Prostate Cancer Taskforce Finding

[tjscott0]

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

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.

 

[MichaelB]

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.

 

[Richard4444]

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.

 

[marko]

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?

 

[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.

 

[eytonxav]

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.

 

[Richard4444]

Today's MSNBC article on sigmoidoscopies rther than colonoscopies:
Simple scope exam cuts colon cancer deaths - Health - Cancer - msnbc.com

 

[donheff]

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.

 

[eytonxav]

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.

 

[donheff]

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.

 

[Mulligan]

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.

 

[haha]

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.

Ha

 

[haha]

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.

Ha

 

[tjscott0]

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

http://www.early-retirement.org/forums/f38/good-cholesterol-doctrine-may-be-flawed-study-61434.html

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:
http://www.early-retirement.org/forums/f38/any-new-info-on-psa-screening-54657-2.html

you will note I have changed my view on having the psa test.

 

[TromboneAl]

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).

 

[MichaelB]

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.

 

[Zero]

PSA testing is like checking the stock market everyday.

 

[Free To Canoe]

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

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.

 

[bbbamI]

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.

 

[donheff]

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.

 

[bentley]

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.

More than most posters here, I appreciate your comments. I was 57 at first diagnosis of PCa. My psa was less than 3, however it had risen to 2.93, from 2.26 a year earlier, both tests from routine annual physical. Family doc did a DRE and felt nothing. Said that we would watch it next year. This continued to bug me for the next few days, so after doing a little research, I called family doc, and asked for a "free psa" test. Doc agreed...and free psa test indicated all was not well.....this all prompted a visit to my urologist. He reviewed data, and said....we'll check it in 4 months, but first, I want to do a DRE. I told him that had just been done a week earlier, but he insisted. Guess what?....he felt a nodule on right side pf prostate.

Went for biopsy, which proved that prostate was 60% cancerous. But that wasn't the worst news. It was a Gleason 4+5=9 Major issue.

Uro recommended a prostatectomy. I asked him how this would evolve were I to do nothing. His profound statement was that within a year, I would have metastatic PCa, and within 3, I would be dead.

Obviously, these predictions were only his opinion, but he wouldn't have missed it much if at all.

Psa is painless and cheap, yet is just one indicator. There are others.
Prostatectomy surgery is not fun, but is manageable. I have no problems at all with urine control.

However I lost both nerves in the surgery. And there are a number of methods of dealing with that as well.

I would encourage every man to get his psa tested a couple of times during his 40's, and annually from 50 on.

 

[bbbamI]

Bless your heart bentley...a Gleason 9. ...sigh....

I think the misconception of PCa is it's always slow growing...as you and I know, that is not the case.

Yes...here's to regular PSA tests and to you and DH living many more years.

 

[bbbamI]

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.

Ahhhh...don...I can't tell a man what he should do.

I suppose since I've been thru hell and back, I'm rather fixated on my experience.

When push comes to shove, the decision has to be yours. I wish you all good health and a long happy life.

 

[Zero]

My feeling is I want the PSA testing and DRE done yearly, when given the information I will ask questions, collect information and try to become Vulcan-like. But at least I have the info. Now, when I get about 70, I may stop all testing, period.

On that note, I have plenty of older friends who rarely, if ever, even get a physical and they seem to be doing just fine. I also had several relatives in rural places who had almost never seen doctors and all lived pretty long lives.

EDIT: Thought I would add this Prostate Cancer Forum, very informative and they are also having a few words about this latest PSA recommendation.

 

[Zero]

Heck, I'm curious, have any major cancer hospitals like Sloan-Kettering, Johns Hopkins, Mayo Clinic or MD Anderson in Houston, come out to support NOT testing for PSA.

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.".