Re: "Increasing incidence of metastatic prostate cancer in the United States (2004–2013)"

I don't get my PCa news from Fox News, etc, so I missed the big fuss when the new study [1] was picked up by the media.

I caught up with it when Denise Grady wrote about it in the New York Times last Wednesday:

"HEALTH | THE DEBUNKER"

"Flawed Study of Advanced Prostate Cancer Spreads False Alarm"

"The reports suggested that recent medical advice against routine screening might be to blame for the apparent increase in advanced cases, by leading to delays in diagnosis until the cancer reached a late stage."

"But the frightening news appears to be a false alarm — the product of a study questioned by other researchers but promoted with an incendiary news release and initially reported by some news media with little or no analysis from outside experts."

So, no need for the men who stopped screening to worry?

On Nov 17, 2015, Denise Grady also reported [3] that:

"Fewer men are being screened for prostate cancer, and fewer early-stage cases are being detected, according to two studies published Tuesday in The Journal of the American Medical Association.

"The number of cases has dropped not because the disease is becoming less common but because there is less effort to find it, the researchers said.

"The declines in both screening and incidence “could have significant public health implications,” the authors of one of the studies wrote, but they added that it was too soon to tell whether the changes would affect death rates from the disease."

There is no mystery here. Screening levels have declined. Inconsequential PCa is not being detected and over-treated, just as the US Preventive Services Task Force (USPSTF) planned. However, the price is being paid by men who are diagnosed only when symptoms occur.

Here's what the study found:

"The annual incidence of metastatic prostate cancer increased from 2007 to 2013 ... and in 2013 was 72% more than that of 2004."

"(1685 cases in 2004 to 2890 in 2013)"

It's all very well to call this a classic blunder of confusing number of cases with rates, but it looks like the paper is being buried as bad science, when an increase in the rate of metastatic disease at diagnosis is an inevitable outcome of men listening to the USPSTF.

This is how last week's Times' article ends:

"Dr. Brawley said that even if further analysis found an increase in advanced cases, it would probably be from improvements in magnetic resonance imaging scanning. In other words, rather than reflecting more cases of advanced disease, the increase would mean doctors had become better at finding it."

OK, so we are doing less screening, but getting better at finding advanced disease?

-Patrick

[1] nature.com/pcan/journal/vao...

[2] nytimes.com/2016/07/21/heal...

[3] nytimes.com/2015/11/18/heal...

8 Replies

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  • I would still say that if regular PSA screening is not part of your medical regimen, take charge of your own life and get it done yourself. It's only $30-$40 - the price of a dinner out - and well worth it.

  • The message of stopping screening upsets me and also upsets my oncologists and primary care doctor. If my OLD primary care doctor had screened me at 50 or even 52 I would not be sitting here with advanced prostrate cancer and now with rising PSA even on Lupron. Done the whole show in 2009, RP and 36 hits of radiation and Lupron every six months beginning 6 months after radiation because PSA < 2 and doubling every month. Oncologist told me that without question if I would have been screened it would have been caught much earlier and would have had great odds that been contained in prostate and been curable.

    I seriously question USA system of healthcare.

  • I'm among that large group of men who avoided doctors for years because I felt good and was concerned about swings in recommendations on many health issues. In 2012 when I visited a doctor because of frequent urination, he still did not recommend a PSA test. Several months later when my symptoms didn't improve he referred me to a urologist who did an immediate PSA...over 800! Biopsy confirmed aggressive cancer and CT and bone scan confirmed mets to bone and lymph. Who knows how much the six extra months made the problem worse. We immediate insisted our 40 year old son get baseline tested!

  • In 2005 the family practice doctor did not tell my husband that his PSA was 7. No one knows why, because the doctor soon died. We found out this information in 2009 after my husband was sent to a new primary care clinic for high blood pressure and his PSA was found to be 40.5 when they did the new patient full workup. This doctor sent an orange sheet to him with the result and urologist appointment. Gleason 9, metastatic to lymph nodes hiding around the aorta at the kidney level, so no one around here would do surgery or radiation. My brother found his much earlier because our father had died of prostate cancer in the early '90s, and he was able to have seeds implanted and is doing fine. These past 7 years would have been so much different if only... I want to cry every time I think about it.

  • We had a very similar experience. My husband was screened in 2008 and had a psa of 3. We were not advised that this was even a flag by our GP. In 2010 with his PSA at 30 he was diagnosed with metastatic disease and surgery was not offered. radiation was not curative. Hormone treatment he has never been very responsive or only for very short periods. His PSA is now 500, I too am sad that this still could be happening to others. Our GP and health centre had also seen that PC was reported to be over diagnosed...they have now changed their protocol, but we have suffered for this non response. I too can not think of it..

  • Today's New York Times feature's an editorial noting how a reduction in screening especially endangers black men and others who are at higher risk for prostate cancer: nytimes.com/2016/07/27/opin...

  • Jim,

    From a paper this May:

    "It's also important to note that the USPSTF guidelines were based on two studies, one of which reported that only 4 % of its participants were African American. The other did not report demographic information, but used participants from seven European countries with small African American populations."

    ncbi.nlm.nih.gov/pubmed/271...

    The arrogance of the USPDTF, which included no urologists or oncologists, & was almost 50% female. Hard to believe that pediatricians & academics, etc. could have such power over us.

    They had a very simple solution at hand - augment the PSA test with other tests that improve the specifity for PCa. Such a move would reduce biopsies by 60% or more, & have a dramatic effect on over-treatment stats.

    -Patrick

  • How many more incompetent doctors are going to be responsible for not sending our loved ones to urologists when they present with symptoms beyond their scope. We are another so-called casualty of an arrogant internist who absolutely should have known better, especially since her specialty was gerontology. When she first tested my husband's psa was 5. The next psa was 234, 17 months later, with no follow up or even warning that a 5 could possibly indicate PCa.

    Genie