an aggressive cancer before considering treatment).
That approach only works for Vulcans (logical with no emotion), because once the doctor tells you there's a chance that you have a cancer growing in you, it's almost impossible to resist the next step (biopsy) and then the next (treatment).
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Old 05-22-2012, 01:07 PM   #16
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One thing about screenings that I always wonder about is that all the recommendations come from a group comprised entirely of those that benefit economically from the tests: product manufacturers and specialized doctors. Do nothing or do simpler tests would be a severe blow their core business.
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Old 05-22-2012, 01:11 PM   #17
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PSA testing is like checking the stock market everyday.
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Old 05-22-2012, 01:18 PM   #18
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I was trying to explain to DW why I would be against a simple blood test when it would "save my life". We heard about this in the car radio yesterday and it prompted the discussion. Thanks for the good one paragraph summary that explains what I have learned and believe. Will show DW this.
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Old 05-22-2012, 01:25 PM   #19
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Without the regular prostate screening, (PSA) my DH would probably be close to death by now.

Even though he's been treated for PCa, he could still die from it. But it gives him a fighting chance to live longer.
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Old 05-22-2012, 01:53 PM   #20
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Without the regular prostate screening, (PSA) my DH would probably be close to death by now.

Even though he's been treated for PCa, he could still die from it. But it gives him a fighting chance to live longer.
I am sorry to hear about this bbbamI. I know a couple of people in a similar situation who feel the same and I am glad for them and for your husband that they caught it. But for the rest of us the question still remains should we risk biposies and treatment for cancers that would almost undoubtedly not cause us grief (with attendant risks and side effects) to avoid the small chance that we would die? If we lose that bet we will regret it but it may still be the preferable bet for many of us.
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