DavidR

DavidCPA referenced the The United States Preventive Services Task Force final report in May 2012 on PSA testing which concluded that with a positive PSA test, risks of harmful side effects from treating prostate tumors that may be too slow-growing to ever cause a problem were more likely for men than the risk of dying from prostate cancer. It released a draft report back in October, 2011 for comment with the same conclusions. Basically all screening studies have demonstrated considerable harms associated with screening, but only one major study found evidence that screening saves lives -- and that study has some internal inconsistencies. It showed screening saves lives in the Netherlands and Sweden, but not in five other European countries. Even the positive parts of that study did not show a considerable increase in lives saved.
The results have been predictable: the urologists & hospitals whose business is to do PSA tests disagree, while the doctors who rely upon studies agree. Prostate cancer survivors believe it saved their lives (IMO that's because otherwise they would have to accept that they may have had unnecessary surgery and that their doctors led them astray)
The only thing I know for sure about prostate cancer is that just like our cancer, only a biopsy can tell for sure. Heads up, the prostate biopsy is reported to be extremely painful.
Even then, if you know you do have prostate cancer, watchful waiting is often the best TX. All oral cancers are aggressive so that is not an option for any OCF patient.
What I hate the most about this whole mess is the patients are caught in the middle of the doctor's fights. Worse, the issue has been raised that some of the opposition to dropping the PSA is monetary and not medical by Dr. Otis W. Brawley, chief medical and scientific officer of the American Cancer Society and professor at Emory University, In a CNN editorial, he repeated this conversation he had
[quote]Mass screening is a lucrative business. I am haunted by a conversation I had in the late 1990s with a marketing executive at a major American hospital who bragged about his "prostate cancer business plan." His hospital conducted free screening at a local mall every September for Prostate Cancer Awareness Month.

He explained that this was not just cheap and effective advertising for his hospital system. It was also a moneymaker. As he explained it, for every 1,000 men over age 50 who were screened at the mall, 145 would have an abnormal screen, and 135 would go to his hospital for evaluation. Fees collected from them would easily cover the cost of the free screening event. About 45 in that group would have cancer; the rest would be false positives.

The marketer had figured out how many men would be treated with surgery, radiation, and hormones. He had estimates of all the money the center would make from treating all 45 cancer cases. He knew how many men would be treated for urinary incontinence, and what his net profit for treating that would be. Amazingly, he even knew how many of the men would want penile prostheses surgically implanted to treat their impotence.

I asked him one question: "How many lives will you save if you screen a thousand men?" He looked at me as if I were a fool, and said, "Don't you know? No one knows if this stuff saves lives. I can't give you a number on that."
[/quote]
Dr. Brawley's take on the opposition: [quote]As Upton Sinclair once said, "It is difficult to get a man to understand something, when his salary depends on his not understanding it."[/quote]
I wish I had the answer. Myself, I have steadfastly refused to have any PSA test. I was worried that my emotions would overwhelm me and I would just have surgery. Additionally I am biased by conversations in the waiting room for radiation where we all bonded and one prostate patient really regretted getting TX based on the PSA and biopsy and kept saying that he wished he had just waited to see if the cancer was aggressive.
As Dr. Lee Green, a primary care physician at the University of Michigan told MedPage in response to the PSA recommendation

[quote]"Cancer is a fear word," Lee told MedPage Today. "People have a need to believe, a need to feel that we have some power over this terrible disease," he said. "Admitting the truth, that PSA screening doesn't really save lives, is unacceptable because it takes that away."
[/quote]
It's not fair to us to have to decide which view is right and which is mistaken. I'm sorry to hear you are in this mess again
Charm