"Screening" tests



George Conklin wrote:
> "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.

There you go again. You have read a few selected things
about prostate cancer and you ignore everything else.
Ongoing research in a subject like this is always confusing.
No one study or one research group is going to be
definitive.
 
"Leonard Evens" <[email protected]> wrote in message
news:[email protected]...
> 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?

Your assertion is just that. You are culturally biased
into thinking that action is always better than inaction.
It must be due to that math background which asserts that
proofs ought to exist, and if they don't, assert them.
 
"Leonard Evens" <[email protected]> wrote in message
news:[email protected]...
> 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.

Dr Fink is reacting emotionally here because some "may" not
be helped in early detection. You need a definitive
diagnosis in order to find something that is indeed
treatable. He wants to stick his head in the sand and let
fate take it's course. He doesn't want to know if one has
cancer or not because it may not help. That is purely
emotional and not evidenced based. You need to know who has
it and who doesn't in order to study this disease with
prevention being the first on the list. The treatment issue
is a separate issue entirely.
>
> 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.
Two different issues indeed but some in the medical field
act emotionally in not thinking that we are able to separate
the issues so the only answer he can think of is to not
check for cancer in the first place. That is strickly an
emotionally based opinion.

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

Dr Fink doesn't want to give us the option of deciding on
our own individual risk assessment. He doesn't want you to
know if you have cancer or not and thus keep you in the dark
because of the generalization that all prostate cancer
patients should not have known. Why bother going to a doctor
in the first place. He has a cynical position. We are all
going to die anyways of something or another in the long
run. If the survival rates of those having treatment or not
is the same than it becomes entirely an emtional issue. You
need to support the emotional needs of the individual and
the hell with the doctor.

> 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.
> > **********************************
 
On Sun, 04 Jul 2004 09:52:14 -0500, Leonard Evens
<[email protected]> wrote:

>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.

Sadly, there is some truth to the above allegations. The
term "doctor", however, refers only to the (Greek, I think)
derivation of "Doxos", the same root as such words as
"Doctrine" and "Doxology" or "Orthodox" ("straight
doctrine").

So, the title "doctor" merely means someone who promotes
some kind of "doctrine" and that might include some pretty
"far out" concepts.

When I received my medical degree (which, by the way, says
"Medicinae Doctoris" or "Doctor of Medicine"), the
university did not award us "hoods", the item of academic
clothing worn by Ph. D. people. I suspect, however, that
when the Ph. D. folks had their heart attack or developed
their brain tumor, they would not want a "Doctor of
Philosophy" to take care of them..... Somehow, brain surgery
is more than "philosophical".

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.
**********************************
 
In article <[email protected]>,
Leonard Evens <[email protected]> wrote:
>George Conklin wrote:
>
>> Anything you have read is filtered through your
>> emotional need to justify whatever it was you did. But
>> your personal case is irrelevant in a science group.
>> I'm sorry your emotions get in the way all the time.
>
>This "science" group has precious little science of any
>kind. You certainly don't usually address any scientific
>issues. This is a characteristic of many other "science"
>groups. You just spend your time telling me how "emotional"
>I am. But I think, despite my highly "emotional" state, I
>actually spend much more time discussing the actual science
>than you do.

George Conklin is about as unemotional as Miss Piggy,
which is one of the reasons he's been gracing my killfile
for so long.

-- David Wright :: alphabeta at prodigy.net These are my
opinions only, but they're almost always correct. "If I
have not seen as far as others, it is because giants were
standing on my shoulders." (Hal Abelson, MIT)
 
"Leonard Evens" <[email protected]> wrote in message
news:[email protected]...
> dale.j. wrote:
> > In article <[email protected]
> > rthlink.net>, "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.

That is a value statement. The science is not yet
established.

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.
> >
>

Or, it might not matter at all given current
treatments, right?
 
In article <[email protected]>,
Leonard Evens <[email protected]> wrote:

>
> 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.

What cancer do we not have an effective treatment for if
found early enough? I'm curious because I thought that if
cancer were found early the treatments would be effective
and I was also under the impression there are treatments for
all types of cancer.

Perhaps we are still not finding the cancer early enough.
Example, if we somehow could find that first abnormal cell
and eliminate it wouldent that be a cure? Most likely not
practical, but just a thought of mine.

Dale J.

--
Email: [email protected]
 
George Conklin wrote:
> "Leonard Evens" <[email protected]> wrote in
> message news:[email protected]...
>
>>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?
>
>
> Your assertion is just that. You are culturally biased
> into thinking that action is always better than
> inaction. It must be due to that math background which
> asserts that proofs ought to exist, and if they don't,
> assert them.

So you are now a cultural anthropologist to add to your
other talents?

You know very little about my biases, cuturally or
otherwise. Also, you obviously know very little about
mathematics or mathematicians. Few of us think that
proofs ought to exist, and we certainly don't assert
proofs that don't exist. But we are trained in the exact
use of language.
 
On Sun, 4 Jul 2004 11:38:58 -0700, "Robert" <[email protected]>
wrote:

>Dr Fink doesn't want to give us the option of deciding on
>our own individual risk assessment. He doesn't want you to
>know if you have cancer or not and thus keep you in the
>dark because of the generalization that all prostate cancer
>patients should not have known. Why bother going to a
>doctor in the first place. He has a cynical position. We
>are all going to die anyways of something or another in the
>long run. If the survival rates of those having treatment
>or not is the same than it becomes entirely an emtional
>issue. You need to support the emotional needs of the
>individual and the hell with the doctor.

Hey, WHOA! Please don't put words in my mouth. This all
started with my posting of an article concerning the
opinions of a credentialled researcher and commentator. I
never said that anyone should be "prevented" from having all
the tests one wants (and is willing to pay for). Anyone who
wants to have needles inserted through their rectal wall is
fully entitled to that bit of pleasure; I make no attempt to
deny such folks their preferences.

But for me, who had a borderline PSA test (7) 10 years ago
and who is otherwise healthy (at age 66), it doesn't make
sense for me to get "screening tests". My family physician
agrees, and that's good enough for me. But, those of you who
want to be pushed and prodded, please be my guest!

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 Sun, 04 Jul 2004 09:52:14 -0500, Leonard Evens
> <[email protected]> wrote:
>
>
>>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.
>
>
>
> Sadly, there is some truth to the above allegations. The
> term "doctor", however, refers only to the (Greek, I
> think) derivation of "Doxos", the same root as such words
> as "Doctrine" and "Doxology" or "Orthodox" ("straight
> doctrine").
>
> So, the title "doctor" merely means someone who promotes
> some kind of "doctrine" and that might include some pretty
> "far out" concepts.
>
> When I received my medical degree (which, by the way, says
> "Medicinae Doctoris" or "Doctor of Medicine"), the
> university did not award us "hoods", the item of academic
> clothing worn by Ph. D. people. I suspect, however, that
> when the Ph. D. folks had their heart attack or developed
> their brain tumor, they would not want a "Doctor of
> Philosophy" to take care of them..... Somehow, brain
> surgery is more than "philosophical".

You are missing the point. I don't go to doctors of
philosophy to be treated for disease. I go to them to find
out about things they teach and/or do research in. That is
what they were trained to do and spend their professional
lives doing. Medical research is done both by Ph.
D.s and MDs. Many MDs doing research are well trained for
that work, but some are not. The usual medical school
education doesn't aim at that.

I go to a physician or a surgeon to be treated for disease
not because he or she is a "dcotor" but because of his or
her training and experience in the profession.

Most Ph.D.s don't claim to be able to treat disease, so
there is little reason for them to worry about the title. As
you must be aware, the conflict arises mostly in
psychotherapy where clinical psychologists or others with
Ph. D.s do treat patients. Psychiatrists are sometimes
unhappy about such people claiming to be "doctors". They are
of course "doctors" but they are not medical doctors. There
is a certain amount of protecting turf going on here, but us
academic Ph. D.s have nothing to do with it.

By the way, people often ask me for medical advice, and tell
me I know more about the relevant subject than their
physicians do. I sometimes tell them the little because it
may help them get straight in their minds what their
physicians have been telling them. But I always add that I
am not a physician and that while I may have some
superficial knowledge, but I don't know what one would learn
through 3 years of medical school, followed by residency and
then years of practice. I tell them to rely on their
physicians and if they aren't happy to change physicians.
Sadly, in some cases it appears I may actually know more
than their physicians, but I never claim that.

>
>
> 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 15:46:01 -0500, "dale.j. " <[email protected]>
wrote:

> In article <[email protected]>,
> Leonard Evens <[email protected]> wrote:
>
>
>>
>> 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.
>
>
>What cancer do we not have an effective treatment for if
>found early enough? I'm curious because I thought that if
>cancer were found early the treatments would be effective
>and I was also under the impression there are treatments
>for all types of cancer.
>
>Perhaps we are still not finding the cancer early enough.

I just happened to be reading the book by the author
discussed in the press release that Bob Fink posted (Should
I be tested for cancer? Univ Calif Press, 2004). Of course,
the story is more complex than the simple press release, and
the book deals with it much better.

In a sense, early detection is the problem. The earlier the
detection, the less definitive it is. So, some may benefit
from the early detection, but others may be hurt by it (by
the diversion of resources to treating something that is not
worth treating).

The case is not black/white. The author would not object to
those who make an informed choice to be tested, esp if they
have risk factors or symptoms. But he also would not object
to those who look at all that is known and choose not to (in
the absence of symptoms).

Of course, this helps make the case for improved detection
-- meaning not so much earlier but better (more accurate).

bob
 
"dale.j. " <[email protected]> wrote in message
news:[email protected]...
> In article <[email protected]>,
> Leonard Evens <[email protected]> wrote:
>
>
> >
> > 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.
>
>
> What cancer do we not have an effective treatment for if
> found early enough?

The article was saying that prostate cancer may well be
one of many.
 
George Conklin wrote:
> "Leonard Evens" <[email protected]> wrote in
> message news:[email protected]...
>
>>dale.j. wrote:
>>
>>>In article <[email protected]
>>>earthlink.net>, "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.
>
>
> That is a value statement. The science is not yet
> established.
>
>
> 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.
>>>
>>
>
>
> Or, it might not matter at all given current treatments,
> right?

That's right. It might not. But I think there is
significant evidence that current treatments are helpful in
many cases. I keep describing my particular case, where I
had to make a decision about what to do based on the
available evidence. I opted for treatment and I think the
science, while uncertain, combined with my particular
attitudes towards different risks, justified that. From the
sorts of things you say, it seems to me---again a value judgement---
that you don't understand much about current knowledge
about prostate cancer, but you still seem to like to make
statements about it.

I've talked to various men facing the same decision. I
always point out to them that they might in fact live
forever without treatment or that they might be treated and
the treatment might be ineffective. But I can't give them
precise odds about any of these matters. They have to make
their own decisions.
 
dale.j. wrote:
> In article <[email protected]>,
> Leonard Evens <[email protected]> wrote:
>
>
>
>>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.
>
>
>
> What cancer do we not have an effective treatment for if
> found early enough? I'm curious because I thought that if
> cancer were found early the treatments would be effective
> and I was also under the impression there are treatments
> for all types of cancer.

There are certain cancers which have very low survival
rates. Dr. Fink mentioned some brain tumors, and he would
know more about that than I
do. If you want to scare yourself you can go to the
American Cancer Society web site and find other
examples.

>
> Perhaps we are still not finding the cancer early enough.
> Example, if we somehow could find that first abnormal cell
> and eliminate it wouldent that be a cure? Most likely not
> practical, but just a thought of mine.

A problem with early detection is that you may detect
cancers which will never amount to anything. So you may end
up treating perfectly healthy people needlessly and in some
cases there will be undesirable side effects. This is a
subject of intense study and some debate in the medical
research community, and I don't believe there are going to
be easy answers. Ideally, if you could actually find those
abnormal cells long before they can do damage, you could be
relatively certain they would not be harmless, and you could
excise them with little risk of side effects, it would be
worth doing. But in practice that is hard to do.

Take prostate cancer as an example. It is known from autopsy
studies that a large number of men who die of other causes
show microscopic evidence of prostate cancer. The estimates
vary by age and they also vary quite a bit in different
autopsy studies. But it seems to be at least 50 percent in
men over 80, and perhaps a lot higher. It would be lower in
younger men but still fairly high. Remember that only about
16 percent of men in the US are likely to be diagnosed with
clinical cases of prostate cancer during their lifetimes. So
there is a difference between the microscopic kinds of
cancers found on autopsy and those actually diagnosed
through current techniques. If you do PSA testing, you will
catch some cases that don't need treatment (and you will
miss some that do, but that is another story). No one really
knows how many, but again it varies by age. Few experts
would recommend testing and aggressive treatment in men over
80, but most urologists, at least, generally feel there is
no question that men under 70 should be tested and treated
if necessary. For men 70-80, it depends on a variety of
factors, including life expectancy. The available diagnostic
tools, like PSA and Gleason scores are helpful, but they are
not entirely reliable. Current research using modern
techniques such as DNA analysis are beginning to find
markers which can distinguish the cases needing treatment
from those that don't, but they aren't yet available for
general use. I suspect that in a few years, physicians will
be able through appropriate testing to distinguish those
cases which do need aggressive treatment from those that
don't, and at that point the debate will become moot. But we
are not there yet.

Biostatisticians talk about risk-benefit analysis. That is
the benefit of treatment has to be balanced against the
risks of treatment. But as I keep pointing out that
analysis really has to be done separately for each
patient, and that will depend on the specifics of the
case. But what we have to help make the decision is
statistics, much of it of questionable validity, about
large populations. It is hard to translate those
statistics to odds as they apply in individual cases. I've
taught a lot of premeds in my day and I know quite a few
physicians. Few of them really have the background in
advanced statistics to be able to make decisions of this
kind based on formal theory. That is probably a good thing
because it is unlikely that going by the numbers would
actually take into account all the relevant facts. So
doing it on the basis of experience and feeling about a
given patient is probably a better way to go.

>
> Dale J.
 
"Leonard Evens" <[email protected]> wrote in message
news:[email protected]...
> George Conklin wrote:
> > "Leonard Evens" <[email protected]> wrote in
> > message news:[email protected]...
> >
> >>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?
> >
> >
> > Your assertion is just that. You are culturally biased
> > into thinking
that
> > action is always better than inaction. It must be due to
> > that math background which asserts that proofs ought to
> > exist, and if they don't, assert them.
>
> So you are now a cultural anthropologist to add to your
> other talents?
>
> You know very little about my biases, cuturally or
> otherwise. Also, you obviously know very little about
> mathematics or mathematicians. Few of us think that proofs
> ought to exist, and we certainly don't assert proofs that
> don't exist. But we are trained in the exact use of
language.
>
>
Were that the case, you would not be asserting what
is not proven in hopes that someday it might be
because you wish it were to be true. As for cultural
anthropology, yes, I am familiar with that to say
the least.
 
On Sat, 03 Jul 2004 15:46:01 -0500, "dale.j. " <[email protected]>
wrote:

>What cancer do we not have an effective treatment for if
>found early enough? I'm curious because I thought that if
>cancer were found early the treatments would be effective
>and I was also under the impression there are treatments
>for all types of cancer.

Lung cancer, for one. Also, to a greater or lesser extent,
ovarian cancer, malignant glioma (brain tumors), many adult
leukemias, pancreatic cancer, and a number of forms of
stomach cancer, to name a few.

There are, indeed, treatments for all cancers; but there are
not many "cures" with some tumors.

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 have a PSA that's varied in a range from 5 to 13 (the 13
happened soon after starting testosterone therapy); it's now
back to a steady 6-7, and I'm still on testosterone. I've
also had two negative needle biopsies.

Sadly, there are very few physicians around (maybe it's
because of lawsuit anxiety) who are willing and able to
explain to a patient what the risk tradeoffs are -- and to
say right out that it's a personal and subjective decision
how to choose between the alternatives. Aggressive diagnosis
and treatment may lengthen your lifespan -- but again, it
may not, and it's not without its own risks and costs. Most
urologists seem to be very aggressive in biopsying and in
attaching great significance to high PSA. The one I was
seeing certainly was.

Fernando -- the one with a family history of aggressive
prostate cancer -- certainly has high risk factors. But even
in his case, I'd say that a physician should not dictate the
choice of whether or not to biopsy. The most aggressive
course of treatment would be prostatectomy, on the grounds
that even a negative biopsy might have missed a tumor that
was there. On the other hand, the treatment following a
positive biopsy might not actually prolong his life
significantly.
 
Robert A. Fink, M. D. wrote:
> On Sun, 4 Jul 2004 11:38:58 -0700, "Robert"
> <[email protected]> wrote:
>
>
>>Dr Fink doesn't want to give us the option of deciding on
>>our own individual risk assessment. He doesn't want you to
>>know if you have cancer or not and thus keep you in the
>>dark because of the generalization that all prostate
>>cancer patients should not have known. Why bother going to
>>a doctor in the first place. He has a cynical position. We
>>are all going to die anyways of something or another in
>>the long run. If the survival rates of those having
>>treatment or not is the same than it becomes entirely an
>>emtional issue. You need to support the emotional needs of
>>the individual and the hell with the doctor.
>
>
>
> Hey, WHOA! Please don't put words in my mouth. This all
> started with my posting of an article concerning the
> opinions of a credentialled researcher and commentator. I
> never said that anyone should be "prevented" from having
> all the tests one wants (and is willing to pay for).
> Anyone who wants to have needles inserted through their
> rectal wall is fully entitled to that bit of pleasure; I
> make no attempt to deny such folks their preferences.
>
> But for me, who had a borderline PSA test (7) 10 years ago
> and who is otherwise healthy (at age 66), it doesn't make
> sense for me to get "screening tests". My family physician
> agrees, and that's good enough for me. But, those of you
> who want to be pushed and prodded, please be my guest!

Do you continue to have PSA tests, or have you stopped all
such testing? If your PSA is rising, why don't you have a
biopsy to at least see what the situation is? It is a
relatively safe procedure and if done properly not
particularly painful. If it turns out you do have prostate
cancer, you don't have to have it treated. Why don't you
make the decision with all the information available?

I know there are arguments for your course of action, and I
am not suggesting that your decision was wrong. But I am
curious as to just how you rationalized your choice.

>
>
> 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." <[email protected]> wrote in message
news:[email protected]...
> On Sun, 4 Jul 2004 11:38:58 -0700, "Robert"
> <[email protected]> wrote:
>
> >Dr Fink doesn't want to give us the option of deciding on
> >our own
individual
> >risk assessment. He doesn't want you to know if you have
> >cancer or not
and
> >thus keep you in the dark because of the generalization
> >that all prostate cancer patients should not have known.
> >Why bother going to a doctor in the first place. He has a
> >cynical
position.
> >We are all going to die anyways of something or another
> >in the long run. If the survival rates of those having
> >treatment or not is the same than
it
> >becomes entirely an emtional issue. You need to support
> >the emotional
needs
> >of the individual and the hell with the doctor.
>
>
> Hey, WHOA! Please don't put words in my mouth. This all
> started with my posting of an article concerning the
> opinions of a credentialled researcher and commentator. I
> never said that anyone should be "prevented" from having
> all the tests one wants (and is willing to pay for).
> Anyone who wants to have needles inserted through their
> rectal wall is fully entitled to that bit of pleasure; I
> make no attempt to deny such folks their preferences.
"That bit of pleasure"? You are dealing with that phobia of
yours of invasive procedures from a strickly emotional
point of view.

>
> But for me, who had a borderline PSA test (7) 10 years ago
> and who is otherwise healthy (at age 66), it doesn't make
> sense for me to get "screening tests". My family physician
> agrees, and that's good enough for me. But, those of you
> who want to be pushed and prodded, please be my guest!
You may have had prostatitis or something else elevating
your PSA. No said PSA was 100% specific for anything. More
definitive testing would have to be undertaken and if you
want to put your head in the sand and don't want to know if
it's cancer or not then find plenty of sand. I would prefer
that prostate cancer be studied and in order to do that you
must diagnose it first. You mentioned leukemia. Childhood
leukemia was always fatal before treatment gradually
progressed to the excellent cure rate it's at now. If people
had simply thrown up their hands and said that it was
incurable so why diagnose it, then no progress would have
been made. You have to look at something in order to study
it and not ignore because their is no cure. That is not
science but strickly emotional. So you are afraid to know if
you have prostate cancer, then thanks for your contribution
to the state of prostate cancer research buddy.

>
>
> 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.
> **********************************
 
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