Re: Question About the USPSTF Report

[Guest guest]

Hi, Chuck D. (C. De)

Radiotherapy is not automatically associated with bowel dysfunction. In 2004, I received external radiation, IMRT, for a Gleason 9 prostate cancer, no evidence of metastasis. I had the maximum allowed total dose of 80 Grey, over 38 sessions. The main side effects were fatigue, urination frequency and slight burning toward the end and I was getting up at night 3 to 5 times. In the final week, I had a few episodes of rectal bleeding, which cleared up a couple of weeks later and has not returned. Urination has returned to normal for an 82-year-old at once a night. Bowel function is back to normal and my PSA has stayed low and steady, below 0.20.

The statement: "up to 5 in 1000 men will die within 1 month of prostate cancer surgery" is rather vague. "Up to" could mean any number from 0 to 5. So you have just as good a chance of having no bad side effects.

Manny

P.S. I believe the USPSTF is a bunch of alarmists.

Subject: Question About the USPSTF ReportTo: "ProstateCancerSupport " <ProstateCancerSupport >Date: Tuesday, May 22, 2012, 10:31 PM

As I consider treatment options for my PC, the report from the USPSTF titled, "Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement caused some concern." From the report:

Adequate evidence shows that nearly 90% of men with PSA-detected prostate cancer in the United States have early treatment with surgery, radiation, or androgen deprivation therapy (7, 8). Adequate evidence shows that up to 5 in 1000 men will die within 1 month of prostate cancer surgery and between 10 and 70 men will have serious complications but survive. Radiotherapy and surgery result in long-term adverse effects, including urinary incontinence and erectile dysfunction in at least 200 to 300 of 1000 men treated with these therapies. Radiotherapy is also associated with bowel dysfunction

Is this statement correct? 0.5% will die from surgery and 1% to 7% will have a serious complications but survive.

Chuck D.

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[Guest guest]

Charlie De wrote:

> As I consider treatment options for my PC, the report from the

> USPSTF titled,  " Screening for Prostate Cancer: U.S. Preventive

> Services Task Force Recommendation Statement caused some

> concern. "   From the report:

     

> Adequate evidence shows that nearly 90% of men with

> PSA-detected prostate cancer in the United States have early

> treatment with surgery, radiation, or androgen deprivation

> therapy (7, 8). Adequate evidence shows that up to 5 in 1000

> men will die within 1 month of prostate cancer surgery and

> between 10 and 70 men will have serious complications but

> survive. Radiotherapy and surgery result in long-term adverse

> effects, including urinary incontinence and erectile

> dysfunction in at least 200 to 300 of 1000 men treated with

> these therapies. Radiotherapy is also associated with bowel

> dysfunction

> Is this statement correct? 0.5% will die from surgery and 1% to

> 7% will have a serious complications but survive.

> Chuck D.

I seem to recall reading those same numbers, and I accept that

they may be correct.

Here are the conclusions I draw from them:

 1. Men who clearly don't need treatment shouldn't be treated.

    We have published, evidence based criteria for who needs

    treatment and who doesn't.  The criteria I've seen have to do

    with PSA, Gleason score, the number and percent of biopsy

    cores positive for cancer, age, general health, and maybe

    some other characteristics.

    I don't know how good those criteria are.  I suspect they try

    to err on the side of not treating men who clearly don't need

    it rather than men who just probably don't need it.

    However, it is clear that large numbers of men have been

    treated who don't need treatment.  Every urologist should

    know the criteria for treatment and, I believe that those who

    treat patients who shouldn't be treated are engaging in

    malpractice.

 2. Men who are not treated should have active surveillance.

    " Active surveillance " is not the same as neglect.

 3. Diagnostic tests should be properly done and results should

    be properly evaluated.

    I have read stories of men who were told that they had cancer

    when a more experienced lab looking at the same slides said

    they did not.  Getting second opinions on biopsies is a good

    idea.

    We also know that some imaging centers do a far better job

    than others at detecting and locating cancer sites.  Dr.

    " Snuffy " Myers went to the best imaging center he could find

    when he was diagnosed.  They found cancer outside the

    prostate in some specific spots.  A top radiation oncologist

    radiated those spots as well as radiating the prostate and

    now, many years later, Dr. Myers still has a low PSA.

 4. Men who are treated should all be treated in centers of

    excellence.

    How many of the deaths and how many of the serious side

    effects of treatment are due to treatment by inexperienced,

    less competent or incompetent doctors?

    There's no good reason for that.  Prostate cancer is not an

    emergency.  In the U.S., if a doctor diagnoses a patient he

    should refer that patient to an NCI Designated Cancer Center,

    or some similar highly reputable place.  Insurance companies

    should not just be sending cancer patients to " in-network "

    low bidder doctors.  It's a false and dangerous economy that

    has far higher costs down the road.

    

    Real outcomes, not just self-reported outcomes, should be

    monitored at cancer centers and at all hospitals and centers

    that are not performing should be brought up to standard or

    doctors and insurers should stop referring patients to them.

I don't know what the effects of all that will be, but I believe

that there has to be some positive effect.  It is my

understanding that all of the studies indicate that in cancer

treatment, as in other medical treatment, centers of excellence

have much better outcomes than other places.

I've heard some horror stories of things that happened at very

highly regarded hospitals.  So I know that s--t can happen

anywhere.  It's a serious problem and it needs to be addressed.

However I do NOT draw the conclusion that we should not screen

for prostate cancer.

There can be problems with screening.  If a screen produces a

very high percentage of false positives, it can cause serious

problems for patients and there is a point where such screening

does more harm than good.  An example in prostate cancer is bone

scans for men who have low PSAs and have not had treatment.

Statistics I have seen claim that, for men with PSA below 10, a

fairly large number of men have positive bone scans (I seem to

recall the number 13%) but all or almost all are not due to

cancer.  The bone scan thus causes great anxiety and invasive

follow-up for great numbers of men, hardly any of whom need it.

So I recognize that screening can have drawbacks.  But I'm not

yet convinced that the drawbacks we've seen for PSA testing

outweigh its advantages.

At this time, I'd rather that we implement the steps above to

alleviate the problems and see how that effects the statistics

rather than eliminate PSA testing.

    Alan