PCa Over diagnosed?

Did the news on PSA screening cause you concern? Did the media and anti-screening advocates go nuts on the recent reports about PSA screening?

The term over diagnosis makes no sense when it comes to prostate cancer. One either has prostate cancer or one does not  Many people reason that all cancer should be diagnosed and most aren’t comfortable living with cancer that hasn’t been treated. 

BE AN ADVOCATE of EARLY DETECTION. That’s our sound bite.  The test does not carry any risk.  It’s a simple blood test, not unlike what you get done annually when kidney and liver function are measured. After all you don’t lose your peace of mind when you have those tests done annually?  Like my old boss who served under Admiral Rickover used to say, “ If you don’t measure it you cannot manage it.” So in taking charge of your health care use the results of PSA test to look for early signs of cancer.  Have it done early to give yourself a baseline. If you take the discussion to their logical conclusion, PSA screening is not just to save lives but to diagnose early, and early prostate cancer can be cured with a single mode treatment. 

I came on a position in all the writings starting late last March that I think the ProtonPals can take and post on our web site.  I would like to know what you think.  It was written last week by our Canadian friends and has a lot going for it.  First it does no harm, will probably save many lives and will certainly improve the quality of life.  Note, I’m not thinking that the early cure is done with radical surgery, and maybe that’s what the flap is all about. Either the serious side effects of radical surgery or the cost containment agenda.

The Canadian Prostate Cancer Network (CPCN), an organization that speaks for men with prostate cancer and their families from across Canada,and the USA( italics mine) has reviewed the current research on PSA testing thoroughly. Its policy on early detection using the PSA test remains the same: CPCN advises men in their forties to start a yearly regimen of PSA testing and digital rectal exams.
Within the framework of the recent debate, CPCN takes the following positions: 

  • A man has the right to know whether he might be at risk from prostate cancer, a disease that kills an estimated 4,300 Canadian men and 20,000 to 30,000 American men,(the italics are mine) annually.
  • The PSA test is safe, no more risky than any other blood test. So PSA testing is not harmful in and of itself.
  • Currently, the PSA test is one of the best methods of early detection available. Refinements of the simple PSA test, such as measurements of PSA velocity, PSA doubling time, and percentage of free to total PSA, have improved the use we are able to make of its results. So getting a higher than normal PSA reading need not necessarily lead to follow-up procedures or treatments that pose risk, but should spark a serious discussion between a man and his doctor.
  • “Over diagnosis” is a term that is potentially confusing; one either has prostate cancer or one does not. The question should be how best to respond to individual men who are diagnosed with prostate cancer rather than whether or not men should have access to information that might lead to a diagnosis.
  • The question of whether to offer asymptomatic men the PSA test should be divorced from the issue of the overtreatment of prostate cancer. Not all prostate cancers need treatment. But we should use what tools we have to discover prostate cancer early, so it can be treated if necessary.
  • PSA test results are used consistently in nomograms designed to help physicians and patients decide which prostate cancer therapies will result in the greatest benefit. Although we need new and more accurate ways of distinguishing between aggressive prostate cancer and more indolent forms of the disease, today, PSA levels are used to help make this determination. A baseline PSA reading at age 40 can prove useful to men as they age.

SOME COMMENTS FROM THE INTERNET

“The last thing I wanna see is that they read this and say ‘Oh,see I’m not gonna have a PSA test.”

“The media reaction and anti screening advocates has been a completely crazy over interpretation of the results.” 

“No, no one advocates overtreatment but would you sacrifice lives of 20-30,000 men?”

“The papers stated that two out of every five men who are diagnosed would probably never experience any symptoms from prostate cancer and would eventually die of something else. Therefore, they concluded, fewer men should be treated than are being treated today.   ‘But here’s the dilemma: How do they know which two of the five will never experience symptoms, and which three will?”   Bob Marckini

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