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
Mr Randall
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.
Joe Paduda
Sent from my iPhone
Joseph Paduda
Health Strategy Associates, LLC
203-314-2632
Begin forwarded message:
Date: March 12, 2010 8:22:04 PM EST
Subject: FW: New "Contact Us" submission from Sabina Carinci
Joe,
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.
http://www.yourownhealthandfitness.org/notenoughhealth.php
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.
Sabina Carinci
------ Forwarded Message
From: Ed Randall <edwrandall@yahoo.com>
Date: Thu, 11 Mar 2010 07:27:23 -0800 (PST)
To: Sabina Carinci <scarinci@verizon.net>
Cc: Joseph Nunziata <joseph@nunziata-advertising.com>, Dan Mulligan <dan.mulligan@batforthecure.org>, <michaelrizzo@nyc.rr.com>, <neilromano@comcast.net>, <shelleychristie@yahoo.com>, <tmorrow@womenagainstprostatecancer.org>
Subject: New "Contact Us" submission from Sabina Carinci
Dear Sabrina:
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.
Sincerely,
Ed Randall
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
email:
phone:
message:
http://www.joepaduda.com/archives/001760.html
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
Posts
2 comments:
Dear Ed,
I am a big fan of baseball and of "Talking Baseball". And I am a doctor at a very well-known cancer center whose father and grandfather both had prostate cancer.
I too appreciate your passion about the subject of prostate cancer. However, your views on PSA are as cloudy as your vision on baseball is clear. I believe you are not looking at PSA correctly. First off we need to refute your usual rejoinder: WE HAVE NO IDEA WHETHER YOU WOULD BE ALIVE OR NOT RIGHT NOW had your prostate cancer not been diagnosed. Since you are knowledgeable about this subject you undoubtedly know that most men die *with* prostate cancer, and not *of* it. There is absolutely NO WAY you can possibly know that your treatment saved your life. And that is one of the many problems with PSA. Not only does it have poor sensitivity and specificity for prostate cancer, even when it is right about prostate cancer being present, it can make no distinction between prostate cancer that will kill you and prostate cancer that will leave you unharmed (like most prostate cancer).
Here is a statement from Richard J Ablin, the man who *discovered* PSA: "I never dreamed that my discovery four decades ago would lead us to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments."
I have held my tongue thus far as you preach PSA on your show, but must contribute now. Please approach PSA with more knowledge and less dogma and fanaticism. Ask yourself difficult questions such as "Do I really KNOW I would have been dead had prostate cancer not been diagnosed?" Perhaps you had a really bad sort of prostate cancer like Gleason 9 or 10, even still, Gleason score is not perfect either--we have NO REAL BIOMARKER, PSA or other, that can distinguish prostate cancer that will kill you from the kind you live with for 30 years. We DESPERATELY need such a marker--PSA is totally inadequate and potentially quite harmful. Also ask yourself the following: "Even if I indeed benefitted from PSA testing, is it possible that PSA may have led to many unnecessary procedures and damaging surgery in others who had prostate cancer that wouldn't have killed them?"
Please think carefully about what I am saying before you react negatively,
Sincerely,
--S
before funding ANY charity (su2c, ect..). please visit, MRMCMED.ORG (reform march of dimes.org) over 200 charities NO LONGER FUND animal research (humaneseal.org). animal research has NEVER been validated (pcrm.org). "currently, nine out of ten experimental drugs FAIL in clinical studies because we cannot accurately predict how they will behave in people based on laboratory animal studies" said health and human services secretary mike leavitt. "there is a laundry list of problems with mouse models of cancer research" dr.bob weinburg, director of the ludwig center for cancer research at m.i.t. every year charities spend 100s of millions of dollars on animal research. STILL no cure, how many more millions (BILLIONS??) before they listen.. and stop this INSANITY... INSANITY: doing the same thing over and over and expecting different results - albert einstein.
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