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The point is that depending on
the autopsy study 30 to 70% of
men older than 40 walk around
with PCa, but only 3% of them
die of it mostly at old age.
The PSA test and follow up work,
cannot capture and pinpoint these
3%, hence it's useless.
The only thing that makes sense
is to wait for symptoms and treat
these symptoms. Symptoms need not
to be directly metastasis, miction
problems will be the first sign
in the majority of cases. This
was the situation until the ninetees
before the advent of PSA.
The only alternative would be
to remove prostates preventively
at say the age of 40 in all men.
However even this would not work
either since micrometastatic
disease will be present in some
individuals that cannot be
pinpointed in advance.
The proof for this that in RP
specimina pathologically graded
as pT2, the best case scenario
("we got it all"), still some
3 to 10% progress depending
on the study you believe.
I still must disagree. It is not the knowledge that causes problems, it is what you do with it. If you know you have a rising PSA, you can be checked for other urinary tract problems, if you find from biopsy you have PCa you can undertake certain lifestyle changes to arrest its progression with out undergoing anything radical. If you know you do not have to wait for symptoms to make beneficial changes. I have cut down on red meat, added vitamins, drink pomegranate juice, and am losing weight. If these work(some say yes some say no-only time will tell) the fact that I knew there was a problem and could take corrective action could either stop further symptoms or delay them.
The failure rate of RP is too high whether it is 5% or 35%, if people would take a deep breath after a Dx and study and learn, then I firmly believe that knowing is power. I have the power to make changes to possibly avert further symptoms, metastases, complications etc because I know.