Good evening, MNCC! Now that Movember, a movement to raise awareness and funds for men’s health, including prostate cancer, is drawing to a close, I thought it would be a good time to provide an update of sorts on my first diary from two years ago.
Monday Night Cancer Club is a Daily Kos group for anyone who has cancer, has a loved one with cancer, or who has questions, issues, or information to share about cancer, including clinicians, researchers, or others who have a special interest and can help to educate our readers. We have many different members who fit all these categories, sometimes more than one at a time. Please share if you can, or just listen; there is plenty to learn just from reading our extensive catalogue of past diaries and postings. All are welcome to use this group as a resource. Volunteer diarists post Monday evenings between 7:30-8:30 PM ET on topics related to living with cancer, which is very broadly defined to cover physical, spiritual, emotional and cognitive aspects. While most diaries focus on a specific topic or area relevant to cancer, each diary is also an Open Thread for sharing concerns, announcements, and information. Mindful of the controversies endemic to cancer prevention and treatment, we ask that both diarists and commenters keep an open mind regarding strategies for surviving cancer, whether based in traditional, Eastern, Western, allopathic or other medical practices. This is a club no one wants to join, in truth, and compassion will help us make it through the challenge together.
A main discussion in that diary was the use of the prostate-specific antigen screening test (PSA). In May, 2012, the US Preventative Services Task Force issued their recommendation against using the PSA test to screen men for prostate cancer. Officially, they have graded the test a “D”, which means they discourage the use of the test; they don’t actually say it shouldn’t be done, just that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” Previously, in 2008, the USPSTF made the same recommendation for men over 75.
So what has happened since? An article in the Washington Post details some statistics of a new study published in the Journal of the American Medical Association. According to the study, use of the PSA test has declined 25% in 5 years. 40.6% of men over 50 reported having the test in 2008, and that has dropped to 30.8% in 2013. Similarly, and not unexpectedly, the resulting rate of prostate cancer diagnosis in men over 50 has dropped from 534.9 per 100,000 in 2005 to 416.2 per 100,000 in 2012. I don’t know why the statistics don’t line up by year with the study, but the trend is clear. This translates to about 34,000 fewer men receiving diagnoses in 2012 vs. 2011. And of course, this means that over the 5 years of the study, and presuming the trend is the same in the last three years, we can presume there are hundreds of thousands of men who might have been diagnosed who now have not been diagnosed.
This is dramatic, to be sure. But is this a “good” outcome? To quote Otis Brawley, Chief Medical Officer of the American Cancer Society, and one of the authors of the study:
“It’s only a good thing if (the numbers) went down because doctors and patients consciously decided together that it shouldn’t be done...I think it’s terrible to tell a man he must get screened. I think it’s terrible to tell a man he can’t get screened.”
Personally, I worry about the number of men who might succumb to an aggressive cancer that was missed due to not screening. But I am heartened by the number of men who are now not undergoing radical prostatectomies for relatively indolent cancers, and avoiding the considerable side effects that affect quality of life.
What do you think? As always, please also consider this an open thread to discuss anything that’s on your mind today.