Re: Could it be that PC is actually good for you ??? (just kidding!)

[Guest guest]

Chuck,

The

article to which you refer includes these statements:

<snip>

.. At present, no conclusive data demonstrate that early screening, detection,

and treatment reduce mortality……….Potential harms of screening

for prostate cancer include potential adverse health effects associated with

false-positive and negative results and adverse effects of treatment. Other

limitations of screening are that a survival benefit from prostate cancer

screening has not been proved in rigorous trials. <snip>

Do you

agree with them and if not, why not? Are there survival benefits from early

treatment? is there conclusive data that early screening reduces mortality? Is

there not significant over-treatment as a result of screening?

I saw a

quote today that is apt here, I think: The whole aim of practical politics is to keep the populace

alarmed -- and hence clamorous to be led to safety -- by menacing it with an

endless series of hobgoblins, all of them imaginary. -H.L. Mencken, writer,

editor, and critic (1880-1956) Or as Dr Logothetis put it to a US-Too

meeting some years ago:

<SNIP> One of the problems

with prostate cancer is definition. They label it as a cancer, and they force

us all to behave in a way that introduces us to a cascade of events that sends

us to very morbid therapy. It's sort of like once that cancer label is put on

there we are obligated to behave in a certain way, and its driven by physician

beliefs and patient beliefs and frequently they don't have anything to do with

reality. And they are only worrisome because the pathologist has decided to

call it a cancer. <SNIP>

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of (Chuck) Maack

Sent: Thursday, 7 February 2008

3:54 PM

To: ProstateCancerSupport

Subject:

Could it be that PC is actually good for you ??? (just kidding!)

Please don't shoot the messenger. Could it be that PC is actually good

for you ??? (just kidding!)

In the below

report the American College of Preventive Medicine has made the decision

advising member physicians that it does not recommend prostate cancer

screening with DRE, PSA, CME/CE. This despite being contradictory to

the recommendation of the American Cancer Society and the American Urological

Association for such testing. No wonder we have problems making men aware

of the possibility of prostate cancer while at the same time having men

initially diagnosed with advanced disease because their physician never

recommended annual testing. Read and draw your own conclusions:

American

College of Preventive

Medicine Does Not Recommend Prostate Cancer Screening With DRE, PSA

CME/CE

http://www.medscape.com/viewarticle/569719

(Chuck)

Maack/Prostate Cancer Advocate

Wichita, Kansas

Chapter, Us TOO

Bio: http://www.ustoowichita.org/leaders.cfm?content=bio & id=1

Email: maack1@...

Website: www.ustoowichita.org

[Guest guest]

: Let me put my two cents in before retiring for the night. I

go in the morning (Thursday) for my stress test to see my risk

factors. It has been postponed for about one month due to my

cancelations, and the Dr. in Surgery. Really scared as it is a four

to six hour test. My Urologist wants to know my risk factors due to

problems with Antrial Fibulation, Dietbetics, Accute anxiety, and

depression. It is now 1:30AM and I hope my son will wake me at

6:00AM. Hopefully I can get my risk factors after my test, and pray

they will allow me to have the de'vinci surgery. Even then it will be

a five week wait for surgery due to schedules.

>

> Please don't shoot the messenger. Could it be that PC is actually

good for you ??? (just kidding!)

>

>

> In the below report the American College of Preventive Medicine has

made the decision advising member physicians that it does not

recommend prostate cancer screening with DRE, PSA, CME/CE. This

despite being contradictory to the recommendation of the American

Cancer Society and the American Urological Association for such

testing. No wonder we have problems making men aware of the

possibility of prostate cancer while at the same time having men

initially diagnosed with advanced disease because their physician

never recommended annual testing. Read and draw your own conclusions:

>

>

>

> American College of Preventive Medicine Does Not Recommend Prostate

Cancer Screening With DRE, PSA CME/CE

>

>

> http://www.medscape.com/viewarticle/569719

>

>

>

> (Chuck) Maack/Prostate Cancer Advocate

> Wichita, Kansas Chapter, Us TOO

> Bio: http://www.ustoowichita.org/leaders.cfm?content=bio & id=1

> Email: maack1@...

> Website: www.ustoowichita.org

>

[Guest guest]

>> " In the current recommendation, the ACPM concludes that there is

insufficient evidence to recommend routine prostate cancer screening

with either the digital rectal examination or PSA.<< "

I guess my dad followed this policy, unknowingly. Died of PCa, and a

horrible death at that.

>> " The Canadian Task Force on Preventive Health Care recommends

against routine screening with PSA<< "

A result of Universal Health Care? Treatment is expensive, regardless

of type.

And:

>> " Although men who undergo screening seem more likely to be diagnosed

with prostate cancer vs those who do not undergo screening<< "

Well, duh...

My recommendations, get screened/tested and at least know what you

have so you can make decisions, if only to write a will.

[Guest guest]

Terry,

Let me answer in simplest terms: Would we rather not know and then be

diagnosed with advanced, uncontrolable disease and die because of the

cancer and in the very well known manner in which we have learned is

not a very pleasant death, or would we rather be aware and be

accorded the intelligence that we can make our own decisions

regarding further testing/treatment? I'll choose the latter, as it

appears would be the patients who have responded to this posting

directly to me. And, it would appear from the innumerable posts on

this and other prostate cancer support lists, that way too many men

were ignorant of their cancer through little fault of their own since

their physicians never made them aware of prostate cancer or tests

that could determine if that cancer was developing. Ignorance is NOT

bliss.

Chuck

>

> Chuck,

>

> The article to which you refer includes these statements:

>

> <snip> . At present, no conclusive data demonstrate that early

screening,

> detection, and treatment reduce mortality....Potential harms of

screening

> for prostate cancer include potential adverse health effects

associated with

> false-positive and negative results and adverse effects of

treatment. Other

> limitations of screening are that a survival benefit from prostate

cancer

> screening has not been proved in rigorous trials. <snip>

>

> Do you agree with them and if not, why not? Are there survival

benefits from

> early treatment? is there conclusive data that early screening

reduces

> mortality? Is there not significant over-treatment as a result of

screening?

>

> I saw a quote today that is apt here, I think: The whole aim of

practical

> politics is to keep the populace alarmed -- and hence clamorous to

be led to

> safety -- by menacing it with an endless series of hobgoblins, all

of them

> imaginary. -H.L. Mencken, writer, editor, and critic (1880-1956) Or

as Dr

> Logothetis put it to a US-Too meeting some years ago:

>

> <SNIP> One of the problems with prostate cancer is definition. They

label it

> as a cancer, and they force us all to behave in a way that

introduces us to

> a cascade of events that sends us to very morbid therapy. It's sort

of like

> once that cancer label is put on there we are obligated to behave

in a

> certain way, and its driven by physician beliefs and patient

beliefs and

> frequently they don't have anything to do with reality. And they

are only

> worrisome because the pathologist has decided to call it a cancer.

<SNIP>

>

>

>

> All the best

>

>

>

> Terry Herbert

>

> I have no medical qualifications but I was diagnosed in '96: and

have

> learned a bit since then.

>

> My sites are at www.yananow.net <http://www.yananow.net/> and

> <http://www.prostatecancerwatchfulwaiting.co.za/>

> www.prostatecancerwatchfulwaiting.co.za

>

> Dr " Snuffy " Myers : " As a physician, I am painfully aware

that most

> of the decisions we make with regard to prostate cancer are made

with

> inadequate data "

>

>

>

> _____

>

> From: ProstateCancerSupport

> [mailto:ProstateCancerSupport ] On Behalf Of

(Chuck)

> Maack

> Sent: Thursday, 7 February 2008 3:54 PM

> To: ProstateCancerSupport

> Subject: Could it be that PC is actually

good for

> you ??? (just kidding!)

>

>

>

> Please don't shoot the messenger. Could it be that PC is actually

good for

> you ??? (just kidding!)

>

>

>

> In the below report the American College of Preventive Medicine has

made the

> decision advising member physicians that it does not recommend

prostate

> cancer screening with DRE, PSA, CME/CE. This despite being

contradictory to

> the recommendation of the American Cancer Society and the American

> Urological Association for such testing. No wonder we have

problems making

> men aware of the possibility of prostate cancer while at the same

time

> having men initially diagnosed with advanced disease because their

physician

> never recommended annual testing. Read and draw your own

conclusions:

>

>

>

> American College of Preventive Medicine Does Not Recommend Prostate

Cancer

> Screening With DRE, PSA CME/CE

>

>

>

> http://www.medscape <http://www.medscape.com/viewarticle/569719>

> .com/viewarticle/569719

>

>

>

> (Chuck) Maack/Prostate Cancer Advocate

> Wichita, Kansas Chapter, Us TOO

> Bio: http://www.ustoowic

> <http://www.ustoowichita.org/leaders.cfm?content=bio & id=1>

> hita.org/leaders.cfm?content=bio & id=1

> Email: maack1@...

> Website: www.ustoowichita. <http://www.ustoowichita.org/> org

>

[Guest guest]

> ...

> Are there survival benefits from early treatment? is there

> conclusive data that early screening reduces mortality? Is

> there not significant over-treatment as a result of screening?

> ...

This is an amazingly controversial subject. You'd think that

after decades of research the experts would at least agree on

whether testing is desirable or not. But they don't.

I work at the National Cancer Institute (as a computer

programmer, not as a doctor or scientist) and I have personally

met some truly outstanding cancer specialists who almost

violently disagree on this issue. If the experts disagree, then

who am I to try to arbitrate between them?

Not surprisingly, in addition to the medical disagreement, there

is also much journalistic hype. If the medscape article is

accurate, the study didn't actually recommend against all PSA and

DRE testing. They recommended against _routine_ testing and

said: " The effectiveness of prostate cancer screening is

questionable in elderly men with competing comorbidities and men

with life expectancies of less than 10 years. " They also

suggested that physicians explain the benefits and drawbacks of

testing and ask the patients what they wanted to do.

I'm going to leave aside the social/political/economic question

of whether testing is the best way to spend public health money

and think only about whether it is in the interest of patients.

My own thinking about this depends a great deal on answers to the

following questions:

1. Does anyone benefit from treatment?

If men who have had surgery or radiation are just as likely to

suffer and die of prostate cancer as men with the same disease

characteristics who have not been treated, then testing is

pointless.

However if men who have been treated are less likely to suffer

and die of PCa than those with the same disease characteristics

who have not been treated, then it's not pointless at all.

I know for a fact that there are many men who have been treated

and lived for decades with no recurrence. I believe that

treatment _can_ work. It doesn't always work, but it doesn't

always fail either.

2. Can we tell who will benefit from treatment?

There are two categories of men who don't need treatment. Those

who will surely die of something else before PCa can kill them,

and those who will die just as quickly in spite of treatment.

It is currently possible to identify some of these men, but not

all of them and not with absolute certainty.

My view of this question is that a good doctor can produce a

useful probability statement about whether a man can benefit from

treatment. Sometimes he can project a high probability of death

when there is no treatment. Sometimes he can project a high

probability of successful treatment. Sometimes he can only offer

intermediate or low probabilities. It's then up to the informed

patient to make his own determination of the odds.

If some men can benefit from treatment, and if a doctor can

sometimes make useful probability statements, it seems to

me that testing is warranted.

3. Are the consequences of treatment worse than the disease?

Some men who are now impotent, incontinent, or have other

significant side effects wish they had just taken their chances

with the disease.

Others consider side effects to be insignificant in comparison

with the risk of death from PCa. Some lucky ones seem to have

very few significant side effects at all - and that number may be

increasing as the treatments get better over time.

If a man considers the risk of side effects to be worse than the

risk of cancer, then for him, testing would seem to be

inappropriate.

-----

It seems to me that the answers to questions 1 and 2 are

objective, and incline towards testing. The answer to question 3

is subjective.

-----

> ... The whole aim of practical politics is to keep the populace

> alarmed -- and hence clamorous to be led to safety -- by

> menacing it with an endless series of hobgoblins, all of them

> imaginary. ...

This is a problem, but I know it's not universally true. My HMO

doesn't make an extra penny from me by treating my cancer. They

lose money. But they recommended treatment. I got treatment in

a clinical trial at NCI. They don't make any money from it

either. Sometimes we really should be alarmed and really should

seek safety.

I personally thought testing was a waste of time. I was sure I

was healthy. When my HMO told me my PSA was high and I might

have cancer I thought they were crazy. But when I found out that

I really did have cancer, and then found out that it was a

Gleason 4+3 that would very likely kill me well before my

statistical life expectancy was up, I opted for treatment. I'm

not sorry I did. I am glad that I was tested.

Alan Meyer

ameyer2@...

________________________________________________________________________________\

____

Be a better friend, newshound, and

know-it-all with Yahoo! Mobile. Try it now.

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

[Guest guest]

Good Post, Alan.

My situation, very similar to yours, and these thoughts occured to me

preop too. I've also lost my thryoid, and wish they had never found

that one, also. I am a Nurse Anesthetist, and sometimes wonder if we

do ourselves any favors. I thought about a more primitive man, who

lived shorter, but didn't worry about all this crap. Death is not

necessarily always the worst thing that happens to us.

> > ...

> > Are there survival benefits from early treatment? is there

> > conclusive data that early screening reduces mortality? Is

> > there not significant over-treatment as a result of screening?

> > ...

>

> This is an amazingly controversial subject. You'd think that

> after decades of research the experts would at least agree on

> whether testing is desirable or not. But they don't.

>

> I work at the National Cancer Institute (as a computer

> programmer, not as a doctor or scientist) and I have personally

> met some truly outstanding cancer specialists who almost

> violently disagree on this issue. If the experts disagree, then

> who am I to try to arbitrate between them?

>

> Not surprisingly, in addition to the medical disagreement, there

> is also much journalistic hype. If the medscape article is

> accurate, the study didn't actually recommend against all PSA and

> DRE testing. They recommended against _routine_ testing and

> said: " The effectiveness of prostate cancer screening is

> questionable in elderly men with competing comorbidities and men

> with life expectancies of less than 10 years. " They also

> suggested that physicians explain the benefits and drawbacks of

> testing and ask the patients what they wanted to do.

>

> I'm going to leave aside the social/political/economic question

> of whether testing is the best way to spend public health money

> and think only about whether it is in the interest of patients.

>

> My own thinking about this depends a great deal on answers to the

> following questions:

>

> 1. Does anyone benefit from treatment?

>

> If men who have had surgery or radiation are just as likely to

> suffer and die of prostate cancer as men with the same disease

> characteristics who have not been treated, then testing is

> pointless.

>

> However if men who have been treated are less likely to suffer

> and die of PCa than those with the same disease characteristics

> who have not been treated, then it's not pointless at all.

>

> I know for a fact that there are many men who have been treated

> and lived for decades with no recurrence. I believe that

> treatment _can_ work. It doesn't always work, but it doesn't

> always fail either.

>

> 2. Can we tell who will benefit from treatment?

>

> There are two categories of men who don't need treatment. Those

> who will surely die of something else before PCa can kill them,

> and those who will die just as quickly in spite of treatment.

>

> It is currently possible to identify some of these men, but not

> all of them and not with absolute certainty.

>

> My view of this question is that a good doctor can produce a

> useful probability statement about whether a man can benefit from

> treatment. Sometimes he can project a high probability of death

> when there is no treatment. Sometimes he can project a high

> probability of successful treatment. Sometimes he can only offer

> intermediate or low probabilities. It's then up to the informed

> patient to make his own determination of the odds.

>

> If some men can benefit from treatment, and if a doctor can

> sometimes make useful probability statements, it seems to

> me that testing is warranted.

>

> 3. Are the consequences of treatment worse than the disease?

>

> Some men who are now impotent, incontinent, or have other

> significant side effects wish they had just taken their chances

> with the disease.

>

> Others consider side effects to be insignificant in comparison

> with the risk of death from PCa. Some lucky ones seem to have

> very few significant side effects at all - and that number may be

> increasing as the treatments get better over time.

>

> If a man considers the risk of side effects to be worse than the

> risk of cancer, then for him, testing would seem to be

> inappropriate.

>

> -----

>

> It seems to me that the answers to questions 1 and 2 are

> objective, and incline towards testing. The answer to question 3

> is subjective.

>

> -----

>

> > ... The whole aim of practical politics is to keep the populace

> > alarmed -- and hence clamorous to be led to safety -- by

> > menacing it with an endless series of hobgoblins, all of them

> > imaginary. ...

>

> This is a problem, but I know it's not universally true. My HMO

> doesn't make an extra penny from me by treating my cancer. They

> lose money. But they recommended treatment. I got treatment in

> a clinical trial at NCI. They don't make any money from it

> either. Sometimes we really should be alarmed and really should

> seek safety.

>

> I personally thought testing was a waste of time. I was sure I

> was healthy. When my HMO told me my PSA was high and I might

> have cancer I thought they were crazy. But when I found out that

> I really did have cancer, and then found out that it was a

> Gleason 4+3 that would very likely kill me well before my

> statistical life expectancy was up, I opted for treatment. I'm

> not sorry I did. I am glad that I was tested.

>

>

> Alan Meyer

> ameyer2@...

>

>

>

________________________________________________________________________________\

____

> Be a better friend, newshound, and

> know-it-all with Yahoo! Mobile. Try it now.

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

>

[Guest guest]

Terry,

Are you saying that PCa is not a cancer?

Are you assuming that people will not die from it? Many breast cancers are not life

threatening and the breast cancer community is just beginning to discuss that

issue.

Both are not true. It is cancer and can be

life threatening. I have lost too many friends to see the disease as an innocuous

disease.

The problem with the ACPM statement is that

they say in their Pearls of Wisdom that if caught early PCa survival is “very

good” and then they say they do not recommend screening based on waiting

for the completion of the clinical trials looking at whether screening saves

lives. They do not say that men should not be offered testing for PCa. They

whole piece has many contradictions. If men are treated it will increase

survival as the British study I sent today shows but when and how do you know

when to treat? Treatment for PCa doesn’t seem to be debated but rather

the debate is around PSA and in this case DRE also. Maybe the debate is wrong

and should be more focused on appropriate treatment. I have been getting pap

smears since I was a teenager. It never went through trials. It saved lives.

Have you read the comments on the NYT blog?

Some are very interesting.

Kathy

>

> Chuck,

>

> The article to which you refer includes these statements:

>

> <snip> . At present, no conclusive data demonstrate that early

screening,

> detection, and treatment reduce mortality....Potential harms of

screening

> for prostate cancer include potential adverse health effects

associated with

> false-positive and negative results and adverse effects of

treatment. Other

> limitations of screening are that a survival benefit from prostate

cancer

> screening has not been proved in rigorous trials. <snip>

>

> Do you agree with them and if not, why not? Are there survival

benefits from

> early treatment? is there conclusive data that early screening

reduces

> mortality? Is there not significant over-treatment as a result of

screening?

>

> I saw a quote today that is apt here, I think: The whole aim of

practical

> politics is to keep the populace alarmed -- and hence clamorous to

be led to

> safety -- by menacing it with an endless series of hobgoblins, all

of them

> imaginary. -H.L. Mencken, writer, editor, and critic (1880-1956) Or

as Dr

> Logothetis put it to a US-Too meeting some years ago:

>

> <SNIP> One of the problems with prostate cancer is definition. They

label it

> as a cancer, and they force us all to behave in a way that

introduces us to

> a cascade of events that sends us to very morbid therapy. It's sort

of like

> once that cancer label is put on there we are obligated to behave

in a

> certain way, and its driven by physician beliefs and patient

beliefs and

> frequently they don't have anything to do with reality. And they

are only

> worrisome because the pathologist has decided to call it a cancer.

<SNIP>

>

>

>

> All the best

>

>

>

> Terry Herbert

>

> I have no medical qualifications but I was diagnosed in '96: and

have

> learned a bit since then.

>

> My sites are at www.yananow.net <http://www.yananow.net/>

and

> <http://www.prostatecancerwatchfulwaiting.co.za/>

> www.prostatecancerwatchfulwaiting.co.za

>

> Dr " Snuffy " Myers : " As a physician, I am painfully

aware

that most

> of the decisions we make with regard to prostate cancer are made

with

> inadequate data "

>

>

>

> _____

>

> From: ProstateCancerSupport

> [mailto:ProstateCancerSupport ]

On Behalf Of

(Chuck)

> Maack

> Sent: Thursday, 7 February 2008 3:54 PM

> To: ProstateCancerSupport

> Subject: Could it be that PC is actually

good for

> you ??? (just kidding!)

>

>

>

> Please don't shoot the messenger. Could it be that PC is actually

good for

> you ??? (just kidding!)

>

>

>

> In the below report the American College of Preventive

Medicine has

made the

> decision advising member physicians that it does not recommend

prostate

> cancer screening with DRE, PSA, CME/CE. This despite being

contradictory to

> the recommendation of the American Cancer Society and the American

> Urological Association for such testing. No wonder we have

problems making

> men aware of the possibility of prostate cancer while at the same

time

> having men initially diagnosed with advanced disease because their

physician

> never recommended annual testing. Read and draw your own

conclusions:

>

>

>

> American College of Preventive Medicine Does Not

Recommend Prostate

Cancer

> Screening With DRE, PSA CME/CE

>

>

>

> http://www.medscape <http://www.medscape.com/viewarticle/569719>

> .com/viewarticle/569719

>

>

>

> (Chuck) Maack/Prostate Cancer Advocate

> Wichita, Kansas Chapter, Us TOO

> Bio: http://www.ustoowic

> <http://www.ustoowichita.org/leaders.cfm?content=bio & id=1>

> hita.org/leaders.cfm?content=bio & id=1

> Email: maack1@...

> Website: www.ustoowichita. <http://www.ustoowichita.org/>

org

>

[Guest guest]

I recall in surgery, as a nurse anesthetist, hearing surgeons who were removing a suspected inflamed appendix, that the goal set for surgeons treating suspected appendicitis is "if you aren't removing x% of normal appendices, you are not removing them often enough, and will miss some that need to come out". Do you follow that, I think that the gamble of leaving prostates in that present with elevated PSAs, Gleason scores which are worrisome, and to some degree they almost all are, and glands that are growing or feel nodular, is gonna allow some to slip through and not get that life saving treatment, whatever might be chosen. Someday, on won't it be sweet, there will be a vaccine for our sons, or grandsons, so they won't face all this, but for us, it seems the death rates are dropping, and for sure, the club of PCa survivors is growing, and we are getting younger in our demographic.

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