"Screening" tests



R

Robert A. Fink

Guest
From the Washington Post:

------------------------------------------------------------
------------

washingtonpost.com Dangers in Early Detection

By H. Gilbert Welch

Thursday, July 1, 2004; Page A23

You feel well. You're only 60. Your PSA -- the blood test
for prostate cancer -- is normal. Much to your chagrin, you
learn of recent research that suggests you still might have
prostate cancer. But the only way researchers know this is
because they performed a more aggressive test
--
placing a probe through the rectum of normal men and inserting a
biopsy
needle six, maybe 12 times to search for cancer in various parts of
their
prostate. Should this procedure be performed on you? Should it be
performed on all healthy men?

This is American medical care today -- care increasingly directed
toward
the well. Ironically, the primary service we offer them is relentless
testing to establish whether they are, in fact, sick. We screen for
early
forms of diabetes, heart disease, osteoporosis, hepatitis, vascular
disease and, of course, cancer. The conventional wisdom is that early
detection improves health. But this assumption may be wrong.

Why? Because early disease detection means more people become
patients.
Inevitably some will be treated needlessly and suffer as a result.

To understand this, you need to understand that each of us harbors
early
forms of disease. Even in middle age, many of us who feel well have
evidence of diabetes, heart disease, osteoporosis, hepatitis, vascular
disease and cancer. Just because we harbor these early forms of
disease
doesn't mean that they will ever affect our health. Some diseases
progress
so slowly that people die of other causes long before the diseases
generate symptoms. Other diseases may not progress at all. Unless we
were
tested, we'd never have known we were sick.

Prostate cancer is the classic example. Among men age 60, around half
have
microscopic evidence of prostate cancer if we look hard enough. Yet
only
four in 1,000 will die from prostate cancer in the next 10 years. How
can
this be? Because prostate cancer isn't just one disease: It's a
spectrum
of disorders. Some forms of prostate cancer grow very rapidly and kill
men. Some grow slowly and men die of something else before the cancer
ever
causes symptoms. And others look like cancer under the microscope but
never grow at all.

A little over a decade ago, doctors started looking hard for prostate
cancer using the PSA and lots of needle biopsies. And we found a great
deal: Roughly 2 million cases were diagnosed in this period -- almost
a
million more than would have been without the test.

Did prostate cancer screening help men? To be honest, we aren't sure
about
the net effect. There has been a small decline in the death rate from
prostate cancer, but this may simply reflect that our treatments are
better. While screening probably has helped a few men live longer, it
has
also clearly hurt others. Millions have been biopsied who otherwise
wouldn't have been. Many with nonprogressive disease have been turned
into
cancer patients unnecessarily. Most have been treated, and many have
suffered ill effects. A few have even had their lives shortened by
treatment.

This is the reality of early detection. A few may be helped, because
their
disease is destined to cause problems and because early treatment is
able
to solve those problems in a way that later treatment cannot. But many
simply are told earlier that they have a disease and gain nothing,
because
their disease could have been treated just as well later, when
symptoms
appeared. And others are hurt by treatment for a disease that would
have
otherwise never affected their health.

What's next? Consider CAT scans of the chest to look for lung cancer.
During mass screenings in one region of Japan, CAT scans found 10
times as
many patients with lung cancer as had been found a few years earlier
using
chest X-rays. Incredibly, nonsmokers were almost as likely to have
lung
cancer as smokers. Is smoking getting safer? Of course not. Everyone
agrees that smoking is far and away the most important cause of lung
cancer. The CAT scans were simply labeling some people as lung cancer
patients who otherwise would never be affected by a few abnormal
cells.

Why not treat these patients -- just to be safe? Because some people
die
from treatment. In the Mayo Clinic study comparing lung cancer
screening
(using chest X-rays) to standard care, more people in the screening
group
were told that they had lung cancer. It didn't help them live longer;
in
fact, slightly more people in that group died.

And some think we should scan the whole body. But the harder we look,
the
more we find. CAT scans of the chest lead more people to be told they
have
lung cancer, and there are even more abnormalities to find in the
abdomen.
As one radiologist who has read thousands of these scans put it, "With
this level of information, I have yet to see a normal patient."

Millions of healthy Americans are being told that they are sick (or
"at
risk"). More are undergoing invasive evaluations with needles,
flexible
scopes and catheters. And more are taking drugs for early forms of
diabetes, heart disease, osteoporosis, hepatitis, vascular disease and
cancer.

We need to start asking hard questions about whose interests are
served by
the relentless pursuit of disease in people who are well. Clearly it's
good business -- for test manufacturers, hospitals, pharmaceutical
companies. And it's good for some doctors.

But is it in society's interest? Many suggest that it saves money by
lowering the cost per patient. But the savings per patient (if they
exist)
are overwhelmed by the increased expense of having so many more to
treat.
Is it in the interest of sick patients? Absolutely not, as caring for
the
well increasingly distracts doctors from caring for the truly sick.
And
what about the well? Is it in their interest? Only they can decide --
after they have been informed that early detection is a double-edged
sword.

The writer is a professor of medicine in the Department of Veterans
Affairs and Dartmouth Medical School. He is the author of "Should I Be
Tested for Cancer? Maybe Not and Here's Why."

© 2004 The Washington Post Company

===================================

Best,

Bob

Robert A. Fink, M. D.
Neurological Surgery
2500 Milvia Street Suite 222
Berkeley, CA 94704-2636 USA
510-849-2555

**********************************
NOTE: The material above is not "medical
advice". Medical advice can only be
given after an in-person contact between
doctor and patient.
**********************************
 
Robert A. Fink, M. D. wrote:
> From the Washington Post:
>
> ----------------------------------------------------------
> --------------
>
> washingtonpost.com Dangers in Early Detection
>
>
> By H. Gilbert Welch
>
> Thursday, July 1, 2004; Page A23
>
>
> You feel well. You're only 60. Your PSA -- the blood test
> for prostate cancer -- is normal. Much to your chagrin,
> you learn of recent research that suggests you still might
> have prostate cancer. But the only way researchers know
> this is because they performed a more aggressive test
> --
> placing a probe through the rectum of normal men and
> inserting a biopsy needle six, maybe 12 times to search
> for cancer in various parts of their prostate. Should this
> procedure be performed on you? Should it be performed on
> all healthy men?
>
> This is American medical care today -- care increasingly
> directed toward the well. Ironically, the primary service
> we offer them is relentless testing to establish whether
> they are, in fact, sick. We screen for early forms of
> diabetes, heart disease, osteoporosis, hepatitis, vascular
> disease and, of course, cancer. The conventional wisdom is
> that early detection improves health. But this assumption
> may be wrong.
>
> Why? Because early disease detection means more people
> become patients. Inevitably some will be treated
> needlessly and suffer as a result.
>
> To understand this, you need to understand that each of us
> harbors early forms of disease. Even in middle age, many
> of us who feel well have evidence of diabetes, heart
> disease, osteoporosis, hepatitis, vascular disease and
> cancer. Just because we harbor these early forms of
> disease doesn't mean that they will ever affect our
> health. Some diseases progress so slowly that people die
> of other causes long before the diseases generate
> symptoms. Other diseases may not progress at all. Unless
> we were tested, we'd never have known we were sick.
>
> Prostate cancer is the classic example. Among men age 60,
> around half have microscopic evidence of prostate cancer
> if we look hard enough. Yet only four in 1,000 will die
> from prostate cancer in the next 10 years. How can this
> be? Because prostate cancer isn't just one disease: It's a
> spectrum of disorders. Some forms of prostate cancer grow
> very rapidly and kill men. Some grow slowly and men die of
> something else before the cancer ever causes symptoms. And
> others look like cancer under the microscope but never
> grow at all.
>
> A little over a decade ago, doctors started looking hard
> for prostate cancer using the PSA and lots of needle
> biopsies. And we found a great deal: Roughly 2 million
> cases were diagnosed in this period -- almost a million
> more than would have been without the test.
>
> Did prostate cancer screening help men? To be honest, we
> aren't sure about the net effect. There has been a small
> decline in the death rate from prostate cancer, but this
> may simply reflect that our treatments are better.

Actually the absolute number of deaths in the US due to
prostate cancer has dropped by about one quarter during the
time of large scale PSA testing. For the arithmetically
challenged, let me explain what "death rate" means. It is
the number of deaths divided by the size of the vulnerable
population, usually expressed in deaths per 100,000. So if
the actual number of deaths has declined by about 25
percent, and the vulnerable population has increased, that
means that the death rate has actually declined by more than
25 percent. That seems to me to be more than a small
decline. Also, note that death rates due to prostate cancer
have not declined in countries like Sweden which don't do
large scale PSA testing. There is no reason to believe that
US doctors are better at treating prostate cancer than
Swedish doctors. The author of this article, who has been
sermonizing about this for years, is being very misleading.
He uses language imprecisely and tries to imply more than
his words actually say. Notice the regular use of the word
"may". He is trying to convince people not to be tested for
prostate cancer. While the situation is not entirely clear,
there is no scientific evidence today for such a
recommendation. It would be better to present the actual
facts that are known, including all the uncertainties, and
then let men decide for themselves what to do.

> While screening probably has helped a few men live longer,
> it has also clearly hurt others.

The author has no scientific evidence which allows him to
estimate just how many men have had their life expectancies
increased because of screening. I could just as well say it
this way. "Screening has clearly helped some men live
longer, but it has also clearly hurt a few others." Both my
statement and his statement are misleading and not based
firmly on what we now know. There are a few studies ongoing
now which are investigating these matters, but the results
won't be in for a while. Also, since prostate cancer is such
a complex disease, any one study has to be confirmed through
other studies.

> Millions have been biopsied who otherwise wouldn't have
> been. Many with nonprogressive disease have been turned
> into cancer patients unnecessarily.

Again, he has no idea how often this happens. For example,
one study based on Medicare data estimated that 15 percent
of prostate cancer in men of European descent was treated
unnecessarily and 45 percent of men of African descent were
so treated. I don't have any great confidence in that
particular study. But suppose you learned that you had a 50-
50 chance of living a long disease free life vs suffering a
painful, quite unpleasant disease. Suppose also that the
treatment probably would cure you and you might have some
undesirable side effects which you could live with. What
would you decide?
 
In article <[email protected]>,
"Robert A. Fink, M. D." <[email protected]> wrote:

> From the Washington Post:
>
> Best,
>
> Bob
>
>
> Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
> Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555
>
> **********************************
> NOTE: The material above is not "medical advice". Medical
> advice can only be given after an in-person contact
> between doctor and patient.
> **********************************

I admit to not reading the entire above, sorry.

It's my understanding that early detection is key to curing
cancer of almost any kind. Do I have that part right?

Dale J.

--
Email: [email protected]
 
"Robert A. Fink, M. D." <[email protected]> wrote in message
news:[email protected]...
> From the Washington Post:
>
> ----------------------------------------------------------
> --------------
>
> washingtonpost.com Dangers in Early Detection
>
>
> By H. Gilbert Welch
>
> Thursday, July 1, 2004; Page A23
>
>
> You feel well. You're only 60. Your PSA -- the blood test
> for prostate cancer -- is normal. Much to your chagrin,
> you learn of recent research that suggests you still might
> have prostate cancer. But the only way researchers know
> this is because they performed a more aggressive test
> --
> placing a probe through the rectum of normal men and
> inserting a biopsy needle six, maybe 12 times to search
> for cancer in various parts of their prostate. Should this
> procedure be performed on you? Should it be performed on
> all healthy men?
>
> This is American medical care today -- care increasingly
> directed toward the well. Ironically, the primary service
> we offer them is relentless testing to establish whether
> they are, in fact, sick. We screen for early forms of
> diabetes, heart disease, osteoporosis, hepatitis, vascular
> disease and, of course, cancer. The conventional wisdom is
> that early detection improves health. But this assumption
> may be wrong.
>
> Why? Because early disease detection means more people
> become patients. Inevitably some will be treated
> needlessly and suffer as a result.
>
> To understand this, you need to understand that each of us
> harbors early forms of disease. Even in middle age, many
> of us who feel well have evidence of diabetes, heart
> disease, osteoporosis, hepatitis, vascular disease and
> cancer. Just because we harbor these early forms of
> disease doesn't mean that they will ever affect our
> health. Some diseases progress so slowly that people die
> of other causes long before the diseases generate
> symptoms. Other diseases may not progress at all. Unless
> we were tested, we'd never have known we were sick.
>
> Prostate cancer is the classic example. Among men age 60,
> around half have microscopic evidence of prostate cancer
> if we look hard enough. Yet only four in 1,000 will die
> from prostate cancer in the next 10 years. How can this
> be? Because prostate cancer isn't just one disease: It's a
> spectrum of disorders. Some forms of prostate cancer grow
> very rapidly and kill men. Some grow slowly and men die of
> something else before the cancer ever causes symptoms. And
> others look like cancer under the microscope but never
> grow at all.
>
> A little over a decade ago, doctors started looking hard
> for prostate cancer using the PSA and lots of needle
> biopsies. And we found a great deal: Roughly 2 million
> cases were diagnosed in this period -- almost a million
> more than would have been without the test.
>
> Did prostate cancer screening help men? To be honest, we
> aren't sure about the net effect. There has been a small
> decline in the death rate from prostate cancer, but this
> may simply reflect that our treatments are better. While
> screening probably has helped a few men live longer, it
> has also clearly hurt others. Millions have been biopsied
> who otherwise wouldn't have been. Many with nonprogressive
> disease have been turned into cancer patients
> unnecessarily. Most have been treated, and many have
> suffered ill effects. A few have even had their lives
> shortened by treatment.
>
> This is the reality of early detection. A few may be
> helped, because their disease is destined to cause
> problems and because early treatment is able to solve
> those problems in a way that later treatment cannot. But
> many simply are told earlier that they have a disease and
> gain nothing, because their disease could have been
> treated just as well later, when symptoms appeared. And
> others are hurt by treatment for a disease that would have
> otherwise never affected their health.
>
> What's next? Consider CAT scans of the chest to look for
> lung cancer. During mass screenings in one region of
> Japan, CAT scans found 10 times as many patients with
> lung cancer as had been found a few years earlier using
> chest X-rays. Incredibly, nonsmokers were almost as
> likely to have lung cancer as smokers. Is smoking getting
> safer? Of course not. Everyone agrees that smoking is far
> and away the most important cause of lung cancer. The CAT
> scans were simply labeling some people as lung cancer
> patients who otherwise would never be affected by a few
> abnormal cells.
>
> Why not treat these patients -- just to be safe? Because
> some people die from treatment. In the Mayo Clinic study
> comparing lung cancer screening (using chest X-rays) to
> standard care, more people in the screening group were
> told that they had lung cancer. It didn't help them live
> longer; in fact, slightly more people in that group died.
>
> And some think we should scan the whole body. But the
> harder we look, the more we find. CAT scans of the chest
> lead more people to be told they have lung cancer, and
> there are even more abnormalities to find in the abdomen.
> As one radiologist who has read thousands of these scans
> put it, "With this level of information, I have yet to see
> a normal patient."
>
> Millions of healthy Americans are being told that they are
> sick (or "at risk"). More are undergoing invasive
> evaluations with needles, flexible scopes and catheters.
> And more are taking drugs for early forms of diabetes,
> heart disease, osteoporosis, hepatitis, vascular disease
> and cancer.
>
> We need to start asking hard questions about whose
> interests are served by the relentless pursuit of disease
> in people who are well. Clearly it's good business -- for
> test manufacturers, hospitals, pharmaceutical companies.
> And it's good for some doctors.
>
> But is it in society's interest? Many suggest that it
> saves money by lowering the cost per patient. But the
> savings per patient (if they exist) are overwhelmed by
> the increased expense of having so many more to treat.
> Is it in the interest of sick patients? Absolutely not,
> as caring for the well increasingly distracts doctors
> from caring for the truly sick. And what about the well?
> Is it in their interest? Only they can decide -- after
> they have been informed that early detection is a double-
> edged sword.
>
> The writer is a professor of medicine in the Department of
> Veterans Affairs and Dartmouth Medical School. He is the
> author of "Should I Be Tested for Cancer? Maybe Not and
> Here's Why."
>
>
>
> © 2004 The Washington Post Company
>
>
> ===================================
>
> Best,
>
> Bob
>
>
> Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
> Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555
>
> **********************************
> NOTE: The material above is not "medical advice". Medical
> advice can only be given after an in-person contact
> between doctor and patient.
> **********************************

Well, this is going against the cultural bias of more,
more and more health care. Patients seem to demand it, and
think that if some test somehow discovers even one cancer
cell, or something which might be one, they need immediate
aggrressive therapy or they are doomed. Culture, not
science, is the issue here.
 
Leonard, George and Dale....

Always enjoy your answers and viepoints on subjects
discussed.....I have learned a lot from all of you.....

To "Dr" Fink, I am POSITIVE he is on the wrong track.....

I have 9 brothers....4 of us have been Dx'd with Prostate
Cancer...after knowing that 3 of my brothers had PCa, a Dr
friend of mine suggested I go for a complete phyisical exam
including PSA... After this, I found out that my PSA was 5.2
( at 49 years old)....subsequent test indicated that I also
had PCa !!! 5 years ago, I had RRP....my last PSA test was
still undetectable....In the meantime, One of my brothers
died of PCa, another is on his last days and the other is
still fighting the cancer strong....

I have SOLID evidence and experience that screening is very,
very valuable in treating PCa.

To "Dr" Fink, maybe he should go back and do his own
studies.

Fernando


"Robert A. Fink, M. D." <[email protected]> wrote in
message news:[email protected]...
> From the Washington Post:
>
> ----------------------------------------------------------
> --------------
>
> washingtonpost.com Dangers in Early Detection
>
>
> By H. Gilbert Welch
>
> Thursday, July 1, 2004; Page A23
>
>
> You feel well. You're only 60. Your PSA -- the blood test
> for prostate cancer -- is normal. Much to your chagrin,
> you learn of recent research that suggests you still might
> have prostate cancer. But the only way researchers know
> this is because they performed a more aggressive test
> --
> placing a probe through the rectum of normal men and
> inserting a biopsy needle six, maybe 12 times to search
> for cancer in various parts of their prostate. Should this
> procedure be performed on you? Should it be performed on
> all healthy men?
>
> This is American medical care today -- care increasingly
> directed toward the well. Ironically, the primary service
> we offer them is relentless testing to establish whether
> they are, in fact, sick. We screen for early forms of
> diabetes, heart disease, osteoporosis, hepatitis, vascular
> disease and, of course, cancer. The conventional wisdom is
> that early detection improves health. But this assumption
> may be wrong.
>
> Why? Because early disease detection means more people
> become patients. Inevitably some will be treated
> needlessly and suffer as a result.
>
> To understand this, you need to understand that each of us
> harbors early forms of disease. Even in middle age, many
> of us who feel well have evidence of diabetes, heart
> disease, osteoporosis, hepatitis, vascular disease and
> cancer. Just because we harbor these early forms of
> disease doesn't mean that they will ever affect our
> health. Some diseases progress so slowly that people die
> of other causes long before the diseases generate
> symptoms. Other diseases may not progress at all. Unless
> we were tested, we'd never have known we were sick.
>
> Prostate cancer is the classic example. Among men age 60,
> around half have microscopic evidence of prostate cancer
> if we look hard enough. Yet only four in 1,000 will die
> from prostate cancer in the next 10 years. How can this
> be? Because prostate cancer isn't just one disease: It's a
> spectrum of disorders. Some forms of prostate cancer grow
> very rapidly and kill men. Some grow slowly and men die of
> something else before the cancer ever causes symptoms. And
> others look like cancer under the microscope but never
> grow at all.
>
> A little over a decade ago, doctors started looking hard
> for prostate cancer using the PSA and lots of needle
> biopsies. And we found a great deal: Roughly 2 million
> cases were diagnosed in this period -- almost a million
> more than would have been without the test.
>
> Did prostate cancer screening help men? To be honest, we
> aren't sure about the net effect. There has been a small
> decline in the death rate from prostate cancer, but this
> may simply reflect that our treatments are better. While
> screening probably has helped a few men live longer, it
> has also clearly hurt others. Millions have been biopsied
> who otherwise wouldn't have been. Many with nonprogressive
> disease have been turned into cancer patients
> unnecessarily. Most have been treated, and many have
> suffered ill effects. A few have even had their lives
> shortened by treatment.
>
> This is the reality of early detection. A few may be
> helped, because their disease is destined to cause
> problems and because early treatment is able to solve
> those problems in a way that later treatment cannot. But
> many simply are told earlier that they have a disease and
> gain nothing, because their disease could have been
> treated just as well later, when symptoms appeared. And
> others are hurt by treatment for a disease that would have
> otherwise never affected their health.
>
> What's next? Consider CAT scans of the chest to look for
> lung cancer. During mass screenings in one region of
> Japan, CAT scans found 10 times as many patients with
> lung cancer as had been found a few years earlier using
> chest X-rays. Incredibly, nonsmokers were almost as
> likely to have lung cancer as smokers. Is smoking getting
> safer? Of course not. Everyone agrees that smoking is far
> and away the most important cause of lung cancer. The CAT
> scans were simply labeling some people as lung cancer
> patients who otherwise would never be affected by a few
> abnormal cells.
>
> Why not treat these patients -- just to be safe? Because
> some people die from treatment. In the Mayo Clinic study
> comparing lung cancer screening (using chest X-rays) to
> standard care, more people in the screening group were
> told that they had lung cancer. It didn't help them live
> longer; in fact, slightly more people in that group died.
>
> And some think we should scan the whole body. But the
> harder we look, the more we find. CAT scans of the chest
> lead more people to be told they have lung cancer, and
> there are even more abnormalities to find in the abdomen.
> As one radiologist who has read thousands of these scans
> put it, "With this level of information, I have yet to see
> a normal patient."
>
> Millions of healthy Americans are being told that they are
> sick (or "at risk"). More are undergoing invasive
> evaluations with needles, flexible scopes and catheters.
> And more are taking drugs for early forms of diabetes,
> heart disease, osteoporosis, hepatitis, vascular disease
> and cancer.
>
> We need to start asking hard questions about whose
> interests are served by the relentless pursuit of disease
> in people who are well. Clearly it's good business -- for
> test manufacturers, hospitals, pharmaceutical companies.
> And it's good for some doctors.
>
> But is it in society's interest? Many suggest that it
> saves money by lowering the cost per patient. But the
> savings per patient (if they exist) are overwhelmed by
> the increased expense of having so many more to treat.
> Is it in the interest of sick patients? Absolutely not,
> as caring for the well increasingly distracts doctors
> from caring for the truly sick. And what about the well?
> Is it in their interest? Only they can decide -- after
> they have been informed that early detection is a double-
> edged sword.
>
> The writer is a professor of medicine in the Department of
> Veterans Affairs and Dartmouth Medical School. He is the
> author of "Should I Be Tested for Cancer? Maybe Not and
> Here's Why."
>
>
>
> © 2004 The Washington Post Company
>
>
> ===================================
>
> Best,
>
> Bob
>
>
> Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
> Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555
>
> **********************************
> NOTE: The material above is not "medical advice". Medical
> advice can only be given after an in-person contact
> between doctor and patient.
> **********************************
 
"Leonard Evens" <[email protected]> wrote in message
news:[email protected]...
> Robert A. Fink, M. D. wrote:
> > From the Washington Post:
> >
> > --------------------------------------------------------
> > ----------------
> >
> > washingtonpost.com Dangers in Early Detection
> >
> >
> > By H. Gilbert Welch
> >
> > Thursday, July 1, 2004; Page A23
> >
> >
> > You feel well. You're only 60. Your PSA -- the blood
> > test for prostate cancer -- is normal. Much to your
> > chagrin, you learn of recent research that suggests you
> > still might have prostate cancer. But the only way
> > researchers know this is because they performed a more
> > aggressive test
> > --
> > placing a probe through the rectum of normal men and
> > inserting a biopsy needle six, maybe 12 times to search
> > for cancer in various parts of their prostate. Should
> > this procedure be performed on you? Should it be
> > performed on all healthy men?
> >
> > This is American medical care today -- care increasingly
> > directed toward the well. Ironically, the primary
> > service we offer them is relentless testing to establish
> > whether they are, in fact, sick. We screen for early
> > forms of diabetes, heart disease, osteoporosis,
> > hepatitis, vascular disease and, of course, cancer. The
> > conventional wisdom is that early detection improves
> > health. But this assumption may be wrong.
> >
> > Why? Because early disease detection means more people
> > become patients. Inevitably some will be treated
> > needlessly and suffer as a result.
> >
> > To understand this, you need to understand that each of
> > us harbors early forms of disease. Even in middle age,
> > many of us who feel well have evidence of diabetes,
> > heart disease, osteoporosis, hepatitis, vascular disease
> > and cancer. Just because we harbor these early forms of
> > disease doesn't mean that they will ever affect our
> > health. Some diseases progress so slowly that people die
> > of other causes long before the diseases generate
> > symptoms. Other diseases may not progress at all. Unless
> > we were tested, we'd never have known we were sick.
> >
> > Prostate cancer is the classic example. Among men age
> > 60, around half have microscopic evidence of prostate
> > cancer if we look hard enough. Yet only four in 1,000
> > will die from prostate cancer in the next 10 years. How
> > can this be? Because prostate cancer isn't just one
> > disease: It's a spectrum of disorders. Some forms of
> > prostate cancer grow very rapidly and kill men. Some
> > grow slowly and men die of something else before the
> > cancer ever causes symptoms. And others look like cancer
> > under the microscope but never grow at all.
> >
> > A little over a decade ago, doctors started looking hard
> > for prostate cancer using the PSA and lots of needle
> > biopsies. And we found a great deal: Roughly 2 million
> > cases were diagnosed in this period -- almost a million
> > more than would have been without the test.
> >
> > Did prostate cancer screening help men? To be honest, we
> > aren't sure about the net effect. There has been a small
> > decline in the death rate from prostate cancer, but this
> > may simply reflect that our treatments are better.
>
> Actually the absolute number of deaths in the US due to
> prostate cancer has dropped by about one quarter during
> the time of large scale PSA testing. For the
> arithmetically challenged, let me explain what "death
> rate" means.

I knew you would respond immediately. Demographers have
long known that even if cancer were 100% cured, the
nation's life expetancy would increase by only 2 years. 2
years. Why? Because if one cause of death declines,
others take over. Since the life expectancy of the nation
has been going UP anyway, all diseases show declines,
including prostate cancers. Heart attacks showed a real
decline long before modern aggressive treatments came
along. In Canada, you don't have the aggressive
treatments for heart ailments, yet you live just as long
after an attack. What about prostate cancer? Yes, Len,
there is a connection.
 
"dale.j. " <[email protected]> wrote in message
news:[email protected]...
> In article <[email protected]>,
> "Robert A. Fink, M. D." <[email protected]> wrote:
>
> > From the Washington Post:
> >
> > Best,
> >
> > Bob
> >
> >
> > Robert A. Fink, M. D. Neurological Surgery 2500
> > Milvia Street Suite 222 Berkeley, CA 94704-2636 USA
> > 510-849-2555
> >
> > **********************************
> > NOTE: The material above is not "medical advice".
> > Medical advice can only be given after an in-
> > person contact between doctor and patient.
> > **********************************
>
> I admit to not reading the entire above, sorry.
>
> It's my understanding that early detection is key to
> curing cancer of almost any kind. Do I have that
> part right?
>
> Dale J.
>
>

Not according to the article. Early detection simply means
you know about it earlier.
 
dale.j. wrote:
> In article <[email protected]>,
> "Robert A. Fink, M. D." <[email protected]> wrote:
>
>
>>From the Washington Post:
>
> >
>
>>Best,
>>
>>Bob
>>
>>
>>Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
>>Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555
>>
>>**********************************
>>NOTE: The material above is not "medical advice". Medical
>> advice can only be given after an in-person contact
>> between doctor and patient.
>>**********************************
>
>
> I admit to not reading the entire above, sorry.
>
> It's my understanding that early detection is key to
> curing cancer of almost any kind. Do I have that
> part right?

No. It depends on the cancer. There is considerable
uncertainty about how effective early detection is for some
common cancers. Certainly some will tell you that there is
no proof that early detection makes any difference. What
that means is that there has been no double blind randomized
study demonstrating it. In such a study a carefully chosen
group is randomly assigned to two different groups, one is
subjected to the method being proposed and one is not, and
then the results are compared. There is one such study in
progress in the US now, but the results are not in yet.

But double blind studies are not the only kind of valid
evidence. They are the best kind because they try to avoid
what are called confounders, which are other factors which
might explain the results other than the feature being
studied. But they are not foolproof themselves. Actually a
study will only tell you about what you might expect to find
in a population which matches that of the study population.
For example, if you study PSA testing and follow you
population for 12 years, you can't necessarily translate the
results to another population which would be followed for
15-20 years. Also, results in one country might not be
helpful for men in another country.

But note that just because we haven't proved by a certain
method that something is beneficial doesn't mean that we
have proved that it isn't beneficial. Some people think you
shouldn't do anything not supported by a double blind
study. By that argument, it has never been proved that
smoking causes lung cancer, heart disease, etc., so it
would be perfectly safe to continue smoking. You would of
course be ignoring all the other evidence about the dangers
of smoking.
>
> Dale J.
 
"Fernando" <[email protected]> wrote in message
news:6sCFc.19141$IQ4.2196@attbi_s02...
> Leonard, George and Dale....
>
> Always enjoy your answers and viepoints on subjects
> discussed.....I have learned a lot from all of you.....
>
> To "Dr" Fink, I am POSITIVE he is on the wrong track.....
>
> I have 9 brothers....4 of us have been Dx'd with Prostate
> Cancer...after knowing that 3 of my brothers had PCa, a Dr
> friend of mine suggested I go for a complete phyisical
> exam including PSA... After this, I found out that my PSA
> was 5.2 ( at 49 years
old)....subsequent
> test indicated that I also had PCa !!! 5 years ago, I had
> RRP....my last PSA test was still undetectable....In the
> meantime, One of my brothers
died
> of PCa, another is on his last days and the other is still
> fighting the cancer strong....
>
> I have SOLID evidence and experience that screening is
> very, very valuable in treating PCa.
>
> To "Dr" Fink, maybe he should go back and do his own
> studies.
>
> Fernando
>
>

But you would not accept the results in any case.
 
On Sat, 03 Jul 2004 06:27:01 -0500, "dale.j. " <[email protected]>
wrote:

>It's my understanding that early detection is key to curing
>cancer of almost any kind. Do I have that part right?

This is not always true. Some cancers which are easily
detectable are associate with a poor survival even if
treated early (certain malignant brain tumors, for
example); and other malignancies (like prostate cancer) may
take a very long time to kill (or never will) even if
picked up late.

Best,

Bob

Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555

**********************************
NOTE: The material above is not "medical advice". Medical
advice can only be given after an in-person contact
between doctor and patient.
**********************************
 
On Sat, 03 Jul 2004 17:57:22 GMT, "Fernando" <[email protected]>
wrote:

>Leonard, George and Dale....
>
>Always enjoy your answers and viepoints on subjects
>discussed.....I have learned a lot from all of you.....
>
>To "Dr" Fink, I am POSITIVE he is on the wrong track.....
>
>I have 9 brothers....4 of us have been Dx'd with Prostate
>Cancer...after knowing that 3 of my brothers had PCa, a Dr
>friend of mine suggested I go for a complete phyisical exam
>including PSA... After this, I found out that my PSA was
>5.2 ( at 49 years old)....subsequent test indicated that I
>also had PCa !!! 5 years ago, I had RRP....my last PSA test
>was still undetectable....In the meantime, One of my
>brothers died of PCa, another is on his last days and the
>other is still fighting the cancer strong....
>
>I have SOLID evidence and experience that screening is
>very, very valuable in treating PCa.
>
>To "Dr" Fink, maybe he should go back and do his own
>studies.
>
>Fernando
>

Fernando,

Your "statistics" are what is called "anecdotal". You need
thousands of cases in order to prove a statistical
correlation, and those studies which *are* truly statistical
are quite equivocal as to whether widespread screening with
the PSA followed by aggressive treatment/biopsy really makes
a difference in survival.

Your comments suggest that you have an emotional attachment
to your beliefs (they are beliefs, not scientific evidence),
and while I can understand that (in view of your family
history), it doesn't make them "scientific".

Why, BTW, do you need to disparage my title, Fernando? You
know, I am a "real doctor".

Best,

Bob

Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555

**********************************
NOTE: The material above is not "medical advice". Medical
advice can only be given after an in-person contact
between doctor and patient.
**********************************
 
On Sat, 03 Jul 2004 06:27:01 -0500, "dale.j. " <[email protected]>
wrote:

>It's my understanding that early detection is key to curing
>cancer of almost any kind. Do I have that part right?

This is not always true. Some cancers which are easily
detectable are associate with a poor survival even if
treated early (certain malignant brain tumors, for
example); and other malignancies (like prostate cancer) may
take a very long time to kill (or never will) even if
picked up late.

Best,

Bob

Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555

**********************************
NOTE: The material above is not "medical advice". Medical
advice can only be given after an in-person contact
between doctor and patient.
**********************************
 
Fernando wrote:
> Leonard, George and Dale....
>
> Always enjoy your answers and viepoints on subjects
> discussed.....I have learned a lot from all of you.....
>
> To "Dr" Fink, I am POSITIVE he is on the wrong track.....
>
> I have 9 brothers....4 of us have been Dx'd with Prostate
> Cancer...after knowing that 3 of my brothers had PCa, a Dr
> friend of mine suggested I go for a complete phyisical
> exam including PSA... After this, I found out that my PSA
> was 5.2 ( at 49 years old)....subsequent test indicated
> that I also had PCa !!! 5 years ago, I had RRP....my last
> PSA test was still undetectable....In the meantime, One of
> my brothers died of PCa, another is on his last days and
> the other is still fighting the cancer strong....
>
> I have SOLID evidence and experience that screening is
> very, very valuable in treating PCa.
>
> To "Dr" Fink, maybe he should go back and do his own
> studies.
>
> Fernando

To be fair to the critics of PSA testing, many of them would
recommend testing for men with a family history or other
special characteristics. There are a few extremists among
the critics who will claim that even men like you should not
be tested. What most of the critics claim is that it is not
clear that men in the general population benefit enough to
justify the cost, economic and in unnecessary treatment. I
don't agree with that, but it is an arguable position. One
thing should be made clear. No one really knows how to do
the cost-benefit analysis at this stage. Also, this is
basically an unsettled scientific debate and should probably
not be taken to the public.

>
>
>
>
>
>
> "Robert A. Fink, M. D." <[email protected]> wrote in
> message news:[email protected]...
>
>>From the Washington Post:
>>
>>----------------------------------------------------------
>>--------------
>>
>>washingtonpost.com Dangers in Early Detection
>>
>>
>>By H. Gilbert Welch
>>
>>Thursday, July 1, 2004; Page A23
>>
>>
>>You feel well. You're only 60. Your PSA -- the blood test
>>for prostate cancer -- is normal. Much to your chagrin,
>>you learn of recent research that suggests you still might
>>have prostate cancer. But the only way researchers know
>>this is because they performed a more aggressive test
>>--
>>placing a probe through the rectum of normal men and
>>inserting a biopsy needle six, maybe 12 times to search
>>for cancer in various parts of their prostate. Should this
>>procedure be performed on you? Should it be performed on
>>all healthy men?
>>
>>This is American medical care today -- care increasingly
>>directed toward the well. Ironically, the primary service
>>we offer them is relentless testing to establish whether
>>they are, in fact, sick. We screen for early forms of
>>diabetes, heart disease, osteoporosis, hepatitis, vascular
>>disease and, of course, cancer. The conventional wisdom is
>>that early detection improves health. But this assumption
>>may be wrong.
>>
>>Why? Because early disease detection means more people
>>become patients. Inevitably some will be treated
>>needlessly and suffer as a result.
>>
>>To understand this, you need to understand that each of us
>>harbors early forms of disease. Even in middle age, many
>>of us who feel well have evidence of diabetes, heart
>>disease, osteoporosis, hepatitis, vascular disease and
>>cancer. Just because we harbor these early forms of
>>disease doesn't mean that they will ever affect our
>>health. Some diseases progress so slowly that people die
>>of other causes long before the diseases generate
>>symptoms. Other diseases may not progress at all. Unless
>>we were tested, we'd never have known we were sick.
>>
>>Prostate cancer is the classic example. Among men age 60,
>>around half have microscopic evidence of prostate cancer
>>if we look hard enough. Yet only four in 1,000 will die
>>from prostate cancer in the next 10 years. How can this
>>be? Because prostate cancer isn't just one disease: It's a
>>spectrum of disorders. Some forms of prostate cancer grow
>>very rapidly and kill men. Some grow slowly and men die of
>>something else before the cancer ever causes symptoms. And
>>others look like cancer under the microscope but never
>>grow at all.
>>
>>A little over a decade ago, doctors started looking hard
>>for prostate cancer using the PSA and lots of needle
>>biopsies. And we found a great deal: Roughly 2 million
>>cases were diagnosed in this period -- almost a million
>>more than would have been without the test.
>>
>>Did prostate cancer screening help men? To be honest, we
>>aren't sure about the net effect. There has been a small
>>decline in the death rate from prostate cancer, but this
>>may simply reflect that our treatments are better. While
>>screening probably has helped a few men live longer, it
>>has also clearly hurt others. Millions have been biopsied
>>who otherwise wouldn't have been. Many with nonprogressive
>>disease have been turned into cancer patients
>>unnecessarily. Most have been treated, and many have
>>suffered ill effects. A few have even had their lives
>>shortened by treatment.
>>
>>This is the reality of early detection. A few may be
>>helped, because their disease is destined to cause
>>problems and because early treatment is able to solve
>>those problems in a way that later treatment cannot. But
>>many simply are told earlier that they have a disease and
>>gain nothing, because their disease could have been
>>treated just as well later, when symptoms appeared. And
>>others are hurt by treatment for a disease that would have
>>otherwise never affected their health.
>>
>>What's next? Consider CAT scans of the chest to look for
>>lung cancer. During mass screenings in one region of
>>Japan, CAT scans found 10 times as many patients with
>>lung cancer as had been found a few years earlier using
>>chest X-rays. Incredibly, nonsmokers were almost as
>>likely to have lung cancer as smokers. Is smoking getting
>>safer? Of course not. Everyone agrees that smoking is far
>>and away the most important cause of lung cancer. The CAT
>>scans were simply labeling some people as lung cancer
>>patients who otherwise would never be affected by a few
>>abnormal cells.
>>
>>Why not treat these patients -- just to be safe? Because
>>some people die from treatment. In the Mayo Clinic study
>>comparing lung cancer screening (using chest X-rays) to
>>standard care, more people in the screening group were
>>told that they had lung cancer. It didn't help them live
>>longer; in fact, slightly more people in that group died.
>>
>>And some think we should scan the whole body. But the
>>harder we look, the more we find. CAT scans of the chest
>>lead more people to be told they have lung cancer, and
>>there are even more abnormalities to find in the abdomen.
>>As one radiologist who has read thousands of these scans
>>put it, "With this level of information, I have yet to see
>>a normal patient."
>>
>>Millions of healthy Americans are being told that they are
>>sick (or "at risk"). More are undergoing invasive
>>evaluations with needles, flexible scopes and catheters.
>>And more are taking drugs for early forms of diabetes,
>>heart disease, osteoporosis, hepatitis, vascular disease
>>and cancer.
>>
>>We need to start asking hard questions about whose
>>interests are served by the relentless pursuit of disease
>>in people who are well. Clearly it's good business -- for
>>test manufacturers, hospitals, pharmaceutical companies.
>>And it's good for some doctors.
>>
>>But is it in society's interest? Many suggest that it
>>saves money by lowering the cost per patient. But the
>>savings per patient (if they exist) are overwhelmed by
>>the increased expense of having so many more to treat.
>>Is it in the interest of sick patients? Absolutely not,
>>as caring for the well increasingly distracts doctors
>>from caring for the truly sick. And what about the well?
>>Is it in their interest? Only they can decide -- after
>>they have been informed that early detection is a double-
>>edged sword.
>>
>>The writer is a professor of medicine in the Department of
>>Veterans Affairs and Dartmouth Medical School. He is the
>>author of "Should I Be Tested for Cancer? Maybe Not and
>>Here's Why."
>>
>>
>>
>>© 2004 The Washington Post Company
>>
>>
>>===================================
>>
>>Best,
>>
>>Bob
>>
>>
>>Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
>>Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555
>>
>>**********************************
>>NOTE: The material above is not "medical advice". Medical
>> advice can only be given after an in-person contact
>> between doctor and patient.
>>**********************************
>
 
"Leonard Evens" <[email protected]> wrote in message
news:[email protected]...
> dale.j. wrote:
> >In article <[email protected]>,
> > "Robert A. Fink, M. D." <[email protected]> wrote:
> >
> >
> >>From the Washington Post:
> >
> > >
> >
> >>Best,
> >>
> >>Bob
> >>
> >>
> >>Robert A. Fink, M. D. Neurological Surgery 2500
> >>Milvia Street Suite 222 Berkeley, CA 94704-2636 USA
> >>510-849-2555
> >>
> >>**********************************
> >>NOTE: The material above is not "medical advice".
> >> Medical advice can only be given after an in-
> >> person contact between doctor and patient.
> >>**********************************
> >
> >
> > I admit to not reading the entire above, sorry.
> >
> > It's my understanding that early detection is key to
> > curing cancer of almost any kind. Do I have that part
> > right?
>
> No. It depends on the cancer. There is considerable
> uncertainty about how effective early detection is for
> some common cancers. Certainly some will tell you that
> there is no proof that early detection makes any
> difference. What that means is that there has been no
> double blind randomized study demonstrating it. In such a
> study a carefully chosen group is randomly assigned to two
> different groups, one is subjected to the method being
> proposed and one is not, and then the results are
> compared. There is one such study in progress in the US
> now, but the results are not in yet.
>
> But double blind studies are not the only kind of valid
> evidence. They are the best kind because they try to avoid
> what are called confounders, which are other factors which
> might explain the results other than the feature being
> studied. But they are not foolproof themselves. Actually a
> study will only tell you about what you might expect to
> find in a population which matches that of the study
> population. For example, if you study PSA testing and
> follow you population for 12 years, you can't necessarily
> translate the results to another population which would be
> followed for 15-20 years. Also, results in one country
> might not be helpful for men in another country.
>
> But note that just because we haven't proved by a certain
> method that something is beneficial doesn't mean that we
> have proved that it isn't beneficial.

But not for prostate cancer treatments as currently
evaluated. Those is a horrible amount of self-selection
by social class. It was the same with women and HRT,
which was ultimately proven to be harmful in many ways,
as in causing higher cancer rates, not lower as supposed.
But the demographic evidence is in, and it does show that
while there are widespread differences of treatment
patterns in the USA, they do NOT correlate with
longevity. Thus what is known is not when you want to
hear Len. Sorry.
 
"Robert A. Fink, M. D." <[email protected]> wrote in message
news:[email protected]...
> On Sat, 03 Jul 2004 17:57:22 GMT, "Fernando"
> <[email protected]> wrote:
>
> >Leonard, George and Dale....
> >
> >Always enjoy your answers and viepoints on subjects
> >discussed.....I have learned a lot from all of you.....
> >
> >To "Dr" Fink, I am POSITIVE he is on the wrong track.....
> >
> >I have 9 brothers....4 of us have been Dx'd with Prostate
> >Cancer...after knowing that 3 of my brothers had PCa, a
> >Dr friend of mine suggested I go for a complete phyisical
> >exam including PSA... After this, I found out that my PSA
> >was 5.2 ( at 49 years
old)....subsequent
> >test indicated that I also had PCa !!! 5 years ago, I had
> >RRP....my last PSA test was still undetectable....In the
> >meantime, One of my brothers
died
> >of PCa, another is on his last days and the other is
> >still fighting the cancer strong....
> >
> >I have SOLID evidence and experience that screening is
> >very, very
valuable
> >in treating PCa.
> >
> >To "Dr" Fink, maybe he should go back and do his own
> >studies.
> >
> >Fernando
> >
>
>
> Fernando,
>
> Your "statistics" are what is called "anecdotal". You need
> thousands of cases in order to prove a statistical
> correlation, and those studies which *are* truly
> statistical are quite equivocal as to whether widespread
> screening with the PSA followed by aggressive
> treatment/biopsy really makes a difference in survival.
>
> Your comments suggest that you have an emotional
> attachment to your beliefs (they are beliefs, not
> scientific evidence), and while I can understand that (in
> view of your family history), it doesn't make them
> "scientific".
>
> Why, BTW, do you need to disparage my title, Fernando? You
> know, I am a "real doctor".
>
>
> Best,
>
> Bob
>
>
> Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
> Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555
>
> **********************************
> NOTE: The material above is not "medical advice". Medical
> advice can only be given after an in-person contact
> between doctor and patient.
> **********************************

It is hard to give up the cultural bias for more and more
and more medical procedures, both for the averge patient
and the average physician together.
 
George Conklin wrote:
> "Fernando" <[email protected]> wrote in message
> news:6sCFc.19141$IQ4.2196@attbi_s02...
>
>>Leonard, George and Dale....
>>
>>Always enjoy your answers and viepoints on subjects
>>discussed.....I have learned a lot from all of you.....
>>
>>To "Dr" Fink, I am POSITIVE he is on the wrong track.....
>>
>>I have 9 brothers....4 of us have been Dx'd with Prostate
>>Cancer...after knowing that 3 of my brothers had PCa, a Dr
>>friend of mine suggested I go for a complete phyisical
>>exam including PSA... After this, I found out that my PSA
>>was 5.2 ( at 49 years
>
> old)....subsequent
>
>>test indicated that I also had PCa !!! 5 years ago, I had
>>RRP....my last PSA test was still undetectable....In the
>>meantime, One of my brothers
>
> died
>
>>of PCa, another is on his last days and the other is still
>>fighting the cancer strong....
>>
>>I have SOLID evidence and experience that screening is
>>very, very valuable in treating PCa.
>>
>>To "Dr" Fink, maybe he should go back and do his own
>>studies.
>>
>>Fernando
>>
>>
>
>
> But you would not accept the results in any case.

See my remarks about extremists. Few medical authorities, if
any, whatever their position on testing for the general
population, would recommend against testing for a man with
Fernando's family history.
 
Robert A. Fink, M. D. wrote:
> On Sat, 03 Jul 2004 06:27:01 -0500, "dale.j. "
> <[email protected]> wrote:
>
>
>>It's my understanding that early detection is key to
>>curing cancer of almost any kind. Do I have that
>>part right?
>
>
>
> This is not always true. Some cancers which are easily
> detectable are associate with a poor survival even if
> treated early (certain malignant brain tumors, for
> example); and other malignancies (like prostate cancer)
> may take a very long time to kill (or never will) even if
> picked up late.

The operative word is "may". The details are important here.
For example, I had a Gleason 7 prostate cancer.
Retrospective studies on untreated prostate cancer suggest
that the risk of relatively early metastasis is higher than
many of us would want to chance. Also success rates of
treatment, in the best studies, are fairly high for many
such cancers.

One thing you should think about a bit as a surgeon is the
difference in the risk analysis from the point of view of
the surgeon and from the point of view of the patient. The
surgeon is concerned with how effective a treatment will be
for a population. The patient is concerned with what his
options are and whether the benefit to him is worth the
cost. These are two entirely different questions, and they
will generally have different answers. In particular,
although often prostate cancer will take a long time to kill
the patient (and in some cases may not do so), it may still
lead to unpleasant effects short of killing the patient.
Some patients when faced with such a risk may feel the odds
of side effects are low enough. Each of us will weight
different scenarios differently. In my case, I thought the
risk of metastasis, requiring the use of hormone therapy
with its side effects, and ultimately hormone resistant
prostate cancer, was high enough to justify my doing what I
could to avoid that risk. I didn't know if that risk was
over 50 percent. But even if it were as low as 10-20
percent, I wanted to avoid it if I could. It is pretty clear
from lots of evidence that treatment of early prostate
cancers in cases like mine generally delays the onset of
metastasis and in a high percentage of cases results in a
cure. I have seen no reliable estimates of my chances of
living a completely normal life without my cancer every
bothering me. Do you have an estimate of how many Gleason 7
prostate cancers never need to be treated? I would be
surprised if it were even as high as 10 percent.

>
> Best,
>
> Bob
>
>
> Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
> Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555
>
> **********************************
> NOTE: The material above is not "medical advice". Medical
> advice can only be given after an in-person contact
> between doctor and patient.
> **********************************
 
Robert A. Fink, M. D. wrote:
> On Sat, 03 Jul 2004 17:57:22 GMT, "Fernando"
> <[email protected]> wrote:
>
>
>>Leonard, George and Dale....
>>
>>Always enjoy your answers and viepoints on subjects
>>discussed.....I have learned a lot from all of you.....
>>
>>To "Dr" Fink, I am POSITIVE he is on the wrong track.....
>>
>>I have 9 brothers....4 of us have been Dx'd with Prostate
>>Cancer...after knowing that 3 of my brothers had PCa, a Dr
>>friend of mine suggested I go for a complete phyisical
>>exam including PSA... After this, I found out that my PSA
>>was 5.2 ( at 49 years old)....subsequent test indicated
>>that I also had PCa !!! 5 years ago, I had RRP....my last
>>PSA test was still undetectable....In the meantime, One of
>>my brothers died of PCa, another is on his last days and
>>the other is still fighting the cancer strong....
>>
>>I have SOLID evidence and experience that screening is
>>very, very valuable in treating PCa.
>>
>>To "Dr" Fink, maybe he should go back and do his own
>>studies.
>>
>>Fernando
>>
>
>
>
> Fernando,
>
> Your "statistics" are what is called "anecdotal". You need
> thousands of cases in order to prove a statistical
> correlation, and those studies which *are* truly
> statistical are quite equivocal as to whether widespread
> screening with the PSA followed by aggressive
> treatment/biopsy really makes a difference in survival.

You are lissutrating the difference in perspective I
mentioned in another response. It is true that if you want
to discuss the entire population of prostate cancer
patients, then his particular story is just one item which
may prove nothing about the generaly population.

However, as I noted previously, the evidence does support
PSA testing for men with family histories like Fernando's.
Do you know of any studies which dispute that assertion? I
suspect it would be considered unethical even to suggest a
double blind study in such a population. You would have to
find a population of younger men with several close male
relatives with prostate cancer, randomly assign half to PSA
testing and treatment where indicated and the other half to
no testing, and follow them for 15-20 years. I doubt if such
a study would be funded. So we have to base decision making
on other research studies, and I think such studies do
support testing in such cases.

>
> Your comments suggest that you have an emotional
> attachment to your beliefs (they are beliefs, not
> scientific evidence), and while I can understand that (in
> view of your family history), it doesn't make them
> "scientific".

You also have an emotional attachment to your beliefs. We
all do. But I don't think you are in the habit of
questioning them.
>
> Why, BTW, do you need to disparage my title, Fernando? You
> know, I am a "real doctor".

But you are presumably not a prostate cancer researcher, so
your medical degree doesn't give you any more authority than
the rest of us in this discussion.

By the way, an old friend of mine, who also has a Ph. D.
maintains that you "real doctors" are only "doctors" by
curtesty. Originally there were only the teacher kind of
"doctors", and in the Middle Ages the term was extended by
curtesty to physicians. As you probably know, in England,
you would not be a "doctor" but would have another title
entirely. Unfortunately, physicians have so monopolized the
title that "real doctors" like me don't generally insist on
being addressed by that title, which seems ostentatious.

>
>
> Best,
>
> Bob
>
>
> Robert A. Fink, M. D. Neurological Surgery 2500 Milvia
> Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555
>
> **********************************
> NOTE: The material above is not "medical advice". Medical
> advice can only be given after an in-person contact
> between doctor and patient.
> **********************************
 
dale.j. wrote:
> In article
> <[email protected]>,
> "George Conklin" <[email protected]> wrote:
>
>
>> Not according to the article. Early detection simply
>> means you know about it earlier.
>
>
> But wouldent that be a good thing?

Again it depends. If there is no known effective treatment,
knowing about it early rather than late may not be helpful.

For prostate cancer I think it is generally helpful. You
don't necessarily have to treat prostate cancer just because
you know you have
it. It depends on the details of the diagnosis, the age of
the patient and some other factors.

> Dale J.