John,

This quote from your link:

"Clearly, we need a better way of detecting prostate cancer at its earliest stages and as importantly, [we need] a method of determining which tumors will progress."

It's true that many men do not have to have treatment and when everything is properly explained to them, they can and do choose active surveillance.

One of the big problems is, a urologist will recommend a radical prostatectomy and the man puts blind faith in the doctor and has it done even though he would have been a candidate for no treatment, or a different treatment. When the treatment fails to cure the patient, the urologist then passes the patient on to his favorite salvage treatment, which in most cases is radiation.....and, when that fails to cure, he puts the patient on Chemo. and/or hormone therapy.

If you're like most men, you know nothing about prostate cancer so you take the advice that is provided by the doctor.

Luckily, after the doctor told me I wasn't cured (from the surgery), I had just got connected to the internet and I immediately began searching for alternatives......I no longer trusted the doctor. I found a large group of survivors/patients including a half dozen doctors that were volunteering their time. They guided me to make contact with Medical Oncologists that specialize in Prostate Cancer. This saved me much pain and suffering and my life.

So, to make a long story short, one of the things that skews the figures that appear in these studies are many doctors that choose a 25,000-40,000 surgery charge over a patients welfare.

Men have to educate themselves in the alternatives and, yes we do need a better test.......but, right now, the PSA test is all we got.




>Dale,
>
>Here's an article from the US National Cancer Institute: http://www.webmd.com/prostate-cancer/news/20090318/new-debate-on-prostate-cancer-screening
>
>As you can see, they focus on "survival." This is a good example of the "quality years of life" issue I talked about. Mortality adds to 100% in the end so it would be a mistake to require the health service to drive down mortality rates in every area, because it still has to add up to the same in the end. That sort of thinking leads to heroic but ultimately counterproductive efforts towards the end of somebody's natural term. The goal of the health service is not to juggle percentages but to improve quality of life in a cost-effective manner that makes sense. The way to see prostate screening across the board is not to discuss mortality but to quantify the life impacts of catching the disease early. IMHO anyway.
>
>One topic that does matter is the number of people who require treatment after screening to save one life. In the case of breast cancer, it's 10 women needing treatment after screening to save one life. In the European study of prostate it's about 50 men needing treatment after screening to save one life. The challenge is to be sure that one of those men isn't the example I gave elsewhere, somebody who never really recovers and dies in hospital. In that case you've saved one life but you've also ended one early. If it is true that men with prostate tend to be older, what if it actually "costs" 2 or 3 lives to "save" one? This does not show in the cancer mortality figures but it is something that deserves responsible consideration.