The refusal of GP's (General Practitioners) to test for PSA in the context of prostate cancer risk will eventually be revealed to be a scandal.
As we know now the refusal stems from a poorly reasoned and controversial 2012 US "Preventative Services Task Force" recommendation (ncbi.nlm.nih.gov/pmc/articl... ). The recommendation was widely adopted in the US and then copied around the world by national prostate cancer policy bodies.
In this context my doctor in Canada did the usual perfunctory annual DRE. But never a PSA test. And then with a growing back ache suggested I had strained my back muscles. The developing back pain was actually because of cancer on the spine, not a side effect of a localized inflamed prostate, let alone strained muscles.
Ever-stronger painkillers were prescribed over the next 4 months. Eventually after begging for an X-ray, something showed up, indicating a need for a more detailed X-rays.
Finally, via MRI, I was diagnosed with stage 4 hi-volume metastatic prostate cancer and multiple compromised vertebrae and ribs and lymph nodes too, etc. My PSA was 1700. Fortunately my brain scan was negative! Imagine my relief!
Apparently my cancer would have had taken years to metastasize to earn the "hi-volume award". Another way of putting this is to say that I enjoyed years of policy-driven medical incompetence and misjudgment, during which time the cancer grew in my prostate, eventually escaping in order to colonize my spine. The impact on my wife especially was heart-rending.
I'm very fortunate to have been treated at Toronto's Princess Margaret Hospital, with leading-edge triplet therapy, and have responded extremely well, and aside from bone mets have no organ metastasis and have avoided paraplegia (barely). Also my LE has gone from a year to maybe 5 years. At least it looks like I'll have enough time to get my affairs in order.
We are fortunate to live where we do. The quality and sophistication of care and the kindness of the staff at Canadian hospitals have made this journey much easier. Add to this the fact that all costs are covered under Canadian health insurance means none of the terrors and distorted incentives of the alternative south of the border.
But doing life expectancy calculations shows that this missed diagnosis will likely cost me between 11 and 17 years of life! (I'm mid-sixties now.) With my wife and children, one still in highschool!
Note added at later date: The loss revealed by a diagnosis of prostate cancer with metastasis is not only in years, but also in the quality of life during the years that are left. Metastases usually quickly and significantly impair one's quality of life. In my case I count the fact that I have only three vertebrae compromised as a blessing. No other major organs are affected yet. Nevertheless, even if my current metastases are stable for a while, I am still constantly at risk for vertebral fracture or impairment of the spinal cord. And I'm also learning about the effect of therapy on one's energy level. And then there's the dread waiting for the results any new PSA test. There are thousands of stories to tell and some of them end up here in this forum.
The medical community and the media never tire of saying, "you can live with prostate cancer". But that does not apply to metastasized prostate cancer, not at all. There's probably a Pulitzer prize waiting for the journalist that documents the story of the 2012 U-turn on PSA testing.
I have to work very hard not to be bitter about this. The lazy, bad decision-making by Canadian health authorities, policymakers, and physicians is unforgivable.
Another Note Added Even Later (and also posted separately as a reply below too): I recognize that not being more aware of my own responsibility to understand prostate cancer risk is my failure. Those missing years of life are also my responsibility. I'm now working to improve my decision making and focus. Contributing to a broader awareness of the opportunity PC early is one thing I can help with.
(The whole thing reminds me of the 1980s Canadian tainted blood scandal - en.m.wikipedia.org/wiki/Roy... ).
#governance #decisionmaking #economics #policy #skininthegame #SITG #moralhazard #incentives #bigdata #publicpolicy #analysis