10% of PC deaths occur to men under the age of 65

[Guest guest]

There is something I find particularly irritating about the following statement hidden away in an otherwise good commentary on active surveillance (AS) [ Klotz L. Active surveillance for prostate cancer: patient selection and management. Curr Oncol. 2010 Sep;17 Suppl 2:S11-7. PubMed PMID: 20882126; PubMed Central PMCID: PMC2935703 -- http://www.ncbi.nlm.nih.gov/pubmed/20882126 ]

" Of course, patients are occasionally diagnosed with advanced disease at a young age and die rapidly of aggressive prostate cancer. These outliers are likely not helped by screening because of time bias (screening tests preferentially identify slower growing cancers); they generally have high-grade disease at the outset and represent a very small proportion of prostate cancer patients. "

This is actually dead wrong. About 10% of ALL prostate cancer fatalities will occur to men under the age of retirement (65).I know all about this because I was Dx'd at the age of 49 after being ignored by the local urologists. It has crossed my mind more than once that I was consistently ignored for nearly a year because they thought I would die pretty quickly anyway, and a follow-up to my referral and rapidly rising PSA was not worth the bother. Yes I feel angry with Klotz on behalf of all those young men with serious disease who he is proposing that we just ignore. On that count the Klotz article is very damaging and some redress must be made. I don't know how exactly, because comments like his will be taken up by cash strapped health care providers who are looking for ways to reduce overheads, such as costs of population screening. I guess men will have to become more knowledgeable about their own bodies, and INSIST on testing and obtaining a definitive diagnosis in spite of the doctors pooh-poohing them.

To write off this group as Klotz appears to be doing is a travesty of science (they are not " outliers " they are 10% of PC deaths), and of fairness to these men (more than any other group they need definitive treatment). This is a group for whom screening, early detection and timely treatment will clearly produce benefits. The challenge is to devise ways for population screening that return less false positives (leading to overtreatment). However, to meet that challenge we must not dump the idea screening altogether at the cost to these men who seem doomed !

http://www.ncbi.nlm.nih.gov/pubmed/208821261. Curr Oncol. 2010 Sep;17 Suppl 2:S11-7.Active surveillance for prostate cancer: patient selection and management.

Klotz L.Screening for prostate cancer using prostate-specific antigen (psa) has been appealing. However, the significant associated decline in prostate cancer mortality comes at the cost of a very high rate of diagnosis, and many patients with indolent, non-life-threatening cancer are exposed to the risk of significant side effects from radical treatment. Most men with favourable-risk prostate cancer are not destined to die of their disease, even in the absence of treatment. The challenge is to identify the subset that harbour more aggressive disease early enough that curative therapy is still a possibility, thereby allowing the others to enjoy improved quality of life, free from the side effects of treatment. This article reviews current research into active surveillance in favourable-risk disease and some of the issues that arise when prostate cancer is monitored rather than being treated immediately.

PMCID: PMC2935703PMID: 20882126 [PubMed - in process]-- Sam.For your delectation and edification:-http://poetryfromtheprostrateyears.com/