American Cancer Society Updates Prostate Cancer Screening Guidelines.

/, Treatment News/American Cancer Society Updates Prostate Cancer Screening Guidelines.

Here is the latest American Cancer Society Prostate Cancer Screening
Guidelines press release.
Please leave comments about these guidelines, by clicking to comment here

Update Reaffirms the Importance of Shared Decision-Making
ATLANTA –March 3, 2010 – Newly updated prostate cancer screening guidelines from
the American Cancer Society reaffirm the recommendation that men should discuss the
uncertainties, risks and potential benefits of screening for prostate cancer before deciding
whether to be tested. The update is the first since 2001 and was done as part of the
Society’s regular guidelines update process. It included a series of systematic reviews
focusing on the latest evidence related to the early detection of prostate cancer, screening
test performance, harms of therapy for localized prostate cancer, and shared and informed
decision making in prostate cancer screening.
The guideline is published online in advance of print publication in CA: A Cancer
Journal for Clinicians. The updated guidelines include these recommendations:
*Asymptomatic men who have at least a ten-year life expectancy should
have an opportunity to make an informed decision with their health care
provider about screening for prostate cancer after receiving information
about the uncertainties, risks, and potential benefits associated with
screening.
*Men at average risk should receive this information beginning at age 50.
Men at higher risk, including African American men and men with a first
degree relative (father or brother) diagnosed with prostate cancer before
age 65, should receive this information beginning at age 45. Men at
appreciably higher risk (multiple family members diagnosed with prostate
cancer before age 65) should receive this information beginning at age 40.
*Men should either receive this information directly from their health care
providers or be referred to reliable and culturally appropriate sources.
*Patient decision aids are helpful in preparing men to make a decision
whether to be tested.
*Prostate cancer screening should not occur without an informed decision
making process.
*Asymptomatic men who have less than a ten-year life expectancy based
on age and health status should not be offered prostate cancer screening.
*For men who are unable to decide, the screening decision can be left to the
discretion of the health care provider, who should factor into the decision
his or her knowledge of the patient’s general health preferences and
values.
“Two decades into the PSA era of prostate cancer screening, the overall value of
early detection in reducing the morbidity and mortality from prostate cancer remains
unclear,” said Andrew M. Wolf, M.D., Associate Professor of Medicine at the University
of Virginia Health System and Chair of the Advisory Committee. “While early detection
may reduce the likelihood of dying from prostate cancer, that benefit must be weighed
against the serious risks associated with subsequent treatment, particularly the risk of
treating men for cancers that would not have caused ill effects had they been left
undetected.”
The authors say in light of ongoing uncertainties, including the uncertain balance
between benefits and risks, involving men in the screening decision is crucial. “With
these newly updated recommendations, the American Cancer Society places even
stronger emphasis on shared decision making between clinicians and patients,” said Otis
Brawley, M.D., chief medical officer of the American Cancer Society. “The decision
whether to screen should be made with the help of a trusted source of regular care. Men
without access to regular care should not be tested unless high-quality informed decisionmaking
as well as appropriate counseling and follow-up care for those who test positive
can be assured. Without those, community-based screening should not be initiated.”
“Previous guidelines from the American Cancer Society and other organizations
have discussed the importance of informed decision making for men who are considering
prostate cancer screening, however this update is the first to provide details regarding
what information about screening is needed for informed decision-making to occur,” said
Alan G. Thorson, M.D., F.A.C.S., volunteer president of the Society. “For that reason,
the updated ACS guidelines delineate the core elements of information necessary for men
to engage meaningfully in this decision, and encourage inclusion of this information in
patient discussions and decision aids.”
The guidelines also includes updated clinical recommendations regarding
screening tests, intervals, and follow up of abnormal results for those men who choose to
be screened after considering the possible benefits and risks. The guidelines acknowledge
the limited contribution of digital rectal exam (DRE) to prostate cancer early detection
and state that screening can be performed using PSA with or without the DRE. The
guidelines recommend annual screening for men whose PSA level is 2.5 ng/ml or higher,
but state that screening intervals can be safely extended to every two years for men
whose PSA is less than 2.5 ng/ml. The guidelines affirm that a PSA level of 4.0 ng/ml or
higher remains a reasonable threshold to recommend referral for further evaluation or
biopsy for men at average risk of developing prostate cancer; for PSA levels between 2.5
and 4.0 ng/ml, health care providers should consider an individualized risk assessment
that incorporates other risk factors for prostate cancer in the referral decision.
The update included a complete review of the evidence. The American Cancer
Society’s Prostate Cancer Advisory Committee, composed of independent researchers,
clinicians and lay people, examined systematic reviews done by scientific experts at
Emory University, Rollins School of Public Health, met to hear presentations by experts
both on the Committee and by invited outside experts, and deliberated the evidence
before making its final recommendations. The guideline underwent peer review before
going before the American Cancer Society volunteer Board of Directors for approval.
The authors conclude by noting the urgent need for better ways to detect and treat
early-stage prostate cancer, particularly the need to distinguish between cancers that do
not require treatment and those that are aggressive, to help “tip the balance clearly in
favor of screening. Until that time, however, it will remain incumbent on health care
providers and the health care system as a whole to provide men with the opportunity to
decide whether they wish to pursue early detection of prostate cancer.”
Please leave comments about these guidelines, by clicking to comment here

By | 2017-10-19T10:54:11+00:00 March 3rd, 2010|Activism, Treatment News|32 Comments

About the Author:

Malecare is the world's leading men's cancer support and advocacy nonprofit organization.

32 Comments

  1. Helen Baldwin March 3, 2010 at 11:36 am

    There is indeed a dilemma surrounding the diagnosis and treatment of this insidious and potentially life-threatening disease. The prostate specific antigen (PSA) and digital rectal exam (DRE) are imperfect indicators, yet the death rate from the disease has consistently decreased since the inception of the blood test in the early 1990s. Fortunately, there are promising new discoveries that will eventually allow physicians to more accurately differentiate the life-threatening cancers from the less threatening.

    Some professional organizations, such as the American College of Physicians, the Canadian Task Force on Preventive Health Care, and the U.S. Preventive Services Task Force, do not recommend regular screening. They believe that some of these cancers may never affect a man’s health and treating them could cause temporary or long-lasting side effects such as impotence and incontinence.

    The American Urological Association (AUA), American College of Radiology, College of American Pathologists, National Comprehensive Cancer Network (NCCN), and the Arkansas Prostate Cancer Foundation (APCF) Medical Advisory Committee recommend otherwise. They believe current scientific evidence shows that finding and treating prostate cancer early, when treatment might be more effective, may save lives.

    The (NCCN) is made up of world – class cancer treatment centers including Johns Hopkins, MD Anderson, Sloan Kettering, Stanford, Vanderbilt, and Duke. They have combined their considerable statistical data to conclude that the rate of increase in the PSA, also known as PSA velocity (PSAV), is even more indicative of aggressive prostate cancer than the score itself.

    The facts remain that Arkansas’ men are now more likely to die from prostate cancer than Arkansas’ women are from breast cancer1, the premature death rate from prostate cancer has increased by 55% (before age 65), and African American men and those with a family history have a significantly higher risk2. Sometimes the problem is that many know their male relatives died of cancer, but did not know it was prostate cancer — men simply do not talk about it.

    The APCF Medical Advisory committee, composed of urologists, radiation oncologists, an internist, and a physiatrist — three of whom are prostate cancer survivors — accepts the guidance of the NCCN which recommends establishing a baseline score at age 40 with follow up in 6 months to 5 years based on the results. If the baseline or subsequent scores are suspicious based on age and ethnicity, the PSA will be repeated every 6 months for at least 18 months to evaluate velocity. They further recommend that screening after age 75 should be considered individually.

    Screening and treatment choices are complicated. The APCF provides educational and emotional support to empower men and their families to take action and ask the right questions. It encourages state-of-the-art treatment for life threatening prostate cancers aimed at preserving the nerves and vessels and, ultimately, the lifestyles. For low-grade prostate cancer, observation remains an option.

  2. Kathy Meade March 3, 2010 at 12:08 pm

    Unfortunately I have not been able to view the actual guidelines. The press release is above. The headline writers have greatly misrepresented the actual guidelines. The articles so far have been very short and do not give good information. This is all very unfortunate because this will only confuse men and physicians about what they should do.

  3. Phillip B. Olsen March 3, 2010 at 1:23 pm

    We have become accustomed to disappointing statements regarding prostate cancer from the American Cancer Society.

    The public statement just released does little to guide men who may carry lethal prostate tumors in their bodies, and it ignores more than a decade of prima facie evidence that vigorous testing by PSA and DRE have been accompanied by dramatic reduction in deaths due to prostate cancer.

  4. Ray Clauser March 3, 2010 at 5:29 pm

    I can’t believe someone could write so many words about PC and just about say nothing of significance. What do we tell the guy at 45 with a PSA of 20 and an 8 Gleason??? Just leave this between the Dr. and his patient.

  5. Yost Conner March 3, 2010 at 6:05 pm

    My concern over this conversation is that too many people conflate detection with treatment. For fear of how men might react to the knowledge they have cancer, we would deny them the ability to get that knowledge in the first place. Shouldn’t the focus be on overtreatment, not overdiagnosis?

    I would have fallen outside these guidelines, but at age 43, I was diagnosed with stage T3b prostate cancer. My cancer will not be cured under any known regimens, but my life was saved (or extended) by knowing about the cancer and by undergoing treatment.

  6. Russell Windle March 4, 2010 at 7:36 am

    The new guidelines for prostate cancer are in a word inane.
    Were it not for a PSA test that showed my PSA at 5.2, which lead to a DRE that located a bump on the right lobe of my prostate and to a biopsy that confirmed cancer (Gleason 4+3), I would not be celebrating my ninth year of being prostate cancer free, I would be dead or dying by now. The American Cancer Society should rethink the death sentence they are assigning to men under the guise of guidelines, because that what it would have been for me. A PSA test is not perfect, but it can be re-done, and it was a tool that saved my life, and I am sure many others. These new guidelines are stupid, stupid, stupid.

    Russell L. Windle

  7. Paul Carpenter March 4, 2010 at 10:54 am

    I can’t argue with the first guideline:
    > Asymptomatic men who have at least a ten-year life expectancy
    > should have an opportunity to make an informed decision with
    > their health care provider about screening for prostate cancer
    > after receiving information about the uncertainties, risks,
    > and potential benefits associated with screening.
    <—
    Naturally, this information should include the context: Most men will get prostate cancer, and for most of them it will never be life-threatening or even symptomatic. It should also include the current sad fact that screening often leads to treatment that causes permanent damage despite usually being unnecessary.

    I can think of no reason whatsoever for withholding such information from men until they are 50, or 45, or 40. Far better they should get used to the idea that "prostate cancer is common in middle-aged men, almost universal in elderly men, and usually not life-threatening" decades before they're faced with a treatment decision.

    The stretchiest guideline is this one: "Prostate cancer screening should not occur without an informed decision-making process." On whose part? How much information? If it were me, I'd want my doctor to say, "Now that you've turned 40, various things will probably start going wrong as you age, such as [examples]. Chances are good that by age 65, you'll be at risk for one of the biggies, like cancer. If so, we will wish then that we had had information about you now when you were 40, so that we could do better at recommending responses to signs of disease at age 65, or 60. So I recommend several tests now, expecting the results to be negative but informative, and repeated again in 5 or 10 years. Or, some results might indicate a need for more frequent information, or even treatment. If you agree with this approach, let's look at the tests themselves and the followup I'd recommend if the test result is negative, ambiguous, or positive."

    Buried at the end of a middling paragraph is this important quote from Dr. Wolf: "While early detection may reduce the likelihood of dying from prostate cancer, that benefit must be weighed against the serious risks associated with subsequent treatment, particularly the risk of treating men for cancers that would not have caused ill effects had they been left undetected." That information is absolutely crucial for men to make an informed decision. Some variant of it should be communicated to every man before a prostate biopsy is proposed, again before the biopsy is performed, and again before any treatment recommendation is made.

  8. Jerry Sims March 4, 2010 at 12:24 pm

    What ever general guidelines are. The challenge is how to educate men so they can make the right decision for them, at the right time all trough live

  9. Steve Brown March 4, 2010 at 5:24 pm

    I don’t see why they’re saying it can lead to unneccessary treatment. It can lead to unnecessary BIOPSIES,
    and while they’re not fun, I’d rather have a negative biopsy than miss a cancer. The PSA test saved my life. Due
    to the family history of my father dying of prostate cancer (and it’s NOT always SO slowly growing-some strains
    grow more rapidly than we’d like to think), and two uncles having it, they were watching me closely. And in 2000,
    I had a high reading, but negative biopsy. Three years later, high reading (6.1, not that high, but for my age it was,
    50 yo.), and the biopsy was positive in two cores. It was about to take leave of the capsule. DRE detected nothing.

    I also enjoy the comfort of post-operative screening. Since 2003, it’s been undetectable. Seven years (Six actually,
    the last one was done almost six mo ago.). Time is coming for the next one.

  10. John A. March 6, 2010 at 10:57 am

    In reading the new American Cancer Society recommendations for whether
    and when men ought to get tested for prostate cancer, I am reminded of
    the sorts of rationales given during the Vietnam War for sending
    understrength units into exposed positions as “bait” to draw the enemy
    into battles where they could be surrounded and defeated by
    reinforcements air-dropped in. –The strategy sounds great back at the
    Pentagon, and maybe even at Division Headquarters, but when you are one
    of the troops being sent out as “bait”, the feeling about it is quite
    different!
    In the cold, analytic halls of the ACS, it may sound perfectly
    reasonable to keep men ignorant of their prostate cancer status, but no
    man who has actually been diagnosed with the disease is likely to agree.
    I think they are probably correct that a lot of men are undergoing
    treatments they maybe didn’t need, and so are suffering needless quality
    of life losses as a result of being diagnosed with PCa, but then I think
    the ACS picked the wrong means to address the problem. Instead of
    urging men to forgo testing, they should have urged doctors to keep
    testing everyone, and the earlier the better(!), but THEN to be much
    more circumspect in recommending what may be excessive or premature
    treatment. THAT is where doctors ought to be much more forthcoming with
    information and conversation with their patients: The “Okay, what are
    we going to do about it?” part, and NOT the “Let’s not check because if
    we do we might find something.” part.
    Any time there is a disease that is infinitely curable if caught and
    treated early, but generally fatal if diagnosed too late, it is just
    nutty to suggest that possible victims not get tested earlier rather
    than later. But then after a guy gets diagnosed with it, then is the
    time for the doctor to sit down with them and say, “Okay, it is cancer,
    but it appears to be early, small, and non-aggressive, so I recommend we
    just keep an eye on it.” or “Based no the rise in your PSA and the
    Gleason score of your tumor, I recommend we do surgery or radiation at
    the earliest possible date.”

  11. Jeff Kreisberg March 6, 2010 at 12:39 pm

    You will need to become educated about PSA and prostate cancer before you have that discussion with your doctor because it’s unlikely that she’ll bring it up. It’s just another item on the lab order form that’s automatically checked.

  12. Craig Pynn March 8, 2010 at 12:36 pm

    This is a great forum. Although I’ve been silent up to this point, I’ve been following the conversation about the ACS announcement re PSA testing with mixed emotions, since annual PSA tests (and DREs) failed to detect my cancer.

    Back story: Following a bout of prostatitus in 2001 at the age 57, a biopsy reveled high grade PIN and BPH, but no cancer. Subsequent annual PSA tests bounced along between 1 and 1.5 for the next 7 years, with my primary care doc performing a DRE each year, always declaring, “all’s well–nothing more than BPH.”

    In late 2008, a bout of hematuria led to a biopsy, which showed 11 out of 12 cores cancerous, all Gleason 8, even though my PSA was 1.53. The uro doc did a cystoscopy, found a lesion in my urethra, leading to a urethral biopsy, which confirmed locally advanced PCa. (At least I didn’t have to endure surgery to find that out…)

    Treatment: ADT and 42 sessions of IMRT/IGRT. Just completed my first year of ADT (Vantas), now starting year 2 of ADT with Degarelix since T never got below 40 on Vantas. My PSA is currently undetectable (and may that last for a long time…)

    I realize I’m part of a very small population that ends up with aggressive PCa even though they have a PSA well within the “normal” range. My experience notwithstanding, I heartily endorse the idea of PSA screening, but it needs to be more than a non-urologist looking at a number and performing a half-hearted DRE.

    The ACS recommendation makes sense from a statistical and cost/benefit point of view, and I agree that deciding whether or not to test should be a “shared decision” between doctor & patient. If the ACS announcement causes docs (especially primary care docs) to initiate a conversation, that would be great.

    Retrospectively, given my history of prostatitus and PIN, I wish I’d been a more aggressive informed medical consumer and followed up assiduously since the system certainly didn’t do it for me. (No, I didn’t stay under the care of urologist after the prostatitus since my “normal” PSA sent me back to my primary care doc, who, zealously guarding the referral gate, saw no reason for me to go back to the uro doc—and I didn’t insist on it.)

    However, with its over-emphasis on the downsides of PSA testing without equal emphasis on its clear benefits, the ACS pronouncement sews even greater confusion among the male populace (and probably their primary care docs, as well). And that’s just going to lead to more men doing nothing because there’s it’s difficult to think of a more effective way to cause guys to avoid dealing with their prostates than to bandy about the two “I” words. Not to mention insurance companies and HMOs, who would be only too happy to avoid the expense.

  13. Steve C. March 8, 2010 at 11:22 pm

    I was diagnosed almost 15 years ago at age 58 and elected surgery. Pathology after surgery showed Gleason 9, positive surgical margins, and 30 to 40 % of the prostate being malignant. Because of the positive surgical margins I followed up with external; beam radiation. My PSA stayed at the lowest levels reported by the PSA assays for the next 6 or 7 years and then began creeping up slowly. I had bone and CAT scan on 3 different occasions. This year they showed the beginning of metastasis to the bone. I am now being treated for that.

    Given the high Gleason, the extent of the malignancy, and the positive surgical margins, I don’t think that anyone would deny the fact that my prostate cancer was no “pussycat” and that if I had not been diagnosed and treated I would most likely have died within a few years or less.

    As it is, I’ve had 15 years of good life. Given that I now have detectable metastases, it is not unlikely that I will eventually die FROM prostate cancer rather than WITH it. However, statistically, with continued treatment, I should have many more years of good life left.

    What do I think of the new ACS guidelines? I believe that my having serial PSA tests and follow-up treatment have added a minimum of a decade to my life and hopefully it will be at least two decades. While the current ACS guidelines discuss choice, they discourage ever getting to the point where you would have such a choice.

  14. Ron Gerhard March 9, 2010 at 10:49 am

    As I read the American Cancer Society’s recommendations for prostate cancer testing I knew I needed to comment:

    A LIFE DESTROYED – DON’T WALK IN MY SHOES!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    Part 1- My rebuttal to the American Cancer society and a wake-up call to men whose windows of opportunity are still open:

    So, the American Cancer Society says PSA tests may lead to over-treatment of prostate cancer and unnecessary tests and so on and so on. Well, you don’t want to walk in my shoes.

    I went to my family physician and two urologists who either by stupidity or arrogance had already implemented these recommendations and refused to do a biopsy or tell me that a slowly rising PSA (mine was always within the “normal” range) could be cancer. I had been getting a PSA check annually as part of my comprehensive annual physical and was always told I was within normal range.

    What was really happening was my PSA was slowly rising since I was 48 years old. I made these results available to all three of my doctors, since the PSA was part of my annual company physical, and visited them on multiple occasions – obviously concerned that something was amiss with me, especially since I had unusual bleeding from time to time starting at age 50. My comment to all three that I “don’t want to wake up in a year and find out I have cancer,” was greeted with, “No, it isn’t that,” and “Don’t worry, you don’t die from this you die with it,” and, in the case of the second urologist after an ultrasound, “you have a nodule but it is benign.”

    None of these doctors recommended performing the biopsy and the second-opinion urologist not only lied to me but tried to talk me out of the biopsy – which I finally insisted upon at age 52. Not one of these doctors ordered a PSA test after I met with them – rather they just reviewed my annual checkup numbers. Perhaps a different doctor would have ordered an interim PSA to see if the rise continued and ordered the biopsy earlier. My point is not that I had bad doctors or that I was not diligent enough in looking out for myself – both of which are true. Rather, my point is that unknown to me at the time I was following precisely what the American Cancer Society is now recommending.

    A LIFE DESTROYED – DON’T WALK IN MY SHOES!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    Part 2 – Conclusions and suggestions:

    Life is a series of choices – some get made for us and some we make.

    If you choose to not get tested and are unlucky enough to wind up like me, here is what you can expect. I have spent tens of thousands of dollars on surgery, salvage radiation, more surgery and now hormone drugs and other medications. I have experienced various degrees of impotence and incontinence as well as size reduction. I don’t believe any man really recovers from that surgery, and post-surgery I had negative margins and was told surgery cured me.

    After recurrence I had salvage proton radiation in the hope I would be cured finally – quite an expensive trip to Loma Linda in California from Pennsylvania (albeit enjoyable with no side effects and fabulous care – often called a “radiation vacation”) and another recurrence; this time not in the prostate bed which the salvage radiation killed, but, in the lung.

    Prostate cancer sure does have mind of its own, members of the American Cancer Society. Realize too, that while time is passing you will have many sleepless nights wondering if you could have been cured if someone had done the tests earlier. You will have the anxiety of the next doctor visit and the next test result for as long as you live with what is now a terminal disease. When you have exhausted all treatment options for a total cure you will get hormone therapy which will work for some length of time, but nobody knows how long, since each case is different, sort of like a sick case of Russian Roulette.

    So you get to go into each test wondering if this is the one where the treatment will fail. When that happens you can go into chemotherapy, clinical trials, etc., etc, with the additional side effects. And then there also the hot flashes, no sex and “man-boobs.” Your mission is to try to hide those as best you can while you are on the hormones.

    And then, you get to explain all this to your kids and wife and watch the tears roll down their faces as they watch you try to deal with all this and as they see their daddy and husband change. And you will pray and hope and if you get through a day without thinking about it you will rejoice. And if you are like me, you will wonder about future weddings and grandchildren. And you will put up the good fight and keep that positive attitude because that is what we are told to do, however, from time to time you will feel total despair inside and lose all hope. Then you will try to buck up again and have hope that you will be the miracle and press on. Then a few days will pass and the despair will come again and you will want to tell the doctors who would not perform a biopsy that “it may be better to die from it than live with it.” And die from it you will, if you live long enough. Life as you knew it previously is destroyed. From my viewpoint, more and earlier testing is the only way to go.

    Testing saved my younger brother’s life, who was tested for a year or two after my diagnosis and ended up getting prostate cancer at the same age as I did – 52 years old. We had no family history, other than mine.
    He caught his early, has a total cure, and thanks me for saving his life. Glad he didn’t leave this up to the American Cancer Society and its doctors/disciples.

    So for you men whose window of opportunity is still open – don’t walk in my shoes. Ignore this stupid advice and ask your doctors if they are willing to do the tests at your request today. And if they hesitate, get a new doctor immediately. Get an annual DRE. And get your PSA tested every six months starting at age 45 at least, and earlier with family history. Monitor that trend, and if it starts to rise, get it tested sooner. And if the trend continues get that biopsy. The rise is more important than the number. And if you find cancer, the odds are you will catch it soon enough to cure it.

    Don’t let this disease destroy your life as I did – through my own ignorance and with the help of three doctors. Instead, insist on these tests while your window of opportunity to catch this disease early is still open. Shame on these people for these recommendations. Don’t walk in my shoes.

    Fighting on with my brothers,
    Ron Gerhard, Greensboro, N.C.

  15. Craig Pynn March 10, 2010 at 11:46 am

    So, gentlemen, what do you make of the op ed re the evils of PSA screening in yesterday’s New York Times?
    http://www.nytimes.com/2010/03/10/opinion/10Ablin.html?emc=eta1

  16. Stan Rosenfeld March 11, 2010 at 11:41 am

    Of course the Abin op-ed piece had many more errors than I have put in this letter to the Times. What a mess!

    The Great
    Prostate Mistake

    Richard Ablin wrote a dangerous op-ed piece with misleading
    information, important missing information and errors of logic.

    1. His stated instance of the 3.8% detection rate of prostate cancer figure that the FDA used to approve the PSA test was accurate in 1986,but is misleading now, as the current figure is
    significantly higher.

    2. Missing is the fact that death rates from prostate cancer
    declined dramatically in the U.S. – from 39,000 to 27,000 – since 1991, when the PSA test was beginning to be used. And an equally marked decline is in how often prostate cancer is found outside the prostate – from 21% then to 4% now.

    3. How can the author claim that the PSA test has a place in indicating a return of prostate cancer after treatment if the patient hasn’t found his cancer in the first place?

    Doctors, patients, and opinion makers need to divorce testing from treatment. The first is effective and the latter is not always necessary.

  17. bariatric surgery March 12, 2010 at 2:02 am

    From this article,I come to know the new updates regarding the Prostate cancer and its screening rates. Doctors, patients, and opinion makers need to divorce testing from treatment. The first is effective and the latter is not always necessary.Retrospectively, given my history of prostatitus and PIN, I wish I’d been a more aggressive informed medical consumer and followed up assiduously since the system certainly didn’t do it for me. (No, I didn’t stay under the care of urologist after the prostatitus since my “normal” PSA sent me back to my primary care.

  18. American Cancer Society Updates Prostate Cancer Screening … March 16, 2010 at 1:41 am

    […] In late 2008, a bout of hematuria led to a biopsy, which showed 11 out of 12 cores cancerous, all Gleason 8, even though my PSA was 1.53. The uro doc did a cystoscopy, found a lesion in my urethra, leading to a urethral biopsy, …This Post […]

  19. Richard E. Gillespie March 22, 2010 at 10:55 pm

    ;
    I disagree with this statement

    “While early detection
    may reduce the likelihood of dying from prostate cancer, that benefit must be weighed
    against the serious risks associated with subsequent treatment, particularly the risk of
    treating men for cancers that would not have caused ill effects had they been left
    undetected.”

    If a man lived with undetected prostate cancer, low grade or advanced, it is often more accurate to conclude that the man died “with the disease,” rather than automatically assuming that prostate cancer did not contribute in any way to the individual’s demise. A VCU physician two years ago admitted that there had been no research done to determine the results of consciously doing nothing to treat prostate cancer, even low grade disease. So why are many doctors too readily concluding that most prostate cancers won’t kill a patient,so the danger is over treatment

    I know from personal experience that friends, suffering from cancer or other serious diseases died instead from some malady such as pneumonia, because the disease itself over time had seriously weakened the individual’s immune system to respond to almost any disease. My wife, suffering several years from another serious malady, proved unable to survive even a mild bout with pneumonia. Her sediment rate was close to 100 and her C-Reactive Protein level was extremely high (7-8).Alas, doctors did not pay attention!

    Physicians, I think, in their haste to issue a death certificate often don’t sufficiently investigate a prostate cancer patient’s death to determine what role this dread disease actually played. I myself am living “with prostate cancer.” I assume I will die “with prostate cancer.” Since my PSA is not sky high, I don’t want some doctor reporting, without serious investigation that I automatically died from some other cause.

  20. Richard E. Gillespie March 22, 2010 at 10:58 pm

    Physicians, I think, in their haste to issue a death certificate often don’t sufficiently investigate a prostate cancer patient’s death to determine what role this dread disease actually played. I myself am living “with prostate cancer.” I assume I will die “with prostate cancer.” Since my PSA is not sky high, I don’t want some doctor reporting, without serious investigation that I automatically died from some other cause.

  21. American Cancer Society Updates Prostate Cancer Screening Guidelines. April 28, 2010 at 7:44 am

    Here is the latest American Cancer Society Prostate Cancer Screening Guidelines press release. Please leave comments about these guidelines, by clicking to comment here

  22. Katie May 7, 2010 at 9:26 am

    I have to agree with Jerry. The biggest hurdle is educating men.

  23. Audrey May 7, 2010 at 1:16 pm

    This is great news and very needed. My grandfather died of prostate cancer at the age of 64. Now my dad is concerned and is reading James Norris’s new book, “To Pee or Not to Pee…”, which has some humor in it, but also great information on prostate health. You should check it out!

  24. Bruce May 20, 2010 at 10:27 pm

    Of course the Abin op-ed piece had many more errors than I have put in this letter to the Times. What a mess!

    The Great
    Prostate Mistake

    Richard Ablin wrote a dangerous op-ed piece with misleading
    information, important missing information and errors of logic.

    1. His stated instance of the 3.8% detection rate of prostate cancer figure that the FDA used to approve the PSA test was accurate in 1986,but is misleading now, as the current figure is
    significantly higher.

    2. Missing is the fact that death rates from prostate cancer
    declined dramatically in the U.S. – from 39,000 to 27,000 – since 1991, when the PSA test was beginning to be used. And an equally marked decline is in how often prostate cancer is found outside the prostate – from 21% then to 4% now.

    3. How can the author claim that the PSA test has a place in indicating a return of prostate cancer after treatment if the patient hasn’t found his cancer in the first place?

    Doctors, patients, and opinion makers need to divorce testing from treatment. The first is effective and the latter is not always necessary.

  25. Bruce May 21, 2010 at 11:11 pm

    Physicians, I think, in their haste to issue a death certificate often don’t sufficiently investigate a prostate cancer patient’s death to determine what role this dread disease actually played. I myself am living “with prostate cancer.” I assume I will die “with prostate cancer.” Since my PSA is not sky high, I don’t want some doctor reporting, without serious investigation that I automatically died from some other cause.

  26. treat prostate cancer naturally June 9, 2010 at 8:03 pm

    I agree with you, I definitely think that it is not a good move to report that someone died from another cause when in reality, it is prostate cancer that led to that person’s death.

  27. Pearly Vittitoe July 10, 2010 at 5:41 pm

    I like this blog…excellent info. discovered it on Bing. I learned a lot about prostate cancer and will save it as a favorite.

  28. anita December 6, 2010 at 8:23 am

    DEC. 7 2010 MY HUSBAND HAS BEEN DIAGNOSED WITH STAGE THREE PROSTATE CANCER. HE IS 58, AND THIS WAS HIS FIRST PSA TEST. HE HAD SYMPTOMS FOR A FEW YEARS BUT THE DOCS. SAID IT WAS ENLARGED A LITTLE NOTHING TO WORRY ABOUT. NOW WE ARE FACING THE BONE SCAN, AND MRI TO SEE HOW FAR IT IS. WE KNOW IT IS IN THE SEMANAL VESSEL. HIS PSA WAS 20, HIS GLEASON IS 8-9. 13 OUT OF 14 BIOPSIES WERE POSITIVE. TELL US ABOUT EARLY DETECTION, NONE WAS TOLD. THIS IS THE SECOND TIME WE HEARD CANCER THIS YEAR. I HAD A PARTIAL MASTECTOMY IN MARCH. I AM TERRIFIED FOR HIM.MINE WAS CAUGHT EARLY, BUT HERE WE ARE AGAIN, SCARED AND WORRIED. GET TESTED!!!!!!!

  29. Teeter Hang ups February 7, 2011 at 11:43 pm

    Early cancer screening is one of the best weapons we have against cancer. The American Cancer Society recommends that even people with no symptoms go see a physician for cancer screening, which can reduce incidence and mortality rates and improve survival.[1,2] Usually when a patient already has symptoms, the cancer has spread, this makes curing it more difficult with the treatments offered today.

    Some cancers in early stage never cause symptoms, but if found by a screening test, it may improve the chance of a cure or help the person live longer. A lot of research has been done to establish guidelines for the optimal method and timing of various screening procedures, including breast, lung, prostate, colorectal, cervical, and so on. For example, more than 85 percent of the men and women who are diagnosed with lung cancer are diagnosed in a late stage, after symptoms occur and when there is very little chance of cure. As a result, approximately 95% of the 173,000 people diagnosed each year die from the disease. With early detection, 85 percent of cancers can be found in the earliest, most curable stage. If treated promptly with surgery, their cure rate is 92%[3]. Therefor, one of our most potent strategies to accomplish cancer screening is serious.

  30. strumpfhosen February 28, 2011 at 12:40 pm

    If antibiotics lower a rising PSA dramatically, but then the PSA rises again, what is the recommended action? Perhaps, the infection was not totally eliminated and the antibiotic treatment should be tried again. Also, how quickly does the PSA return to normal after a prostititis infection has been cleared and is it always cleared on the first round of antibiotics.

  31. brenda c. andersen May 18, 2011 at 3:53 pm

    Whatever you do, don’t ASSUME your urologist is telling you everything. My husband and I floated for two months thinking the hormonal treatment was going to “do the trick” of eliminating his cancer. Little did we know. We were so uneducated, we didn’t even know the questions to ask. Found out through research the real story. In fact, we got most answers from a local vitamin/supplement guru !! My husband’s cancer is not confined to the prostate, and the Gleason score was 4 + 4 = 8. Aggresive, and the MD never gave us a clue. I’ll tell you he found a different couple the next time we met: we insisted on a referral to an oncologist to start with…and some other lab tests. We’ve learned a great deal, but it wasn’t through the urologist. Nice guy, but dishonest by omission. Research, research, and did more research. Good luck in your own journey

  32. strumpfhosen November 21, 2011 at 4:42 am

    Starting at age 50, talk to your doctor about the pros and cons of testing so you can decide if testing is the right choice for you. If you are African American or have a father or brother who had prostate cancer before age 65, you should have this talk with your doctor starting at age 45. If you decide to be tested, you should have the PSA blood test with or without a rectal exam. How often you are tested will depend on your PSA level.

Leave A Comment