Translation; Limit Mechanical Repair to Cars with Streaming Black Smoke, or Fire coming from their Tailpipes
Holy Cow!!! I thought the Onion had gone bankrupt! No, it appears that they are still open...to be clear the SOC would include focus on the following;
Article; "In a paper published online on May 17 in the BMJ, the panel recommends instead a comprehensive nationwide program that would base PSA testing on individual patient risk and direct those with abnormal results to a managed system of imaging, targeted biopsy only if indicated, and subsequent active monitoring or treatment for those with more aggressive disease features."
So, initially we dont know how these Brainiac's are going to stratify patient risk...well, the article doubles down by stating;
Article; "To make better use of PSA testing, policy makers should choose between a comprehensive, risk adapted approach that is specifically designed to reduce overdiagnosis and overtreatment, or restricting PSA testing to people referred to urologists with symptoms."
I was a patient who never had a single symptom. For 10 years I never missed a DRE or PSA test, headed the PSA 4.0 safety threshold and wound up with a GS 4+3 tumor filling 30% of my prostate before I found out what I had...but, this story gets better!
It was me that got nervous, asked for a 2d opinion, found out something called a Multiparametric MRI (mpMRI) was available and it was me who asked my urologist of 10 years for the scan. I had no symptoms, none, nada, niet, nien! Had I waited for symptoms I would not be typing this right now...
This article and this approach to PCa is horrifying...its unbelievable...I want to sit with a bunch of men I dont know and tell them the person in their life who can wreck it, sap it of its essence and rob them of its 'quite enjoyment' is their urologist...if they dont know that then they are in bigger trouble than they know. And given this article they are headed for a world where a symptom will be needed before they go down the path each reader of this post is walking. I feel sorry for them all.
For my Sons the DRE is dead; waste of time. PSA is a secondary marker. The MRI is the tool to find out what the heck is going on inside your prostate. In my family we have a family history of PCa. Any PSA test for my Sons of 2.0 will yield flashing red lights and require an MRI...if we cant get a Dr to write a script for the scan we'll pay for it...DO NOT wait for symptoms (Oh my God)...DO NOT rely on a PSA of 4.0 to keep you safe...DO NOT think that a DRE can find all your cancer...
For my family we will not be following this articles lead; PSA is checked at least annually. If PSA continues to rise and approaches 2.0 an MRI is needed. DRE's can only find cancers in the back half of your prostate. The SOC PSA level of 4.0 was not developed by random testing of thousands of men, it was simply 2 times the standard deviation of the initial cohort of men in the 80's who participated in landmark studies that proved PSA was linked to PCa. There is no magic protection in the PSA level of 4.0...the leading cause of lawsuits for Dr's today is waiting too long to treat PCa...and this article proposes they wait even longer for symptoms to form!!! O.M.G....
I cant believe medicine is going in this direction...heck, lets do this for all disease...lets just wait for symptoms, then seek treatment. Are they kidding! Have they gone crazy...sorry. This is nuts. Rick
medscape.com/viewarticle/99...
PS to apply this insanity to its conclusion, dont forget...after PCa treatment and BCR, dont conduct any PSA testing and lets all wait for "symptoms" to return before we treat again...does any of this make a lick of sense? If it does then ‘Stranger Things’ are happening (the Upside-down)...Rick
MRI fusion Biopsy
AS or Surgery? 
Leave AS behind now?
Contrast MRI vs biopsy
Next PSA test coming Monday
