There is a dilemma surrounding the diagnosis and treatment of prostate cancer.
The PSA and DRE are imperfect indicators.
And yet, the death rate has consistently decreased from more than 39,000 in 1999 to less than 30,000 last year.
Numerous organizations my charity respects, most especially the National Comprehensive Cancer Network (NCCN), comprised of world-class cancer treatment centers including Johns Hopkins, Sloan Kettering, Stanford, Vanderbilt and Duke, believe current scientific evidence shows that finding and treating prostate cancer early, when treatment might be more effective, may well save lives.
Unfortunately, I have become accustomed to disappointing statements regarding prostate cancer from the American Cancer Society, a bureaucracy infested with a self-interest that will never be confused with yours or mine. They ignore a decade of prima facie evidence that vigorous testing have been accompanied by a dramatic reduction in deaths from prostate cancer. The new so-called 'guidelines' are, in a word, inane. In effect, the ACS, without conscience, is assigning death sentences to countless men under the guise of 'guidelines.' 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.
No, the PSA is not a perfect test. But it was the test that saved my life.
As many men as possible should have the opportunity to make an informed decision after receiving information about the uncertainties, risks and potential benefits associated with screening. Doctors, patients and opinion makers need to divorce testing from treatment.
I also find it hard to even dignify what passed for a dangerous Op-Ed column in The New York Times this past week from Richard Albin. It was overflowing with misleading information, important information was omitted and there were errors in logic.
Here's just one simple question for him: how can he 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?
Frankly, this is not a debate for me.
Sent: Sat, March 13, 2010 7:37:25 AM
Subject: Fwd: New "Contact Us" submission from Sabina Carinci
One of the readers of my blog ManagedCareMatters.com forwarded your note along.
I certainly appreciate the passion and depth of commitment you bring to this issue. I feel the same about the problems inherent in what I believe is over-testing and resulting devastating effects on men, their families, and the entire health care system.
You mention that the evidence against the PSA test is blown away by your belief that it saved your life. There is a cost, in dollars and human suffering, of that result. Hundreds of men were misdiagnosed, rendered incontinent and impotent, subjected to an intensely painful procedure, as a result of false diagnoses. In a very real way, those men 'paid' for each succesful outcome.
How many men need to suffer before the societal cost outweighs the benefit?
Far too many men receive false positive - and false negative - results from the PSA test, so many that the physician who discovered the antigen has publicly decried the test as presently performed.
Incontinence and impotence are only two of the 'side effects' of inappropriate testing. And far, far more men suffer from these than have an accurate diagnosis of the deadly form of prostate cancer.
With all due respect to Mr Haynes, we don't know if his cancer was the deadly firm or not.
We also don't know how many men were harmed by testing that is notoriously inaccurate.
If I may, I'd suggest you may want to consider using your considerable influence to encourage development of a more accurate test, one with fewer and less severe side effects.
I say this with respect and admiration for the passion and commitment you bring to this subject, and hope that all of us can help our fellows lead healthier, happier lives.
Sent from my iPhone
Health Strategy Associates, LLC
Begin forwarded message:
Date: March 12, 2010 8:22:04 PM EST
Subject: FW: New "Contact Us" submission from Sabina Carinci
I am going to assume based on the number of cc's of the email below that quite a few people contacted Ed Randall about his advocacy of routine PSA screening at your recent urging. Apparently there is something to be said about "strength in numbers" since you remarked he wouldn't reply to you alone. I am forwarding the reply in the event you haven't yet seen it. With any luck he will reply to you as well now.
If I recall correctly the exact points you mentioned about PSA screening were mentioned in the book Too Much Medicine-Not enough health.
Mr Randall mentions the recent breast cancer screening guidelines as well which I believe the author devoted an entire chapter to even before all of the latest uproar. I recommend this physician written book if you haven't already read it. I have no interest in the sales of this book-I just found it quite interesting.
Thank you for your blogs. I enjoy them a great deal.
------ Forwarded Message
From: Ed Randall <firstname.lastname@example.org>
Date: Thu, 11 Mar 2010 07:27:23 -0800 (PST)
To: Sabina Carinci <email@example.com>
Cc: Joseph Nunziata <firstname.lastname@example.org>, Dan Mulligan <email@example.com>, <firstname.lastname@example.org>, <email@example.com>, <firstname.lastname@example.org>, <email@example.com>
Subject: New "Contact Us" submission from Sabina Carinci
Thank you so much for contacting us.
The theory--and all it is is a theory--that there should be little-to-no testing, that men are being over-tested is shot out of the sky by this simple fact: had I not been taken that same PSA test, I would be unable to respond to your note because I would have died at age 47.
And thanks to the testing I provided in concert with the Tampa Bay Rays last July, there is a man in St. Petersburg, Florida named Chuck Haynes who credits me with being alive today. He came up to me that day and said, "Ed Randall, you saved my life."
A couple of months ago, the federal government issued new, less stringent guidelines for breast cancer testing for women over the age of 40. There was such a furious reaction from women that Health Secretary Kathleen Sebelius had to call a press conference the following day to disavow what had been said the day before.
Unless and until there is a viable alternative, this charity will continue its work to save lives.
Subject: New "Contact Us" submission from Sabina Carinci
You've received a new submission from your "contact us" through your "Ed Randall's Bat For The Cure" Andy's Web Tools web site.
name: Sabina Carinci
please reconsider your advocacy of routine prostate cancer screening in light of the scientific evidence. see above and links within. thank you.
------ End of Forwarded Message