"After a decline in PSA test usage, there has been an increased burden of late‐stage disease, and the decline in prostate cancer mortality has leveled off."
The following quotes are from the NIH [2].
"... incidence of distant disease—that is, of cancer that has spread from the original tumor to other parts of the body—increased from a low rate of 7.8 new cases per 100,000 in 2010 to 9.2 new cases per 100,000 in 2014."
"“The increase in late-stage disease and the flattening of the mortality trend occurred contemporaneously with the observed decrease in PSA screening in the population,” said Serban Negoita, M.D., Dr.P.H., of NCI’s Surveillance Research Program and lead author of the prostate cancer report. “Although suggestive, this observation does not demonstrate that one caused the other, as there are many factors that contribute to incidence and mortality, such as improvements in staging and treating cancer."
Note the context of the news about the flat PCa mortality rate: "cancer mortality continues to decline" - but not for PCa.
I was diagnosed in 2004. Looking at the mortality trend at that point, it was clear that there had been a steady drop in the PCa mortality rate beginning with the adoption of PSA screening. And yet we had no drug breakthroughs in this period. Men were being treated much the same & yet fewer were dying.
& now, when we have so many more options, we see no improvement in mortality at all:
"after two decades of decline between 1993 and 2013, prostate cancer mortality leveled off between 2013 and 2015"
An interesting finding is that the rates for Gleason score 9-10 have not increased with the reduction in screening. More are being found at a later stage. Any group survival advantage to use of Zytiga, Xtandi & the others seems to have been eroded by more men being treated later.
"An interesting finding is that the rates for Gleason score 9-10 have not increased with the reduction in screening. More are being found at a later stage."
Those two sentences seem contradictory. Please explain.
My interpretation is that progression to metastasis & detection does not depend on cells in the prostate first getting to GS 9-10.
And that the progression from 4+3, say (my case), to 5+5 might not be rapid, or even inevitable. Metastasis trumps whatever is happening in the prostate.
-Patrick
I've never understood why PSA testing has been disparaged by the 'great medical thinkers'. I can see a cause and effect if this author isn't willing to reach that obvious conclusion. There is even thinking that DRE screening should be disparaged too. None of this makes any sense to me. Good post.
Well, I'm certainly a poster child. My PCa wasn't caught until too late due to cession of PSA testing at age 70. That age is arbitrary anyway - if PSA testing makes sense at 68, why does it no longer make sense at 71? If it had been continued with me, the cancer probably would have been caught while it could be dealt with. The insurance companies should insist on it from their own economic well-being. Lack of a couple of $90 tests has cost them approaching $100,000 and rapidly counting so far.
PCa cases increase with age (like an inverted pyramid), so the 70 cut-off cuts off an awful lot of men.
The idea is that there is no point detecting & treating PCa in men who have a remaining life expectancy of not much more than 10 years. The problem with that is that for many men, 70 is the new 50. Many will survive past 90.
A staggered cutoff based on comorbidities makes more sense. Or men could be told to assess their own longevity prospects.
I've used privatemdlabs.com for years for my PSA. You chose the test, the LabCorp near you, pay online and get the results the next pm with a secured link. It's like $47 and I wait for a 15% off email coupon to book it. I then go to LabCorp.com to make and appt and bring in the requisition.
Once it's detected, they kind of have to treat it. There's a good chance that it will be in an advanced stage (like me) and those treatments are expen$ive. Doesn't make economic sense to not continue testing. I resent being "written off" as not worth bothering about - especially as, except for the cancer, my health has been excellent.
Dr. Myers once complained bitterly about agism against males in America. Don't know what irked him so.
I only reached 70 in January, & I haven't experienced it so far.
But the 'stop screening at 70' decision - recommended by a relatively young task force panel - might be a good example.
Perhaps better is reflected in the difference in public attitude towards BCa & PCa during the pink & blue ribbon months.
Another is the barely concealed disgust that older men might want to restore testosterone. As though the so-called andropause is as natural & inevitable (& desirable) as the menopause.
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