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Terry, thanks for sharing. Let Sleeping Dogs Lie? is an excellent reference document. I would wisper. "Of course!"
After reading the book I think very few without symptoms will be enthousastic for a visit to an urologist for a prostate check. The book gives them plenty ammunition to withstand the pressure of Movember and other Morons. For example the simple graphs on pages 101 en 104 straigtforwardly sketch the miniscule benefit of early detection: 1 Pca death prevented in 1000 men over 10 years.
Being convinced of the argument, as I am, means declining blooddrawing for PSA and declining biopsies for Gleason which implies neither Active Surveilleance (AS) nor Local Treatment (LT) and hence doing nothing (DN).
One of the few aspects In Sleeping Dogs that in my view is not as extensively discussed as it merits is the poor quality of the biopsy.
In half to one third of cases the biopsy result is incorrect (as compared with a RP specimen). The Gleason score from biopsy is the core information to decide on for either AS or LT. But as a Gleason 6 can as well be a 7 and vice versa a choice cannot be made. To insist on such a choice nonetheless, as urologists do, is not a testimony of adherence to high standards.
I think this argument erodes the very basis for any action. Apart from the 0,1% 10 years mortality reduction which is so tiny that it is not imaginable, on top of that, the quality of the diagnostic workup is of deplorable poor standard. As an Addendum for Sleeping Dogs here some references to the quality of biopsies.
Doing Nothing is taking the same position as in the eigthees of the last century just before the era of PSA. When local symptoms arose these were treated with TURP and metastic symptoms were treated with orchiectomy or estrogens. 30 years later this program could emulated again but with much more options now in hormonal therapy. Anyhow the 0,1% mortality reduction of AS and LT should be easy to beat.
There certainly is a great misunderstanding about the accuracy of the establishment of Gleason Grades and scores and the changes agreed in January this year (summarised here for anyone interested GLEASON GRADES) will only add ot the problems already caused by GLEASON MIGRATION and the proposed introduction of tertiary focus in the grading system.
I have already had one story submitted from a man who may well have been graded as 3+2=5 prior to these changes (and therefore would not have been tagged as having prostate cancer) but that became a 3+3=6 and because there was a minute amount of what was said to be grade 5 material in a tertiarty focus in one sample, he is being treated as a Gleasaon Grade 8 - i.e. 3+3+5=8.
