Good news, not so good news...

[dentaltwin]

"The report has some mixed news about prostate cancer, the second leading cause of cancer death in men.

The prostate cancer death rate fell by half over two decades, but experts have been wondering whether the trend changed after a 2011 decision by the U.S. Preventive Services Task Force to stop recommending routine testing of men using the PSA blood test. That decision was prompted by concerns the test was leading to overdiagnosis and overtreatment.

The prostate cancer death rate flattened from 2013 to 2016. So while the PSA testing may have surfaced cases that didn’t actually need treatment, it may also have prevented some cancer deaths, the report suggests."

apnews.com/b5589e095abb4a0e...

[Tall_Allen]

Good thing they changed their recommendation!

[dentaltwin in reply to Tall_Allen]

The only thing we can tell is by looking in the rear view mirror.

[timotur]

In 2011 my GP was not recommending PSA tests for this reason.

[dentaltwin in reply to timotur]

That pendulum swings back and forth...

[dentaltwin]

It's just a test, and not a very good one. The question is what you do with the information once you have it. I'm sensitive to the charge that PSA screening leads to "overtreatment". There's got to be a happy medium, and that tends to go out the window when patients hear the word "cancer".

The National Cancer Institute defines "active surveillance" as "A treatment plan that involves closely watching a patient’s condition but not giving any treatment unless there are changes in test results that show the condition is getting worse. Active surveillance may be used to avoid or delay the need for treatments such as radiation therapy or surgery, which can cause side effects or other problems." It mentions use of AS for "certain types of cancer, such as prostate cancer, urethral cancer, and intraocular (eye) melanoma." I know there is discussion as to whether some relatively low-risk cancers, such as papillary thyroid carcinoma should be called "cancer" at all, which begs the question as to what is an appropriate level of aggressiveness when treating cancer. In the United States talk of restricting treatment tends to turn into a political football--which is not useful if you don't want clinical decisions to turn on emotional arguments.

[Jeff85705]

I waited for 2 years to get my prostate cancer treated "thanks" largely to the recommendations AGAINST routine PSA testing and the general (mis)information that prostate cancer is slow-growing and something else will kill a man before it becomes a danger. How wrong that was! I finally got the biopsy done when my PSA steadily increased to 10, got results of Gleason 3+4(7), and chose RALP in February 2017. Pathology revealed a somewhat aggressive 4+3 Gleason, but with no positive margins, no evidence of spread beyond the prostate capsule. I can't for the life of me (literally) understand why such a simple, cheap and revealing test as the PSA would NOT be recommended for men 1) 50 at least, and/or 2) with a family history of prostate cancer. You said it is looking "in the rear view mirror," but that was not needed for the common sense PSA recommendation!

[dentaltwin in reply to Jeff85705]

I'm trying to let go of my anger. My internist of 30 years retired at the end of 2017. I found a new doc, ran a slew of tests including PSA, and everything followed from that. In the course of all that, I requested copies of my records from my former internist, and was surprised to see he had been supervising the steady upward march of my PSA for about 6 or so years, but didn't think to tell me of this.

Water under the bridge.

[Hidden]

Both my urologists have been firm believers in testing. I agree that it's what you do with the data given. At the moment, I'm on AS. Yes I also have a diagnosis. I've spent alot of time reading and listening. The 2011 decision is idiotic.

[dentaltwin in reply to Hidden]

I don't agree. A case can be made for either approach, and I understand the rationale of the USPSTF recommendation(s).

Of course (they'll say), urologists certainly recommend screening--it's connected to a big income stream for them. That was the subtext of the USPSTF recommendation. OTOH, as a clinician myself, and while I appreciate the desire to not have decision making in the hands of people who stand to benefit, the OTHER approach, in which these decisions are made by epidemiologists and public health officials (and the task force, which if memory serves at the time was headed by a female pediatrician) discounts the importance of actually having experience in the field.

I don't know what the answer is, other than a better test that will accurately assess the future behavior of tumors.

[dentaltwin]

I actually HATE that aphorism--"most men die with prostate cancer, not of it". I can't think of any other cancer for which this is said. True, PC on microscopic exam at death is very common. But saying this about a cancer which most surveys say is the second leading cause of cancer death among men (second only to lung cancer, though I've seen it called the third leading cause after lung and CRC) I think shows insensitivity at best and disrespect at worst.

[Hidden]

Good points. I did find it odd that this 2012 may not have had a urologist on the panel. I'd just like to point out that my urologists could have easily pushed for immediate treatment. My thought is that it is important to understand any medical doctors motivation as part of the overall process.

[dentaltwin in reply to Hidden]

"Odd" is one way to put it. I just checked--there still are no urologists on the task force. There are specialists in internal medicine, family medicine, and public health. One member, Michael Barry, is an internist about whom is said:

"He has led prominent research studies, including the Patient Outcome Research Team for Prostatic Diseases, as well as many other clinical trials and patient outcome studies. His work in prostate outcomes research earned “Article of the Year” honors from the Association for Health Services Research (now AcademyHealth)."

There are no other members who are urologists. Curiously (especially since it has been prominently pointed out that urologists perhaps cannot be impartial in setting these guidelines) that there are TWO obstetrician/gynecologists on the task force, and of course the task force also sets policy for screening breast/gynecologic cancers. So far as I can tell, they have not been accused of being biased, although of course some of the guidelines (at what age and what frequency do women get mammographies, at what age do women stop getting Pap smears) have been controversial as well.

uspreventiveservicestaskfor...

[Jp2sea]

I was diagnosed at 42, and it was stage 3. It angers me that testing is not being widely encouraged. I'm a scientist. Data is good.

[dentaltwin in reply to Jp2sea]

The question often is, what do you do with the data, isn't it?

[Jp2sea in reply to dentaltwin]

Absolutely. Data is not the problem. I'm very sad/ disappointed to hear that medical doctors sided on having less data. That's stupid ... in my view.