I guess that professor, and the NHS in general in the UK, are not going to
back off their position until the death rate falls in the US compared to the
UK.  Seems to me that it will, eventually.

Another example of the public health considerations being irrelevant to your
own particular case.

jimhoney

Dan,

I read the article and followed a couple links posted there to some UK
medical sites. It seems that with their socialized medical care, the
attitude is that it's not worth the cost or inconvenience because PSA
testing isn't perfect and may lead to unnecessary biopsies that men may find
uncomfortable or painful (my anesthesiologist had good drugs :)). I believe
the small inconvenience and subsequent dx of my early stage pca was worth
it, rather than wait until palliative care is the only option.

I also find it interesting that Prof. Malcolm Law, the expert quoted in the
article, is not associated with cancer research, but is involved with
preventative medicine. Further, he mentions studies but does not identify or
cite them.

Tom

It seems to me that there's some faulty logic going on in these
claims.

If any treatment is ever effective in curing PCa, then it must
follow that there is some point in time at which the treatment
can be applied to save a man's life.  PSA testing helps us
find that point before it's too late.

There seems to be no question at all that PSA really is a guide
to the development of cancer.  Other factors can raise PSA.
There are false positives with PSA testing.  But as every one
of us can attest, there are true positives as well - as our biopsies
have confirmed.

If PSA testing doesn't save lives, then it must follow that there
is no point at which treatment can be applied to save a man's
life.  He either lives or dies and the treatment makes no difference.

So what is really being argued is not that PSA testing doesn't
work, but that treatment doesn't work.

I wonder if the good professor read a study that said, statistically,
that children who cross the street without looking both ways
live as long as children who do - would he tell his children to
stop looking?  Would he even notice if the study were conducted
in, say, Nepal, where there are no cars?

I taught my children to look before crossing the street.  And I've
told my son that I think he should get annual PSA testing starting
at age 40.

   Alan

There have been as many as 300 people cross paths with us on this NG since I
began lurking.  I'd be willing to bet, in that time, at least 20 were T1a or
T2a.  All of these were probably asymptomatic.  Then, of all those that were
T1b through T2c, how many of those were asymptomatic and how many of those
had doctors who 'felt' the tumors in the prostate only after a positive PSA?

It is amazing the tripe that one can find written by 'experts' who could
have disproved their theories just by looking for the logical antithesis of
their expected proof.

THEORY:  But Prof Law says no form of screening, even general advice on self
examination, should be promoted within the NHS, or even offered as an
option, until there is rigorous scientific proof of its efficacy and
comparative lack of harm.

FACT:  There have been 20 to 50 people here who would not know they had
Prostate Cancer until it was Advanced Prostate Cancer were it not for PSA
exams.

I wonder how many others have longer to live due to PSA exams.

This just rehashes the usual arguments against PSA testing.  As usual it
raises some valid point in an ongoing scientific debate, but more often
it brings up red herrings and false arguments.

For me the largest harm these media reports do---encouraged in this case
I think by the authority being quoted---is to confuse what is a
statistical debate about averages with the issues that confront an
individual man concerned with what to do about prostate cancer.

It could for example be true that ON THE AVERAGE PSA testing has no
effect on overall mortality.   (That certainly has not been proven, but
it could turn out to be the case.)   But that doesn't mean that no man
is ever helped by PSA testing.   The average never tells the whole
story.  Prostate cancer is a complex disease, and the particular
characteristics of the man, and the nature of his particular disease
make an enormous difference.    The great bulk of men diagnosed with
prostate cancer are over 65, and for many of these men, detecting the
cancer and then treating it may do more harm than the disease itself.
On the other hand, I think the evidence is rather strong that younger
men or men with longer life expectancies who are older may benefit
significantly from treatment.   There is always a calculus involved in
these public health discussions.   PSA testing does lead to a
significant number of unnecessary biopsies, and those biopsies lead to
treatment of a certain amount of ineffective treatment or unnecessary
treatment.   Unfortunately, there is no way at present easily to
distinguish those early cancers which need treatment from those that do
not.   So the question is how many men should go through the anxiety and
pain of unnecessary treatment so that some men will be helped thereby.
If it were a matter of your unnecessary treatment vs my benefit, it
would be a difficult question, but given that neither of us knows which
is being benefited and which is not, it makes it an impossible
calculation to do.

Almost all the men who have posted in this newsgroups have had diagnoses
which prudence would suggest treatment for.   For example, I was 67 with
a T1c, PSA 4.5, and Gleason 7=3+4 cancer.  I was in good health and my
life expectancy was at least 10 years, more likely 15 years or more. The
authority quoted in the article would be dishonest if he claimed that he
could be sure the radical prostatectomy in my particular case had no
effect whatsoever on my subsequent health or mortality.   That flies in
the face of many retrospective studies on the natural history of similar
untreated cases, and the results of studies of similar cases when
treated.  He can make various statistical statements about populations,
but were he to tell me personally that he knew for a fact that I gained
no benefit from treatment,  he would be guilty of dishonesty of the
worst kind.