PSA controversy commentary

az4peaks · Regular Joined: 23 Oct 2009 Posts: 17

Commentary on the PSA* controversy
by John E. Holliday, FACMPE

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, or screening in general, may have a legitimate place in the public forum. The pragmatic realities of PCa in the lives of individual 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 but, is directly responsible for another American man’s death every 20 minutes, 24 hours a day, 365 days a year..

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 collective statistics. But, what is the alternative? Should we do away with one of the most successful warning marker in the history of Cancer? Should we wait until there are clinical symptoms and return to the documented, 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 in any logical mind, that the introduction of the PSA blood test and the substantial increase in aggressive treatment due to the widely acknowledged down-staging transition in presenting diagnosis, has saved many lives from PCa death. Early diagnosis statistically correlates with more curable disease stage.

According to the government’s National Cancer Institute (NCI), a division of the National Institute of Health (NIH), PSA tests have advanced detection of PCa by 7 to 9 years. FACT: In the PRE-PSA era (the very late 1980's backward) roughly 3 of every 4 men diagnosed, were found to have advanced disease and 65% of that group, already exhibited invasive metastases. Today, enjoying the benefit of the PSA era (essentially the 1990's forward), the exact statistical reverse now exists, with over 3 of every 4 men presently being diagnosed, are found to have EARLY STAGE disease

Fact: 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 groups 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, revel in stating the obvious. “We need to have better, Cancer specific, diagnostic tests.” Of course we do, but we don’t have them now! 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, dubbed spontaneous in origin.

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 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. 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. 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, 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.

CONCLUSION: 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. I would suggest that you do take advantage of the diagnostic system that is now in place.

Until something is proven to perform better, at as reasonable a cost, I would suggest that you get a PSA blood test. Once you have the results explained, THEN you can decide its true significance and what action, IF ANY, you wish to take for follow-up. Without having had it taken, you know NOTHING. To NOT have a PSA test, solely because you MAY have to make a difficult decision based upon the results, is not only unwise in my view, but in some cases may just be outright irresponsible, if not to yourself, perhaps to your loved ones.

Again, I would encourage you to have a PSA blood test and a digital rectal exam at age 40. Depending upon those results and in consultation with your Physician, you can then decide how often they should be repeated, to adequately monitor your Prostate health.

I hope the above information, and the associated logic, has convinced you to adopt the suggested diagnostic regimen, however, the decision as to your participation, properly remains YOUR decision and your decision alone! – John@newPCa.org. (aka) az4peaks

* Prostate Specific Antigen blood test

Travelingman · Posted: Wed Nov 04, 2009 5:53 pm Post subject: Re: PSA controversy commentary

Thank you for this post. I wish I had seen this subject explained in the forceful yet balanced way you have writen about this disease. I was one of those people told, you might not need treatment as you have a high PSA but your 4th biopsy, (after 3 negative ones) only found cancer in 5% of one core. I had the surgery on October 26th, I got my final pathology yesterday. My Gleason went from biopsy 3+3=6 to 3+4=7. And that 5% of one core is actually 30% of my prostate containing cancer in both lobes. I know I made a good decision to proceed with treatment. I chose surgery rather than the iniatally recommended radiation because I felt with my 18 PSA that something was going on there. I chose surgery because I knew that I would have a pathology report showing the extent of my cancer. If I had chosen radiation, I might have had a lot of regrets as to whether I should have treated the disease. I am glad I listened to my urologist rather than all the media saying that 5% is just some indolant cells! Again, thank you for the tone of your post as well as the message contained in it. Are you a PCa patient as well? I saw that Replicant felt that you are highly educated on this subject & wondered if it was from a personal journey through this disease.
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

JohnRH · Regular Joined: 23 Aug 2009 Posts: 39 Location: Denver

Kudos from me.

My poor ol' simple, non-medical, mind is mystified and amazed when I read reports saying that prostate cancer is over-diagnosed, PSA is over-tested, and both are an undue burden on health care expense. Would the proverbial "they" have us wait, watchfully or otherwise, until it grows unmonitored and is eventually worse? And shudder to think that preventive medicine is a financial burden! (Talk about Death Panels!)

And what pray tell is wrong with health care being a greater percentage of GDP than ever before anyway (not to mention that GOVERNment spending is the greatest percentage of that spending)? Is survival not what humans have strived for since we clawed our way out of the primordial ooze?

Sacrificial Socialism run rampant, IMHO.

P.S. Thanks to Bing\Google we can all be Magnum P.I.s:
http://prostatecancerinfolink.net/2009/10/21/acs-to-make-major-shift-in-cancer-screening-guidance/
http://prostatecancerinfolink.ning.com/profile/JohnEHollidayFACMPE

...to name a few.
_________________
DX 07/2009 with Gleason 4+3, PSA 4.1, age 63 1/2.
DaVinci RRP 09/2009; Gleason 3+4; Stage pT2c, NX, MX; neg surgical margins, neg for extraprostatic extension, neg for seminal vesicle invasion; est. tumor involvement 10% of prostate

Otago · Experienced user Joined: 20 Jan 2008 Posts: 64

Regarding one particular point made in that opinion piece..
-------------------------------------------------------------
"Fact: 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 groups 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.
---------------------------------------------------------------

I don't believe that is true unless the aspect or definition of "directly attributable" has substantially changed or been altered.

In other words, I don't believe the rate of PCa deaths has declined 40% over the past 20 years.

JerryB · Regular Joined: 13 Jul 2009 Posts: 43 Location: UK

Excellent.

Jeremy
_________________
Age - 67
PSA – 7.8 ug/L. in February 2009.
Gleason – 7 (4+3). T stage – 2b. Prostate size - 52 cc
July 2009 - ADT for 3 months to shrink prostate.
September 2009 - decided on HIFU. Scheduled for 30th October 2009.

az4peaks · Regular Joined: 23 Oct 2009 Posts: 17

Hi Otaga, - You have a right to BELIEVE anything that you want, but published facts are still facts. I did not personally count them and THEREFORE, like others, I must rely on the data produced by the Government agencies (on which we taxpayers spend millions) to keep track of such numbers, and/or the content of published medical Studies.

I research the MEDICAL LITERATURE on PCa on a daily basis, to be sure my comments reflect up-to-date information. This has been my continuing commitment for 11 years. Others must judge the veracity of the content, but if challenged, it should be able to be supported.

There are MANY published reports confirming the substantial, documented decline in PCa mortality during the PSA era. Following this note are 3 examples from the literature and a Government Website.

I can only document factual data as it is reported, Beliefs are individual subjective decisions made by the believer, not necessarily supported by the facts, as we know them. Respectfully, - John@newPCa.org (aka) az4peaks
-----------------------------------------------------------------
Here are three examples:

Example #1:
Center for Disease Control and Prevention Report
Death Trends In the United States, deaths from prostate cancer have—

Decreased significantly by 4.1% per year from 1994 to 2005 among men. (JEH NOTE: 4.1% x 10 years = 41.1%)
Decreased significantly by 4.0% per year from 1996 to 2005 among African-American men.
Decreased significantly by 4.1% per year from 1996 to 2005 among Asian/Pacific Islander men.
Remained level from 1996 to 2005 among American Indian/Alaska Native men.
Decreased significantly by 3.5% per year from 1996 to 2005 among Hispanic men.

Source for trend data: Jemal A, Thun MJ, Ries LA, Howe HL, Weir HK, Center MM, Ward E, Wu XC, Eheman C, Anderson R, Ajani UA, Kohler B, Edwards BK. Annual report to the nation on the status of cancer, 1975–2005, . Journal of the National Cancer Institute 2008;100(23):1672–1694.
--------------------------------------------------------------------------
Example #2
In an Opinion Piece Dr. Catalona wrote for the
Washington Post (August 2008), he stated:

"In the United States, the rate of advanced cancer at the time of diagnosis has fallen 75% since the
PSA screening era began, more than for any other cancer. "Age-adjusted prostate cancer death rates
have declined 37% percent.
--------------------------------------------------------------
Eample #3 from:
Drop in Prostate Cancer Mortality Rates
During PSA Screening Era
by Cecilia Lacks, PhD

The NCI reported the following data on
prostate cancer death rates by years:

1975 -1987, an annual increase of 0.9%
1987-1991, an annual increase of 3.0%

In 1991, Dr. Catalona first reported in the
New England Journal of Medicine that the
PSA test could be used as a first-line
screening test for prostate cancer.

1991-1994, an annual decrease of 0.6%

In 1994, Dr. Catalona reported on the
pivotal multi-institutional study that led to the
approval of PSA as an aid to the early
detection of prostate cancer with a 4 ng/ml
threshold recommendation for prostate
biopsy.

1994-2005, an annual decrease of 4.1%

JohnRH · Regular Joined: 23 Aug 2009 Posts: 39 Location: Denver

Math is the devil's playground when it comes to modern-day statistics. As an example just listen to any politician cite data to backup his own personal agenda.

If you're going to refute facts you do need a few facts of your own, not just "beliefs".

Although you can't footnote everything you say, if you're going to "boldly" assert some facts it would be helpful to have some brief references.

I have no desire to debate this topic in minutiae, but I too was curious about the number of deaths declining by 40% over a period. It's a fact you would think you'd hear shouted from the rooftops.

I'm not a mathematician or a medical person. While I surfed the 'Net and waded through a plentiful array of graphs, charts, and tables I could see a definite reported decline in deaths, but I didn't see it stated outright as a "40%" decline.

I decided to chart a basic spreadsheet example for myself, to see what a 4% per year decline added up to in numbers. I didn't need a spreadsheet to see that 4% of a BASE number, such as 100, times 10 years, is a decline of 40% or 40 items. (100 -40 = 60, a 40 item or 40% decline.)

If the 4% per year decline is from each immediately previous year, then over ten years it is actually less than 40% but still a substantial percentage.

Here is the 4% calcuation (subtracting 4% per year from each immediately prior year), for a total of 11 years, including the base year of
100:

100
96
92.16
88.47
84.93
81.53
78.27
75.14
72.13
69.25
66.48

If you count the base year of 100 as year 1 then you wind up at 69.25 deaths in the 10th year, a decline of 31.75% from the base year.

If you count for 10 years after the base year they you have 66.48 deaths in the 11th year, a decline of 33.52% from the base year.

Either way it is an impressive number.

Peace and love brothers and sisters. As Sgt. Joe Friday used to say: "Just the facts, ma'am, just the facts".
_________________
DX 07/2009 with Gleason 4+3, PSA 4.1, age 63 1/2.
DaVinci RRP 09/2009; Gleason 3+4; Stage pT2c, NX, MX; neg surgical margins, neg for extraprostatic extension, neg for seminal vesicle invasion; est. tumor involvement 10% of prostate

az4peaks · Regular Joined: 23 Oct 2009 Posts: 17

Hi again, - I agree that statistical data can be calculated in many differnt ways, which is exactly why I preceded the 40% figure by the word APPROXIMATELY (not capitalized originally).

Here are some real numbers, easily extracted from a previously prepared chart I had made, comparing the American Cancer Society (ACS) figures for both Prostate Cancer (PCa) and Breast Cancer (BCa) for the years 1997 through 2007..

In 1997 the predicted number of PCa deaths was 41,800 and in 2007 it was 27,050, a REDUCTION of 14,750 deaths. If you divide that difference by the original starting number of 41,800, you get a percentage reduction of a little over 35%. This is in just 11 years, not the longer stated 20 year period cited in my original commentary.

You will note from the cited Dr. Catalona article, that reductions actually began in 1991 at an annual rate of 0.6% through 1994 and 4.1% from 1994-1996.

Regardless, I don't intend to endlessly quibble about the statement. If anyone wishes to refute my approximation, let them provide supporting data for their alternative position. I have cited mine and as I stated previously, the acceptance of its credibility will have to be made by each of the readers.

Unless there are specific questions addressed to me, I will now withdraw from further discussion of this topic and return to pursuing my previously stated, long-standing commitment of educating and counseling newly-diagnosed PCa patients. Good health to you all! -John@newPCa.org

JohnRH · Regular Joined: 23 Aug 2009 Posts: 39 Location: Denver

Your math works for me. Thank you for your input.
_________________
DX 07/2009 with Gleason 4+3, PSA 4.1, age 63 1/2.
DaVinci RRP 09/2009; Gleason 3+4; Stage pT2c, NX, MX; neg surgical margins, neg for extraprostatic extension, neg for seminal vesicle invasion; est. tumor involvement 10% of prostate

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

I went into the SEER data (Surveillance Epidemiology End Results) database run by the the US Institutes of Health. I looked at age-adjusted mortality rates, which show the number of deaths per 100,000 attributed to particular cancers.

What follows is the year and the prostate cancer death rate, expressed as a number per 100,000 of population. Note that there was a peak in 1993, after PSA testing became wide spread. In a graph, this shows up as a large mound. The common thinking is that this was due to attribution bias effects--there was no actual increase in prostate cancer deaths during that time, only an increase in attribution due to increased diagnosis following the introduction of PSA testing. If men had been tested with PSA in the 1970's, the thinking goes, the deaths attributable to PCa would have also been higher, and the hump in the data wouldn't be there.

1975 30.97
1976 31.78
1977 31.83
1978 32.66
1979 32.84
1980 33.05
1981 33.17
1982 33.36
1983 33.92
1984 34.06
1985 33.91
1986 34.93
1987 35.11
1988 35.88
1989 37.1
1990 38.56
1991 39.31
1992 39.22
1993 39.34
1994 38.54
1995 37.29
1996 36
1997 34.15
1998 32.63
1999 31.56
2000 30.31
2001 29.17
2002 28.19
2003 26.57
2004 25.51
2005 24.7
2006 23.56

And the prediction for 2009 is a rate of 25.6. So you can see that the death rate fell, but over the last few years is bouncing around the 25-26 per 100,000 range. The decline has leveled off.

If we take the peak (and the more I think about it, that would be correct) of 39.34/100,000, the death rate has fallen by about 13 points. 13/39= 33%.

I don't think we will ever have a crystal clear idea of the effect of PSA testing. One thing that really muddies the water, if you've looked at the health news over the past few days in particular, is the effect of the obesity epidemic upon prostate cancer stats. It could very well be that if we as a group didn't become increasingly obese over the years, the stats would show a more dramatic decrease in prostate cancer mortality.

The American Institute for Cancer Research (AICR) just released a report estimating that over 100,500 extra cancers happen in the U.S. each year because of excess body fat. They have not reported specifically on prostate cancer deaths, but they estimate that 33,000 excess breast cancer cases happen each year due to a woman being overweight or obese. We know that breast cancer and prostate cancer share certain traits. We have already heard from previous studies that excess body fat in men poses specific prostate-related problems, including problems in accurately measuring PSA, and the fact that obese men tend to get more aggressive forms of the disease.

Then there is bias introduced simply by screening, as I think most of us are aware. If a man is treated for truly indolent cancer, and this is a cancer that in years past would not have even been diagnosed, then the tally has just been increased by one in two columns: incidence and cure. The cure rate can be driven up artificially by such bias.

There is also "lead time bias" which occurs when a cancer is simply diagnosed earlier, but in reality the patient life expectancy is not changed. If Patient A dies in 2005 from breast cancer (for example) and it was detected in 2003, we say that she survived two years after diagnosis. If technology improves, and the same type of patient gets diagnosed not in 2003, but in 2000, we say that her survival time was 5 years. Looks good, but all that happened in this circumstance is that we detected the cancer earlier.

(The pure death rate is free from lead time bias, of course)

My take on the studies that failed to show a benefit to screening is that prostate cancer moves slowly, and the data needs to mature more before we can draw any conclusions.

I think that PSA testing played a role in saving my life. But it's far too early to tell. If I had done nothing a few years ago, chances are I would still not be bothered for years to come, according to the natural history of prostate cancer, which has been well documented. Maybe it spared me an early death from cancer, or maybe not. If I fall off the salvage radiation success graph in the next few years, maybe all it did was buy me some time free of hormone therapy. And perhaps not even that.

I like the new AUA Best Practice Statement (emphasis mine)

The American Urological Association (AUA) and the AUA Foundation believe that early detection of and risk assessment for prostate cancer should be offered to asymptomatic men 40 years of age or older who have a life expectancy of at least 10 years. Men who wish to be screened should have both a prostate-specific antigen (PSA) test and a digital rectal exam (DRE). The decision to proceed to prostate biopsy should be based not only on PSA and DRE results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and comorbidities. The AUA strongly supports informed consent before screening is undertaken and the option of active surveillance, in lieu of immediate treatment, for certain men found to have prostate cancer.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

JohnRH · Regular Joined: 23 Aug 2009 Posts: 39 Location: Denver

Thank you Replicant. Information is a good thing.
_________________
DX 07/2009 with Gleason 4+3, PSA 4.1, age 63 1/2.
DaVinci RRP 09/2009; Gleason 3+4; Stage pT2c, NX, MX; neg surgical margins, neg for extraprostatic extension, neg for seminal vesicle invasion; est. tumor involvement 10% of prostate

Otago · Experienced user Joined: 20 Jan 2008 Posts: 64

Well, I think my initial response to az4peaks had to do with his suggestion that he had the facts, and that there should be no controversy for anyone who was logical.

"There should be little doubt in any logical mind, that the introduction of the PSA blood test and the substantial increase in aggressive treatment due to the widely acknowledged down-staging transition in presenting diagnosis, has saved many lives from PCa death"

I'm sure there are lots of responsible scientists and doctors who differ from that interpretation and who would dispute the 40% figure.

Dr. Richard Stamey, one of the pioneers of the PSA test has said, you might as well biopsy people with green eyes or blue eyes as someone with a higher PSA test result.
There are also lot of people who think the trade off in terms of quality of life lost versus lives saved is not worth it.

I've listened to Dr. Catalona's 45 minute response to the recent findings.

http://www.urotoday.com/media/presentations/auany2009/william_catalona_overdetection_is_a_small_issue_09_28_2009/player.html

A worthwhile listen. By a doctor who is certainly pro early testing, pro frequent biopsy and pro treatment.

I've had 4 PSA's this year and a biopsy.

Still, I have serious doubts that the current testing and treatments have cut prostate cancer deaths 40% from what they otherwise would be.
That quite aside from the costs in the quality of life equation, balancing all those who did not need treatment.

BTW, my father had PCa in the pre PSA era, was treated, and lived 25 more years, dying of something else, although PCa was listed on his death certificate along with terminal alzheimers. I'm not sure what role PCa played in his demise as he was 88. I have no idea if he benefited from treatment or how long he would have lived without such treatment.

So I have reason to believe in either interpretation, but don't suggest that a logical person would find it so clear cut or easily answered.

My sister's boyfriend recently was at a point where he could be tested.
I told him it was very reasonable to get tested or not get tested.
I'm not sure what he'll do and I'm certainly not going to be a advocate for either option suggesting one logically better.

Otago

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 49 Location: Ireland

(As usual) a well thought balanced view from Replicant.

Here in Ireland there is no national screening program, nor is there any movement towards it. For instance, the Irish National Cancer Forum recommends that "Population based prostate cancer screening should not be introduced [i]at present[/i]" As in any controversy, many doctors agree with this and do not test, or are reluctant to do so - thank God my GP wasn't one of those.

Apart from the economic aspects, the main objection appears to be a reluctance to cause unnecessary harm or hardship to men, the vast majority of whom will never develop PC, and the majority of the remainder will not die from PC, but from another cause.

It seems to me that the doubters need to turn their focus on its head and, rather than ask "Why are we causing unnecessary hardship to many?" but "How can we find the few aggressive PCs?" At present PSA testing, with its variants, coupled with a DRE are the prime tools and, unfortunately cannot distinguish aggressive PC from indolent but there is a pressing need to find those men in the general population who are asymptomatic but do have aggressive PC.

Without screening, these men will not be diagnosed in time and far greater harm will be done to these few. This, to me is the bottom line.

I have absolutely no doubt that screening has saved my life. In my surgeon's opinion, I was within months of breakout.

I'm sorry for those who may, as a result of screening, have been subjected to unnecessary worry, biopsies or, worse still, unnecessary treatments BUT, imho, the few with aggressive PC deserve a decent stab at life and long term survival.

In any case, I reckon that, within the foreseeable future, it will be possible, through the like of generic markers, to identify men likely to develop PC and we will have the ability to 'switch off' these particular parts of the genome.
_________________
Marathon Man

PSA May 06, then 6 monthly; 4.3-4.9-6.8, Dx Feb 2008, PSA 9.4 @age 54 - Biopsy Gleason 4+3
RRP 22 May 2008 - Gleason 4+4, Tumour Vol 5%, T2a, N0M0, Negative Margins. Aug 08, PSA <0.01, Feb 09 <0.02, Sep 09 <0.02

http://prostaterunner.blogspot.com/ Irregularly updated & months behind!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

Marathon Man, good to hear from you, and even better to see from your signature line that your PSA is where it should be.

I have about two months before my next blood draw, and I can feel a slight twinge of anxiety already.

R.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

az4peaks · Regular Joined: 23 Oct 2009 Posts: 17

AUA Past President John M. Barry, MD. said in a Press Release: AUA RELEASES STATEMENT CLARIFYING PROSTATE CANCER TESTING RECOMMENDATIONS distributed by the American Urologic Association (AUA) on Monday, November 2, 2009.

QUOTE:" - - - U.S. deaths from prostate cancer have DECREASED BY 40 PERCENT over the past decade – a greater decline than for any other cancer. - - -" UNQUOTE.
(EMPHASIS MINE - JEH)

The entire Press Release follows:

AUA releases statement clarifying prostate cancer testing recommendations

Monday, 02 November 2009

LINTHICUM, MD, USA (Press Release) - November 2, 2009 - The American Urological Association (AUA) is aware of recent news reports disparaging prostate cancer testing. We are concerned that these reports are causing significant confusion for patients and we wish to clarify our recommendations on prostate cancer testing with the prostate-specific antigen (PSA) test and digital rectal exam (DRE). The AUA strongly supports early prostate cancer detection and feels it is in a man’s best interest to consider being tested for prostate cancer.

Prostate cancer is most treatable when caught early. Men ages 40 and older should be offered a baseline PSA test and DRE for early detection and risk assessment. The future risk of prostate cancer is closely related to a man’s PSA score; men who are screened at 40 establish a baseline PSA score that can be tracked over time. The AUA strongly supports informed consent, including a discussion about the benefits and risks of testing, before screening is undertaken.

According to the American Cancer Society (ACS), prostate cancer is the most common non-skin cancer affecting men in the United States. One in six men will be diagnosed with prostate cancer in his lifetime—more than 192,000 in 2009. It is the second leading cause of cancer death in American men.

Prior to the emergence of PSA testing, only 68 percent of newly diagnosed men had cancer localized to the prostate and 21 percent had metastatic disease. Today, more than 90 percent of these men have cancer confined to the prostate and only 4 percent have cancer that has spread to other areas of the body. U.S. deaths from prostate cancer have decreased by 40 percent over the past decade – a greater decline than for any other cancer. While the PSA test may be limited because it does not indicate whether a cancer is aggressive, the test provides important information in the diagnosis, pre-treatment staging or risk assessment, and monitoring of prostate cancer patients. It has allowed millions of men to make informed treatment decisions that may have saved their lives.

The controversy over prostate cancer should not surround the test, but rather how test results influence the decision to treat. The decision to proceed to prostate biopsy should be based not only on elevated PSA and/or abnormal DRE results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and comorbidities.

A cancer cannot be treated if it is not detected. Not all prostate cancers require immediate treatment; active surveillance, in lieu of immediate treatment, is an option that should be considered for some men. Testing empowers patients and their urologists with the information to make an informed decision.

The above statement may be attributed to AUA Past President John M. Barry, MD. The AUA Best Practice Statement on Prostate-Specific Antigen can be viewed here: www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf.

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 16,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.

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American Urological Association
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