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.
I had ED at 46 (2014) that was supposedly because I was "in a slump" according to the urologist. Likewise, no family history and no other symptoms. I was told that I was not at risk because of family history.
Seven years later at 53, a PSA of 15.2 with G7 (4+3) biopsy and a surgical pathology of PSA of 16. 2, pni, rt svi, epe and tertiary 5 and a recurrence 8 months later that was 33 rounds of EBRT radiation and 2 years of adt and 18 months of abiraterone.
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. Prostate cancer screening and treatment is more than 30 years down the road and yet, looking at the death rate and all the men facing multiple treatments and all the men on ADT, something is very wrong.
The financial impacts from the challenges with this beast are high costs, too many office visits and procedures, 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 - now we FEAR PSA screening? Successful early diagnosis (even if invasive) and successful treatment appeal to me far more than the simple (non-invasive?) taking of an ADT pill or shot.
Screening provides information. Screening is good. Over-treatment is troublesome. Over-treatment is bad. Only with weird mental gymnastics is over-treatment cured by reduced or discouraged screening. I was lucky to have a great GP who subjected me to DRE's and PSA tests starting in my early 40's.
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.
I know MSK does screening of men in their 40s but I told them that MSK can make it work because they are very good about diverting men to active surveilllance. But what works at MSK will not necessarily work in community practice, where most men with low risk PCa are overtreated.
The thread was about screening, not about treatments. The "slowness" you refer to is not about profits, it's because PPCa is a slow disease in most men and requires a long time to research. Medical science is a cumulative process.
The slowness I refer to is what I have experienced and overcome. Certainly seems to me medical science has the investigative methods and knowledge 'today' to maximize accurate early detection and to minimize overtreatment. Methods such as mpMRI, genomic testing, multiple PSMA PETs and readily available second opinions.
It was nearly ten years ago that my mpMRI finding conflicted with my initial 3+3 biopsy pathology finding. 2nd and 3rd pathology opinions were 3+4. Genomic testing finding was low intermediate risk but there was concern the biopsy samples missed the worst bits.
My RP pathology finding was 4+3 and subsequent second genomic testing finding was elevated to unfavorable intermediate risk. (Indeed unfavorable risk - salvage ePLND confirmed cancer had made it to my para-aortic nodes).
As I share, six years ago I greatly benefited from imaging with Ferrotran nanoparticle MRI. A couple of weeks ago I had what is becoming my annual PSMA PET and liquid blood biopsy testing to help me stay ahead of this beast and to not give it time and obscurity.
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!
I hear you. I had a few symptoms that I now know we're big red flags for prostate cancer. I went to my GP. PSA never offered and I had never heard of a PSA test. Bang I get a second DVT, they do a PSA test, sorry sir you have advanced prostate cancer. Your treatment is palliative not for cure. Funnily enough I'm not angry but I worry about my son's who are both in there 20s. C'est la vie indeed.
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.
This, if it's any consolation, is also the case in the UK. Our health commissioners NICE (or not nice in my opinion), basically accept that by not offering screening some men (like me) are collateral damage. They know full well that the downside of cutting back on testing means some of us will be missed and be diagnosed with terminal stage 4 advanced prostate cancer. In Europe they are fighting hard to increase testing.
More than consolation, validates what not enough of us recognize - we men with prostate cancer are acceptable losses; alive and dead. Great that Europe is fighting hard to increase testing; I say all men in their 40's looking for a PSA under 1 and further investigation if above.
As I side-bar, up to my diagnosis nearly ten years ago, I owned and operated a small company in Surrey, paying my staff's NHS taxes and also for private health insurance I offered them.
Interestingly, my lesion was identified by a urologist at New Victoria Hospital, London, on a Sunday (Americans will not understand). He recommended an immediate mpMRI. My urologist 'back home' in Texas clearly had missed my lesion for years and never mentioned an mpMRI to me.
I can tell that you just believe the narrative rather than digging into the facts of the ACA.
What's a sham is that they use an "evidence based study" (PLCO trial) that has 50% - 85% contamination in the control group depending in how the review of facts. There were NUMEROUS groups who fought against this and they were to go pound sand.
What's a sham is that there was no urologist or oncologist on the panel that consists of "12 experts" who meet in private and confidential meetings.
It is a sham that Dr. David Grossman retired from the USPSTF in 2014 and rejoined in 2015 because Dr. Sui was only a chair for 1 year and then Grossman could lead the 2018 recommendation to be sure to only pitch a Grade C recommendation. All the while KP has their own study that states 64% reduction in prostate cancer related death and 24% reduction in all cause mortality. All the while the national SEER data showing that PCa is showing up younger and more aggressive with distant metastasis up 37% from 2010 - 15 at KP and national data showing 43% 2010 - 18.
It's a sham that your insurance is based on income. The ACA was a money grab for the Industrialized Healthcare Complex. You're forced to have health insurance at guaranteed increases to the IHC. KP added a couple of million new members since but has doubled their revenue from about $50B to $100B.
It's a sham that US healthcare is reporting record PROFITS across all companies! The ACA did NOTHING to keep private equity out that has BK'd numerous hospitals. In fact, Xavier Bercerra at HHS, and the DOJ were running a big investigation this year.
The ACA gave power to the USPSTF to create recommendations for primary care. It provided financial mitigation against prostate cancer with Grade C & D recommendations as they did not have to make a recommendation in support of early detection but actually created a narrative that discouraged screening. The USPSTF recommendation provided legal mitigation because when the "experts in disease prevention" at the USPSTF don't make a recommendation in support of screening men are subjected to being an acceptable loss, because the IHC will get to you when you show up with advanced disease they KNOW early detection is key.
The sham of the ACA is MUCH bigger than your statement. Look at profits and executive compensation. They didn't go down.
Look at the alignment of the American Medical Association connecting the Industrialized Healthcare Complex with their corporate sponsors at BIG PHARMA and other medical companies.
The ACA did NOTHING to improve quality and quantity of care for the patient. The ACA did NOTHING to make healthcare more affordable for the patient. The ACA was a sham that allowed a bigger money grab for the IHC by increasing revenue and minimizing care!
What is your point besides complaining and how does your rant help the people on this forum advance their care? This is a forum for stage 4 prostate cancer. Please focus you energy on that and only that.
An easy way for you to avoid this post is don't read it and don't respond.
There are an enormous amount of men showing up with advanced disease because of the management of prostate cancer by the USPSTF and Industrialized Healthcare Complex.
Most men are unaware of the effects of healthcare policy on their journey of prostate cancer.
Learning how healthcare policy helped a significant amount of men get to this stage 4 group as you call it is helpful.
Hopefully we take what we learn to help others advocate for themselves when the USPSTF and Industrialized Healthcare Complex are lobbying against early detection efforts and limiting our access to care that would help more men from joining this group.
I'm not one to put my head in the sand and take what's given by deceptive practices to mitigate financial exposure to properly caring the screening for prostate cancer. The USPSTF and IHC want an "easy button" for detection for prostate cancer but like all cancers it's a process of testing, imaging and biopsy.
My hope is that you're doing more than just discussing your stage 4 cancer online and are advocating for men to have early detection when prostate cancer is most treatable and at times curable.
Not Stage 3? Not Stage 2? Some sources cite Stage 4 as incurable? And Active Surveillance is discussed here from time to time.
Do I misunderstand the forum's namesake - Unlocked? Maybe it should be changed to Stage 4 Locked Tight Thinking?
This topic is not a soapbox because it is true and carries forward to treatment of Stage 4. Why do so many men have challenges getting frequent PSA testing, imaging including comparative methods and second opinions paid for, liquid blood biopsies, and certain drugs?
certainly other stages are acceptable though there are sites for earlier stages, and his rant is a soapbox. Another malcontent whining about a medical system he can't change. It has nothing to do with the care you seek. If you do change your treatment options based on this gibberish, by all means share specifics. "Why do so many men have challenges getting frequent PSA testing, imaging including comparative methods and second opinions paid for, liquid blood biopsies, and certain drugs?" Your quote - are you having trouble? What specifically and whose your provider blocking your care? Think personal care and not macro medicine. We can help you with specific issues but not on the state of Healthcare.
how did Susan G. Komen Breast Cancer Foundation get stated?
Common shares within HU and other groups are examples of insurance companies and even doctors denying investigative methods. And not having population based screening is another example. So no, not another malcontent and no not a soapbox.
If you read my bio and my posts you will see that I am able to obtain the investigative methods and treatments I need to help me stay ahead of this best.
Would it be wrong to point out that the healthcare providers at Kaiser Permanente are also shareholders? It costs more to perform annual prostate exams and PSA tests if you expand the age range.
Though we may want to think otherwise, the medical industry as a whole is driven by profits like any other. The idea of "over treatment" comes primarily from the health insurance industry and they certainly have a seat at the table. Anyone at that table has some biase, whether selfless or selfish.
100% not wrong to point out another FACT! Most higher level KP doctors are shareholders in the Permanente Group.
KP's design and business model preclude them from wanting any type of recommended population-based screening. The Kaiser Foundation sends their stipends to the Permanente Group and they keep some percentage of their allowance after treating their patients. It's one of the very reasons some friends I know have either gone to work for KP because they pay significantly better or have refused to work for "the devil" because of the lack of autonomy and corporate practices.
A "Smarter Screening Smarter Treatment" population-based screening like Dr. Matt Cooperberg has suggested would take money away from KP's BILLIONS of quarterly and yearly profits. An integrated healthcare system like the KP family of companies needs to control its exposure to regulations and required screenings.
After retiring his position in 2014 Dr. David Grossman quietly made his way back to lead the 2018 USPSTF (Grossman was part of the Group Health Co-op, a 65 year business partner of KP, which KP finalized the purchase in 2017). This position allowed Grossman to have a direct influence on a pivotal recommendation, that if made a Grade A or B would cost Dr. Grossman's employer a few billion a year. While Grossman claimed "no conflicts of interest" his influence helped his employer to avoid any type of responsibility of treating their patient population with the agnostic Grade C recommendation that was nothing new (Family history, black/AA, 55 - 69, informed consent). Soon after accomplishing this Grade C recommendation Grossman retired as a distinguished professor at the Kaiser Permanente Bernard Tyson School of Medicine. KP Research was still in the process of developing their "easy button" prostate cancer risk calculator; Grossman bought another 6+ years for KP Research to research their patients and build the management tools they will use in managing their patient population of prostate cancer. While KP could have written company recommendations regarding the enormous benefit of their 2018 study of 400K members that annual screening has been shown to reduce prostate cancer-related death by 64% and all-cause mortality by 24%, they did not!
"It costs more to perform annual prostate exams and PSA tests if you expand the age range." Are you serious? A DRE test at annual physical costs what? A latex glove and a dab of KY jelly? A PSA test costs what? $50 if that? I was lucky that my GP didn't think the way you do. I was subjected to this inexpensive screening starting in my early 40's.
I wasn't defending this approach. I was only pointing out that the medical industry is about profits. I agree that it should be the standard of care. Please direct your anger somewhere else.
It seems to me that doctors get money by repeated office trips and by doing repeated procedures. Drug companies make money when a patient needs repeated doses of drugs that cost thousands of dollars. Hospitals also are the same.
I think their most hated patient is the cheap and smart bastid that got a PSA every year, and the moment it popped, he got one measly radiation treatment and disappeared and went back to live a long happy life taking care of his children and wife.
Thats what i think.
And you know what? Thats who i was. And they (many) fought me for 2 years preventing me from treatment.
I think if they lost money on advanced PCa patients, there would be very few of them.
Theres only one thing that happens if you don’t look… You have to look. Its really the only option. Then if you don’t want to be “OVER-TREATED” then you can choose to do nothing. But don’t force every other innocent person into your sinking boat.
Every single cancer patient that has been cured ever in the history of mankind, was OVER-TREATED to some degree.
Every cancer patient that died was UNDER-TREATED or UNDER-MONITORED.
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