Over 6 years later the USPSTF has yet to update the screening guidelines and we're seeing more and more men show up with mets and distant mets.
The USPSTF is such a sham group of "experts in disease prevention" mitigating the financial exposure and demand on the Industrialized Healthcare Complex. Since the ACA was enacted the USPSTF gained power to create screening guideline recommendations for primary care.
Dr. David Grossman with Kaiser Permanente was on the panel of the 2012 group he led the 2018 USPSTF Recommendations.
The 2018 USPSTF recommendation states, "Current results from screening trials show no reductions in all-cause mortality from screening."
Released concurrently with the 2018 USPSTF Recommendations was Kaiser Permanente's study of 400K of their own patient population that stated there's a 64% reduction in prostate cancer related death and a 24% reduction in all cause mortality with annual screening.
And the 2018 Recommendations also clarified the other narrative we hear repeated all of time "over treatment". There is no empirical evidence to quantitify how much over treatment there is (possibly 5% - 40%), but yet this is the narrative still regurgitated to justify their position against screening.
The games that are played by the USPSTF to mitigate the Industrialized Healthcare Complex's exposure to prostate cancer screening are blaringly obvious. The ACA was another big sham that did nothing but build in easier profits by moving to an evidence based system where the "experts" get to interpret the evidence how they choose.
Sadly, until we get an appropriate screening recommendation in place will we get ahead of this disease.
In the interim, you're just an acceptable loss!
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Cyclingrealtor
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I agree with you. I was diagnosed at 49. No family history. I would give anything to go back and be screened earlier. Unfortunately, no one is looking out for you.
Can you explain how the healthcare complex benefits from the anti-screening guidelines? Also, can you explain how the health care industry is able to shape guidelines to increase mortality? Seems like a good topic for some investigative journalism, but I haven’t seen any?
Virginia Moyer tried to slow down breast cancer screening and it ended up in congress and was rolled back.
The USPSTF recommendation about everything is based on the new care and delivery models set up in the Affordable Care Act. Evidence based medicine, evidence based studies, evidence based practices, shared decision models, decision aids, best practices, legal mitigation, etc.
This new approach to managing healthcare in the US was nothing but a money grab by the Industrialized Healthcare Complex.
The burden of their knowledge of the risk of NOT SCREENING is 100% on the patient when the patient shows up with advanced disease. The margins on healthcare are ENORMOUS.
In spite of the 50 - 85% contamination rate of the control arm of the PLCO trial, it provided the USPSTF and Industrialized Healthcare Complex the data they needed to stop a population based screening recommendation. And I am quite sure the Industrialized Healthcare Complex is quite happy with the financial and legal mitigation provided by the USPSTF panel that included Dr. David Grossman with Kaiser Permanente who went on to retire soon after his 2018 USPSTF recommendation.
Grossman is a highly distinguished doctor at the Kaiser Permanente Bernard Tyson School of Medicine.
Grossman delayed a solid recommendation another 6+ years with his C recommendation as Chairman of the 2018 USPSTF.
At that time Kaiser Permanente was still developing their proprietary KP Prostate Cancer Risk Calculator. Any bets that the 2024 update may include the use of a Risk Calculator?
As stated in the post, Kaiser Permanente produced their own study that showed SIGNIFICANT benefit of annual screening. It was with Dr. Paul Alpert, a retired KP urologist, urologic expert witness and former KP Medical Legal Chief.
In addition, Kaiser Permanente has the largest population of prostate cancer in their home state of California according to the AmericanCancerSociety.
Any incentive for KP to be involved in the creation national healthcare policy regarding the steering of prostate cancer?
Creating a narrative of over treatment, a "good cancer", easily curable, an old man's disease, "more likely to die with it than from it" is what the USPSTF set up with their recommendations.
The 1996 USPSTF guidelines stated that the screening population would increase from 23M men to about 44M men by 2020. And the 2015 Kaiser Permanente paper showed a 75% increase of screening population by about the same time.
The narrative and recommendations have sone nothing but increase the incidence of metastatic disease and relieve the Industrialized Healthcare Complex of legal exposure and financial exposure to prostate cancer. The burden of advanced disease is on the patients to foot the bill.
And with Kaiser Permanente being the largest research facility outside of academia and the US Government, they can study the patient population with their vertically integrated healthcare system. They have access to everything from the patient, primary care, urology, oncology, nuclear medicine, patient history, pharmacy, etc.
From my own experience, health care providers don’t want to spook men with a clinically insignificant cancer diagnosis and men dislike having their privates invaded (biopsy).
Frequent PSA tests by themselves have this problem. They subject a lot of men to invasive procedures who don’t need them. That’s why MRI has become a tool before biopsy. And even that isn’t great at excluding insignificant cancer and it’s a limited resource and expensive.
My own diagnostic path was high PSA, PI-RADS 4, biopsy and low volume Gleason 3+3, exactly what they want to avoid. It does create anxiety, especially because I just witnessed death from bile duct cancer, glioblastoma and pancreatic cancer, very close family members.
Prostate cancer screening simply sucks. I personally am glad I had it but it’s not a conspiracy in my opinion. It’s a lack of ability to screen efficiently.
yes, often but not always a tough beast to screen for and to determine best treatment paths, which may be unsuccessful. The business result is excessive costs, too many office visits, various medical and legal risks, etc. Unlike colon cancer screening which is a bargain - often the 'cure' (yet this invasive procedure is recommended for all and many participate?)
Women experience medical invasions starting at a young age.
We men once slayed dragons. Looking at the death rate and all the men on ADT, something is very wrong.
And adt is cheap and highly profitable management til it stops working!
I found a website that shows wholesale prices for Lupron Depot (6 month) at $900 - $1,200. They bill Medicare $12K according to a friend who's old enough.
Consider a regular patient like myself who had no other morbidity until advanced disease, I am worth about $18K a year to KP.
I share your mistrust of the health care industry, but my questions were specifically about how the industry benefits from discouraging screening and how the industry was able to shape the guidelines to increase its profits.
Actually, USPSTF completely changed its recommendation and its process in 2018. It now pretty much conforms with AUA recommendations.
Also, you got the profit motive backward. Healthcare companies gain revenues from unnecessary treatments.
Low risk patients are increasingly being encouraged to go on active surveillance, but there is still a lot of overtreatment. And owing to the new recommendations, more high risk patients are being treated earlier.
If this is all going in the right direction it is way too slow. Too many men still dying. Too many men needing multiple treatments. Too many men having to be treated with ADT.
Profits are also achieved by not spending monies - such as not screening all men in their forties, looking for PSA below one and further investigation for any concerns.
As person with no family history of prostate cancer but with an ATM germline mutation, I wish they recommended a genetic screening for all men at 40 in Italy. I would then have started checking my PSA yearly instead of waiting till I got 50 of age. I hate myself sometimes because I feel I did not take care of my body enough. C'est la vie I suppose!
Calling the ACA “another big sham” is an opinion stated without factual basis. It was/is a major improvement to a healthcare system that was very badly broken largely due to its dependence on, and dominance by, private insurance companies whose profits, exorbitant executive compensation, and stock prices are based on taking money from patients, their employers, and doctors.
Dr Matt Cooperberg of UCSF discusses "smarter screening" - screening all men in their forties looking for PSA under 1 and investigating further for any concerns.
Although I self-directed my own screening beginning in my 40's, my doc and I missed the very thing we were screening for, prostate cancer, because of prostate cancer guidelines and misinformation rooted in the USPSTF and ACA. Have these and are these organizations doing good work elsewhere, of course. But, as for men facing prostate cancer, in my humble opinion, these organizations have not served us well.
Simply put, those of us with prostate cancer are simply acceptable losses while the industrial medical complex (comprised of private business and government) searches for the easy button for prostate cancer.
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Old Guy Update
Dad’s blood reports. PSA and testosterone down but ALP up 
Recent paper on osteonecrosis of the jaw - some extracts relevant for PCa patients are given below
LUPRON CASODEX FAILURE NOW WHAT
