Wake up guys!   This is an important event all for the best.

When my PSA got to 4 my doctor said "let's watch it".   If he/we had been
looking at the PSA velocity numbers we would have been ringing alarm bells,
but the dogma at that time was that 4 is a "good" number, not one for
alarms.

Doctors, especially those that graduated some time ago, do need to be
re-educated and brought abreast of the modern trends in their science(s).
Lots of them still cling to the old dogma, like "men don't get breast
cancer", and that leads to grief.

Anything that sends the guys to do PSA tests, and biopsies, will be in their
best interests if these tests are done after careful rationalization of the
existing data for that person.

Indeed, maybe the best way to treat really early prostate cancer is not RP,
or radiation, but chemotherapy.   Obviously if the disease is detected late,
after much spreading has occurred, then RP or radiation, followed by
chemotherapy might be best.   Don't forget that the surgeons and the
radiation oncologists will beg to differ since this would affect their
earnings.

We still need better tests to detect PCa and better chemotherapy drugs.
The battle is still in the early stages.

Best wishes.

Vernon

There is a debate going on in the medical community about whether or not
early diagnosis does much good.  Some physicians, mainly
epidemiologists, think that it may not in many cases, and they fear that
many people are treated for cancers which will never amount to anything,
with attendant side effects that could be avoided.   On the other side
are those who treat cancer who feel generally that early detection does
does work.   The trouble is that few studies have been done which are
statistically without fault and which give an answer one way or the
other.   For some cancers, it is generally clear that early detection is
not much use.  For others, it is clear that it saves lives.  But for
some, such as breast cancer and prostate cancer, one can make arguments
both for and against early detection.

Gina Kolata is a very bright science reporter.  (She was actually a math
major ;=))   But she likes to glom onto controversial issues in science,
particularly medicine.   Her past reporting, as I see it, shows a bias
against early detection.  She shows this by her choice of experts and
what she quotes and what she doesn't.   I don't think there is anything
nefarious going on, but it certainly is attractive to a reporter to
question conventional wisdom, and perhaps to some extent she feels she
is doing that.   She is not entirely subjective.  She does present both
sides of the argument.   But as I see it she ignores the complexities
and oversimplifies.   The problem is that you can't generalize about all
cancers or even from one cancer to another.  In addition, for any
specific cancer, whether early detection makes sense or not can be quite
complex, depending on the circumstances.  For example, for prostate
cancer, PSA testing, I think, makes a lot of sense for men 50 (40 in
case of family history or other factors) to 70.  It doesn't usually make
much sense for men over 80.  For men 70-80, it may or may not make
sense.   In addition, any individual man has to decide himself what he
should do after understanding the issues as they apply to him, and he
can't simply go by age.  Kolata, in her reporting ignores all that
complexity.  It makes a better story that way.  I think that is all
there is to it.

I read the original article - not the newspaper/newscast version.  If
I recall correctly the study followed many men with lower PSAs and at
the end of 7 years did biopsies even though there was no indication of
PCa.  No one should be surprised that cancer was found in many of
these men even some men with PSA values less than 1.0 but I am
surprised that the positive rate was as low as 15%.  Of course since
biopsies don't find all cancers anyway, especially the smaller volume
cancers, the percentage ought to be significantly higher.  It's
interesting that the editor of the mag (I think it was New England
Journal of Medicine) in his editorial regarding the article basically
said "So What?"  It appears to me that men are no better off after the
article than before and what we really need is a better test.
Dave Perry