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I feel that the current diagnostic regiment is pretty good. Men can make a decision to ( 1 ) try to get rid of the cancer one way or another - and perhaps be saddled with some ongoing side effects ( 2 ) delay treatment - active surveillance - so as to delay the possibility of negative side effects or ( 3 ) gamble and hope by doing nothing. Each man can make his own decision based on his priorities at the time of diagnosis. I don't think that there is an over treatment problem per say....just a need for the urologists to "calmly" give us our options upon diagnosis along with a recommendation based upon how they perceive our unique circumstances.
Bobbyboy - The Europeans just published their 13 year update comparing PSA screening vs not screening and found an almost 30% decrease in prostate cancer mortality among those getting regular PSA tests. Never the less they conclude "Despite our findings, further quantification of harms and their reduction are still considered a prerequisite for the introduction of populated-based screening." To reduce 1 prostate cancer death they had to find a27 men with prostate cancer and treat all of them. That means that 95% of the men who were treated didn't need to be treated. Its a tough decision and hard for the doctors to make that decision for their patients. Its hard for the patients to decide.
Yes, we tend to get kind of panicky upon diagnosis. It's not a nice feeling knowing that cancer is present in your body. I went to two urologists and neither made a recommendation. After I made the decision to have the prostate removed by a very high calibre urological surgeon he remarked that because of my age ( only 57 ) and good condition and with low grade cancer " it was a no brainer " to have it removed and move on with my life. I wish that he had given me more guidance beforehand to help with my decision - rather than allowing me to stumble into the " no brainer "treatment he felt best for me.
I think that screening is a very good thing, but those of us with low grade cancer could be advised to simply get another test done in 6 months. Perhaps liability concerns prevent this from happening. I don't really know what to make of the European studies....and I'm personally not a fan of active surveillance/delay. My Gleason was only 6, but they found that I had Gleason 7 after examining my prostate once it was removed. Gleason 7 is nothing to fiddle with so I feel I made the correct decision and should live longer for doing so - thanks to the PSA test.
If the PSA test were good a picking up early high risk prostate cancer e.g. Gleason 4+3 it would be a no-brainer. But it is a test for irritated prostate tissue which occasionally is associated with cancer. The biopsy when positive is usually Gleason 3+3, T1c. That diagnosis is a real problem. There is probably a 10% chance the disease is significantly worse. So what do you do? You have to factor in your age and health and your odds on living another 20 years into the calculation.
The point is that doctors cant make that choice for their patients. Reasonable men might make very different decisions than their doctors would make for them. The huge problem is that most men have no reason to know all they need to know to make that decision until their diagnosis. Then they have to make a big decision on too little information.
Peter whilst I agree with your PSA analogy, it is the only screening test we have to indicate possible prostate pathology. Whilst I understand your concern re unwarranted surgery being undertaken on persons with low grade tumours, we all know that physicians advise what is best for their patients. But of course that expert advice given by the physician is consistent with their training. Good luck in presenting your case to urologists.
Somehow I suspect your wish to halt unwarranted surgery may come to pass but not through the abolition of PSA screening. If advanced metastatic PCa can eventually be managed as a chronic long term disease as say diabetes, then the need for early surgical intervention decreases substantially. That day may perhaps be upon us in the not to distant future.
To put it another way, the Gleason 3 type (3+3) cells are only marginally more likely to turn deadly than normal prostate epithelial cells. Most men wouldn't have their normal prostates taken out, but they would have them taken out if there are Gleason 3 type cells.