Well, originally this was a SCIENCE group where people asked scientific
questions, like, "How come proof of PSA testing has been so long in coming."
But NOW it is simply a supporter group, where people who otherwise are good
in their fields try to justify their decisions by being anit-scientific.
You seem to have noticed this.

If you look at the rest of what I said, I remarked on that.  I also
referred to the necessity of using an appropriately randomized study
comparing alternatives for the best kind of "proof".   But I also
remarked on some of the problems of designing such a study.

In mathematicis, my field, things can be proven, and if you make the
assumption that there is no mistake in the proof, then you logically
must conclude the result is correct.   In medicine, things are not so
clear cut.   If the classical kind of random, double blind test, only
gives you probability.   One typical criterion for accepting a result is
that it is 95 percent likely that the result could not have happened
purely by chance.   But that means, that on the average, one in twenty
of such studies did in fact come up with the results it did purely by
chance, and the result is in fact not correct.

In medicine, the degree of certitude possible in mathematics, is beyond
reach.   One should not actually talk about something being proven, only
that the preponderence of evidence suggests strongly that it is true.
While biostatisticians rightly prefer one kind of evidence over other
forms, that doesn't mean that other forms can or should be ignored
entirely.   The facts about lowered death rates in two countries are
parts of the evidentiary mix.

If you had read further, you would have noticed that I mentioned that
skeptics about PSA testing attribute the drop in death rates in the US
to improved treatment.  I'm not sure how that applies to the Tyrol vs.
the rest of Austria, though, since presumably they use the same
treatments throughout the country.  But it is possible some other
confounder explains that.

Where?

Dale

My highly rated uro told me that if I had not taken the PSA when I did, I
would not have lived until I was 50 (which is when my father died of the
disease).  I'm 49? with a PSA below 0.1.  No emotion.  Maybe not science.
But fact based on an expert's prognosis.

 What is posted here usually states, "Then go to another doctor who is
better at finding cancer."

I pretty much agree with you, but let me put the argument against PSA
testing in a way that does make some sense.

At present, nothing close to a double blind properly randomized study
has ever been done testing whether it is likely that PSA testing either
improves chances for prostate cancer specific survival or overall
survival.    Critics of PSA testing don't often make it clear, but it is
not just the tests they object to but the sequence of events they fear
are highly likely following a suspicious test result.   First they note
there will be a biopsy, which is most cases will be unnecessary.  In
fact, biopsy, done by a competent urologist, is a relatively low risk
procedure, but it does have some risks.  Following the biopsy, if it is
positive for prostate cancer, the doctor and patient will likely feel
that the cancer should be treated aggressively.  (That is not
necessarily the case, but it can happen.)   Some of those cancers would
never have amounted to anything, but no one had a good hold on how many.
  And there are side effects such as long term incontinence, impotence,
and (for radiation) bowel problems associated with treatment.   For the
men whose cancers would never have bothered them, it would be a mistake
to hve to experience these side effects if they occur.   In the extreme
case, some men will die as a result of the treatment, and would have
lived longer untreated even if their cancers progressed.

Sometimes those opposing testing sound as if they believe that it is
never worth treating any case of prostate cancer ever, but that is
clearly nonsense.   The only rational argument against testing is that
after weighing costs and benefits, overall more harm is done by
encouraging testing and dealing with the consequences in treatment than
would be done by waiting until cancer developed in some of the men
currently being treated for early cancer and then treat those men for
advanced metastatic cancer.   It is also contended by the critics that
treatment is chancy and often not effective, although I think that
argument is getting harder to make with results of current up to date
methods for treating early prostate cancer.   Those results seem pretty
good.   The worst that the critics can really argue now is that in the
vast majority of those cases, the men would have done just as well with
no treatment unless or until the cancer metastasized.

Note that this is not an either/or issue.   Essentially every sensible
expert agrees that many prostate cancers should not be treated.   For
example, Patrick Walsh, who is certainly one of those strongly
advocating aggressive early treatment,  in his book, points out that
most men over 75 should not be treated aggressively for or even tested
routinely for prostate cancer.

As I've noted several times, the gold standard of biostatistics, the
double blind randomized study can't be applied easily to prostate
cancer.   But one can come fairly close.  (It is not clear to me that
any of the studies currently in progress has done that, but we shall
have to see.)   However, it is not the only way to establish something
in medicine.   It is universally agreed (even by the Phillip Morris
Corporation, apparently under some legal constraint) that 'smoking
causes cancer'.   Yet no double blind randomized study in humans has
ever been done to establish that.  But the statistics comparing lung
cancer rates in smokers to that in non-smokers is so compelling, that
all the rationalizations such as claiming that people who are likely to
get lung cancer are more likely to smoke have fallen by the wayside.  No
one seriously doubts the link between smoking and lung cancer anymore.
the statistical link between smoking and heart disease is not as strong,
but here again the sum total of the evidence shows that there is a link.
  If you are a smoker, you are more likely to get heart disease.  Since
many more people die of heart disease than of lung cancer, smoking
causes more deaths due to the former than the latter, although the
statistical link is not as strong.

Lots of research still needs to be done, and prostate cancer is a very
complex disease.  With the present state of knowledge, it is possible to
argue that PSA testing is appropriate for all men 50-75 and for some men
younger or older.   It is also possible to argue that for most men it is
not going to extend their lifetimes.   Each of us has to evaluate the
evidence as best he can and then decide what to do.

In my case, I chose PSA testing because my doctor recommended it.  When
my PSA started rising, I had to think harder about the whole thing.
When my urologist recommended either another test in several months or a
biopsy, I chose a biopsy.   At age 67, with a T1c case, had my Gleason
score been 6, and the cancer smaller, according to Walsh, I might still
have been a reasonable candidate for watchful waiting.  But my Gleason
was 7=3+4.   Retrospective studies done in Connecticut years ago showed
that in such cases, the likelihood of progression to metastatic prostate
cancer within about 5-10 years was pretty high, at least 40 percent, and
higher beyond that period of time.   I stood a very good chance of
suffering advanced prostate cancer if I lived long enough and since I
was in good health, that might very well happen.   On the other hand,
the statistics on the likelihood of a cure in a case like mine were well
over 50 percent and the chances of at least extending my life even if I
weren't cured were even higher.

So for me it was a no brainer.   But note had my Gleason score been 6,
and had other criteria applied, it might have made more sense for me to
decide to forego treatment.

As it turned out, I seem to have lucked out.   My post surgery pathology
was about as good as it could get, and my chances of being cured
completely are extremely high.   In addition, I was continent within six
weeks of surgery, and was able to have erections after about 18 months.
  Even during that 18 months, my wife an I were able to maintain an
active sex life using a pump.   But of course, a lot of these things
could have worked out differently.   Still I do feel that I made a
rational choice given the facts I was presented with, and I would not
have regretted the choice had that happened.   Moreover, despite what
other may have said, my choice was based on the science as I understood
it; it was not a purely emotional response to the word 'cancer'.