Castigating the only widely available test, the PSA test, as the source of the problem is less than helpful, and deliberately misleading.

I am concerned that decisions will not be made based on the good of the individual. I am upset because, at least based on what Mike said above, in the editorial there was little consideration to a physician doing a differential diagnosis. Seems to be an attitude of all or nothing. Too bad.

As a patient, I find it ridiculous that we are in this dilemma and the current best advice that our doctors can provide is “Let’ s make a shared decision,” which is about as effective as both the doctor and patient throwing a dart at a dartboard to seek answers.

I thought April’s AUA “Best Practice Statement” and the section on “The Use of PSA for Early Detection of Prostate Cancer” was as near spot on as you can possibly get with the two initial tests we have today.

There was no mention of this statement within the two articles which I find strange and as earlier stated no mention of gaining a “baseline” figure to aid future assessment which is not just a “pity” but an unbelievable omittance, in my opinion.

Overall the two articles are more or less inclined towards the AUA “Best Practice Statement” if you remove the “Baseline PSA age 40 years with anticipated lifespan of 10 or more years” part out of the flow diagram on page 9.

And yes, a new test is required and will arrive but for now we have to use the two initial tests, adjusting them to both catch prostate cancer as early as possible along with avoiding unnecessary evasive treatments while at the same time refraining from emotive language and statistics to confuse the issue further!

Using human males instead of mice, determine once and for all whether it is possible to intercede medically with men who are diagnosed with prostate cancer, if such diagnoses ever become reliable and available, and how to do so in an expeditious, inexpensive, humane manner for males of the human species everywhere, and to quit screwing around with naked mice.

Phil Olsen, HPPC

“The decrease in prostate cancer mortality, occurring just 4 to 5 years after screening began, is difficult to attribute to screening when dealing with a disease of such a long natural history and supports alternative explanations for the decline in mortality. During the same period as screening proliferated, significant improvements developed in surgery and radiation as well as in the application of hormonal therapies to regional and metastatic disease. One such change was the increased use of gonadotropin–releasing hormone agonists and the use of oral androgen–blocking drugs. The dramatic increase in the number of localized prostate cancers detected also simply provided physicians with a greater opportunity to hone treatments, increasing their curative nature while focusing as well on reducing toxicities.”

This is risible because without PSA testing all these advances in surgery, etc., would be invalid. The fact that a stage shift occurred should not be ignored. Typically, treatments applied at an early stage result in better outcomes. The 7,000+ lives and counting saved every year still remain unexplained.

Mike, I am willing to bet a nickel that you’ll never hear Dr. Brawley address how many women have to be tested to save a life. BCa is the blood life of the ACS. He will never go there ….

I just hope the USA doesn’t over react and go the other way regarding the two initial tests, especially when read along with this article that states:

“Until now, if a man could not decide whether he should have his PSA checked, the default recommendation was in favor of testing. These studies suggest the opposite strategy might be better — that unless a man has a particular reason to request a test, the default should be to skip it. ”

You could end up with 56k deaths a year!