RE: USPSTF Draft Recommendation against PSA-based screening for prostate cancer in all age groups

[Guest guest]

Chuck:

Your comment doesn't address the central point of the commitee's recommendation.

That is that the cancer that PSA screening may detect will have limited impact

on a man's life. But unnecessary treatment almost assuredly will have an impact

on a man's life.

It is all a matter of weighing the benefits from PSA screening- early detection

and treatment, vs the negatives- potential surgery or radiation therapy to cure

a cancer that may have no impact on one's life and the almost certain resulting

side effects- ED, incontinence, etc.

Admittedly the studies that the recommendation was based on only looked at a ten

year horizon whereas I suspect that most men who have a PSA elevated enough to

warrant a biopsy have 20-30 years to live. So studies that have a 20-30 year

horizon may result in a different conclusion.

All I can take away from the current controversy is that it is a close call on

whether to continue PSA screening or not.

[Guest guest]

I agree with . There seems to be diffulty in staging the severity of the cancer, beyond the Gleason score, and perhaps its rate of increase. These studies should continue for another 10 to 15 years. The studies should include nutrition, and life style, and exposure to SDTs, as in a Framington Ma style long term study. Genetic targeting has become possible and I would think that it deserves further study also. Regards, T Chuck:Your comment doesn't address the central point of the commitee's recommendation. That is that the cancer that PSA screening may detect will have limited impact on a man's life. But unnecessary treatment almost assuredly will have an impact on a man's life.It is all a matter of weighing the benefits from PSA screening- early detection and treatment, vs the negatives- potential surgery or radiation therapy to cure a cancer that may have no impact on one's life and the almost certain resulting side effects- ED, incontinence, etc.Admittedly the studies that the recommendation was based on only looked at a ten year horizon whereas I suspect that most men who have a PSA elevated enough to warrant a biopsy have 20-30 years to live. So studies that have a 20-30 year horizon may result in a different conclusion.All I can take away from the current controversy is that it is a close call on whether to continue PSA screening or not.

[Guest guest]

Chuck, this was in an article by Dr. B. Samadi on Fox News.com on October 8:

"...The evidence supporting prostate cancer screening is not without controversy. A large American trial failed to illustrate a significant difference in prostate cancer specific deaths between the screening and control groups. However, the data was premature without sufficient follow-up to appreciate a screening benefit.

Additionally, a majority of the patients in the control group were screened during the study period, possibly obscuring the results of the trial. A study of over 200,000 men in Europe, which followed patients for a longer period of time than in the American trial, found favorable results; 9 years following initiation of PSA screening, the study group experienced a 20% decrease in prostate cancer specific deaths, when compared to patients who were not screened. In Sweden, a trial followed men for 14 years, finding that routine PSA screening resulted in a 50% reduction in prostate cancer related deaths.The most powerful argument in favor of PSA screening, however, is the reduction in prostate cancer mortality we have witnessed since PSA screening first became available; a 39% reduction between 1990 and 2007. Prostate cancer mortality is now the lowest it has been since the 1930’s when life expectancy was much lower...."

Read more: http://www.foxnews.com/opinion/2011/10/07/risky-business-men-cant-afford-to-skip-psa-test/#ixzz1aZubrCQ3

It's all very confusing. Who is right about the studies?

Mike

Subject: USPSTF Draft Recommendation "against PSA-based screening for prostate cancer in all age groups"To: advancedprostatecancer , ProstateCancerSupport , pcan@..., "'Merel Grey'" , "Jan Manarite/PC Advocate/Mentor" , "Kathy Meade-Goulait/PC Advocate/Mentor" , "Tom Kirk/President-CEO Us TOO" , "Terri Gibbons Likowski/UsTOO Chapter Services Program Manager" Date: Tuesday, October 11, 2011, 1:07 PM

I just commented on the “Opportunity for Public Comment – Screening for Prostate Cancer: USPSTF Recommendation Statement DRAFT at the following URL

http://www.uspreventiveservicestaskforce.org/uspstf_form3/

with the following statement:

“I disagree with your conclusion concerning PSA blood testing and community-based screening, and disagree even more so the recommendation that PSA blood testing for men be reduced to the rating “D.†Such a rating recommends no testing whereas elsewhere in your recommendations you certainly allow for PSA testing with direction as to the circumstances when that testing would be acceptable. Accordingly, the rating should be raised to a level that recognizes that PSA blood testing, as well as even community-based screening, is acceptable under those described conditions. Your recommendations actually allow for “screening†as long as the man has been explained the reason for the PSA blood test, what the result may provide, and that he then consents to that test. This is yet other reasoning that your recommended “D†rating is flawed. It also

appears that you have ignored the largest and best designed of the screening studies quoted in the report that identified that screening appeared to save lives based on their statistics. I am among what I would expect in my 19 years as a prostate cancer patient while also deeply involved in research and study of this insidious, deadly men’s disease, that there are literally hundreds of thousands of men whose community-based screening with either the PSA blood test or a combination of the PSA blood test and digital rectal examination (DRE) determined the presence of developing prostate cancer. I read this repeatedly with monitoring of several prostate cancer support lists and I hear it from the many men that have been a part of our Wichita, Kansas Us TOO prostate cancer support group over the past 17 years. Again, community-based “screening†identified this presence. Recently here in Kansas at the State Fair, over 300 men

were provided prostate cancer “screening†with a PSA blood test and it was reported on local television last evening that the results determined that well over 200 men showed evidence of sufficient PSA elevation to be considered for further evaluation to determine whether these men were experiencing a urinary infection, prostatitis, benign prostatic-hyperplasia (BPH), or developing prostate cancer; all ailments that can be determined by PSA testing and that, in any event, require some manner of treatment. And here again, yet additional importance of not just PSA blood testing, but community-based prostate cancer screening. In conclusion, I believe it extremely important that you readjust your rating of “D†to a rating that permits both PSA blood testing as well as community-based screening under the conditions you make note that the patient is provided an explanation of why the PSA blood test is offered, what the result may provide,

and that patient consent is obtained.

Respectfully, (Chuck) Maack – Prostate Cancer Advocate/Activistâ€

I encourage all receiving this email to take similar action with your personal comments. If we fail to have the wording in the current draft recommendation improved and the “D†rating upgraded, this recommendation will ultimately recommend against PSA testing if the “D†rating remains.

You can still read the entire original draft here:

http://www.uspreventiveservicestaskforce.org/draftrec3.htm

(Chuck) Maack - Prostate Cancer Advocate/Activist

Email: maack1@...

PCa Help: "Observations": http://www.ustoowichita.org/observations.cfm