What is needed is not to delay or forgo detection, it is more conversation and education about “Okay, what do we do about it?” after it has been detected. THAT is what ACS SHOULD have recommended.

One can only hope ACS corrects itself on this matter before too many thousands of men are condemned to the misery of advanced prostate cancer by the recommendation they have made.

That is the best, most succinct argument I have seen to date on this derisive issue. I whole heartily agree with your reasoning and conclusions.

Thank you,

Bill

Here’s a leader in the prostate cancer world, Dr Walsh:

“If you are the kind of person who doesn’t wear a seat belt nor goes regularly to the dentist or your family doctor for a check-up and are not worried about dying from prostate cancer, do not undergo PSA testing. On the other hand if you are a healthy man age 55-69 who does not want to die from prostate cancer, the European trial provides conclusive evidence that PSA testing can save your life.”

Dr Catalona has a similar view, so it is said.

Here is telling quote from another interview with the biased Dr. Brawley, when he was at Emory University Medical Center. What he says in formal presentations seems to be somewhat different than his less formally prepared remarks. I think the real Otis Brawley is revealed in unprepared interviews. That is my OPINION. – John@newPCa.org (aka) az4peaks

Dr. Brawley: – And by the way, we at Emory have figured out that if we screen 1,000 men at the North Lake Mall this coming Saturday, we could bill Medicare and insurance companies for $4.9 million in health care costs [for biopsies, tests, prostatectomies, etc]. But the real money comes later–from the medical care the wife will get in the next three years because Emory cares about her man, and from the money we get when he comes to Emory’s emergency room when he gets chest pain because we screened him three years ago.”

az4p NOTE: This is pure scare tactics to support his anti-PSA view, and has no supportable scientifically-based evidence.

Interviewer: You’re saying that screening creates long-term customers. So, did Emory Healthcare decide to go ahead with the free PSA screening on Saturday?

Dr. Brawley: “No, we don’t screen any more at Emory, once I became head of Cancer Control. It bothered me, though, that my P.R. and money people could tell me how much money we would make off screening, but nobody could tell me if we could save one life. As a matter of fact, we could have estimated how many men we would render impotent … but we didn’t. It’s a huge ethical issue.”

az4p NOTE: He was successful in stopping free screening by Emory and has now been successful in discouraging PSA testing support by the ACS. I’m not talking about mass screening, I’m talking about screening within the confines of the medical relationship between a Doctor and Patient. — John@newPCa.org

Here is what I sent to you before, with my stance on PSA screening:

Comment by John E. Holliday, FACMPE re: PSA Screening Controversy

Critics of PSA screening for prostate cancer (PCa) generally base that opposition on the view that “over-treatment” of PCa is substantial and in some minds, is rampant. An academic discussion as to the advantages or disadvantages of mass screening may have a legitimate place in the public forum, but the pragmatic realities of PCa in the lives of American men, demand that those of us who constitute the 2 million men presently living with the disease, speak for those who can no longer speak for themselves. Those who have died from what is so often characterized as a largely “indolent” disease.

When opining “over-treatment,” It is easy to talk broad statistics and draw conclusions based on collective numbers, but that does not address the crux of the diagnostic dilemma for the individual patient. The unanswered question is WHICH individual patient’s malignancy is going to remain indolent and WHICH individual patient’s Cancer is going to advance?

Is there some over-treatment in individual cases, undoubtedly, just as there is under-treatment in some individual cases as attested to by the statistics. But, what is the alternative? Should we do away with the most successful warning marker in the history of cancer? Should we wait until there are clinical symptoms and return to the dismal statistical results of the pre-PSA past?

Let’s examine the facts!

The FACT is that there is NO reliable way to determine, with any certainty, which Prostate Cancers (PCa) will remain indolent and which are to progress to life threatening status. If such technology and expertise were available, PCa would not subject newly diagnosed patients to the treatment quandary in which they find themselves.

There should be little doubt to any logical mind, that the introduction of the PSA blood test and the substantial increase in aggressive treatment due to the widely acknowledged transition in presenting diagnosis, from predominantly “ADVANCED” cases in the pre-PSA era to equally statistically predominate “EARLY STAGE” disease today has saved many lives from PCa death.

In the PRE-PSA era (the very late 1980′s backward) roughly 3 of every 4 men diagnosed, was found to have advanced disease and 65% of that group, already exhibited metastases. Today, enjoying the benefit of the PSA era, ((essentially the 1990′s forward), which according to the NCI division of the NIH, has advanced PCa detection by 7 to 9 years, the exact statistical reversal now exists, with over 3 of every 4 men presently being diagnosed, presenting with EARLY STAGE disease.

During roughly this same time period (the PSA era), the number of deaths directly attributable to PCa has DECLINED by approximately 40%. This is true, in spite of the steady expansion in the size of the age group composing the risk pool for those most likely to acquire the disease. These are plain, undeniable, raw figures, not subject to the risk of manipulation that can sometimes taint “adjusted” data.

What then is the most likely reason for this rather dramatic decline in PCa mortality? Has there been any dramatic new discovery in treatment that has substantially extended the expected individual or collective survival rate? NO! Therefore, the logical explanation, and in my opinion, one reasonably supported by the limited statistical data available, is that the advance in diagnosing PCa at an early, curable stage and the resulting increase in the application of aggressive treatment, has been the most likely impetus, for the most substantial mortality decline of any Cancer, in the last 20 years.

Those who WRITE about this disease, rather than personally live it, are great at stating the obvious. “We need to have better, Cancer specific diagnostic tests.” Of course we do, but we don’t have them now, and to discourage the use of what we do have available, just because it is not perfect, is to me grossly irresponsible. If, as some suggest, we only tested men with a family history of PCa, we would miss the majority of PCa tumors that are found to exist today. I don’t favor mass screening, mainly because we don’t yet know what to do with the results, but I heartily endorse the screening of individual patients who are interested in their health and who are seeing Physicians.

Realistically, we recognize that our appointment time with a physician is usually limited. In my opinion, instead of urging that such time be spent explaining the ins and outs of the PSA debate, BEFORE ordering a PSA test, it would be far more productive to use that equivalent time, in educating patients about the true significance of their previously ordered, PSA results.

It is not enough to keep stating where we want to go, we need to create a map and outline the specific route(s) to get there. It is very easy to state the problems, to attack the weaknesses in the present system, to bandy about the obvious, but it is much more difficult to provide true solutions. Here is one suggestion!

Prostate Cancer prompts much the same, or very similar, symptoms as Benign Prostate Hyperplasia (BPH) which is the natural growth of the Prostate, experienced by most men from their 40’s forward. By having a baseline PSA at 40 y/o, while the potential effect of significant BPH is low, you have the best chance of establishing a “normal” PSA, for YOU. Such information, coupled with the results of a Digital Rectal Exam, could help immensely in the decision making process following any “suspicious” results at a later date, more common with advancing age.

How does my PSA compare to other men in my age group? Dr. Catalona at Northwestern did a study that detected the following median PSA levels (50% above/50% below), for the following age groups:

Men in their 40’s = 0.7 ng/ml
Men in their 50’s = 0.9
Men in their 60’s = 1.3
Men in their 70’s = 1.7

These represent typical levels of PSA found in these groups and are NOT absolutes, but they do provide some ROUGH guidelines as to what could be considered as somewhat “normal” for these age groups. The basis for the making of informed decisions can be enhanced, by knowing such data, if it is used in proper perspective.

So should you, or should you not, get a screening PSA blood test?

It remains an individual decision and every indication is that it will continue to be so in the foreseeable future. Until something is proven to perform better, at as reasonable a cost, I would suggest that a PSA blood test coupled with digital Rectal exam, is the best means of monitoring your Prostate health.

Once you have the results explained, THEN and only then, can you decide its true significance and what action, IF ANY, you wish to take for follow-up. Without this combination you know NOTHING and to NOT have this recommended Prostate Examination, leaves you without the information necessary, to make intelligent, informed decisions.

But it remains, as it should, YOUR decision and your decision only! – John@newPCa.org. (aka) az4peaks
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