Comments on: The business of prostate cancer: putting profit before patients

By: Carolyn Thomas

Carolyn Thomas — Tue, 12 Jun 2012 22:38:42 +0000

Thanks for your perspective, Kathleen. But the PSA test is not considered “benign and useful” just because no radiation is involved in the test. In fact, more and more science-based evidence shows that, as the European studies mentioned above showed, the PSA test was clearly linked with “a high risk of overdiagnosis and over-treatment” and thus associated with needless suffering based on that screening. As for radiation-induced cancers, there has long been a recognized link between one and the other, often decades down the road, but as you wisely say – it’s a trade-off.
regards,
C.

LikeLike

By: Kathleen

Kathleen — Tue, 12 Jun 2012 18:17:10 +0000

The PSA is a simple and thoroughly benign screening test, and I see nothing positive in this growing chorus to stop collecting useful information. In the event of an elevated PSA, we do need calm, rational discussion of likely benefit vs. damage from treatment or none, and fear drives many people to over treat, to their own detriment.

We need to weigh the benefit/damage of every screening and treatment, and, while we also need discussion about fear-driven treatment applied to breast lumps (and more), routine mammography screening is different from PSA tests. Mammograms are not benign: they subject healthy women to repeated radiation, and initial ambiguous results mean yet more radiation.

About medical statistics: they are crude tools for individual decisions and provide only odds. Each person has or does not have a condition, and in either case it is 100%. After many misdiagnoses, at the age of 21 I was diagnosed with an aggressive cancer so rare that I think I was the 35th case worldwide; troops of researchers visited my bedside daily, and the 70th case was diagnosed over 30 years later. So obviously, “But that would be very rare” sounds different to me. Radiation treatment most likely caused my brain tumor, recently removed, but, having lived longer after cancer than before, I consider those years a good trade.

With my radiation history, I only let my dentist xray my mouth every 5 years, would gladly put mammograms on the same schedule. But that is based on an assessment of my own risks and benefits, not on a policy driven by insurance company profit, as many of these recommendations seem to be. Doctors need to spend more time with patients, to get information and to build understanding and trust, but a spate of recent policy articles head in the opposite direction.

While there are many problems in how we use information, the PSA test itself is benign and useful.

LikeLike

By: Carolyn Thomas

Carolyn Thomas — Mon, 12 Mar 2012 12:51:36 +0000

Hello Rozier – very odd. I found a number of used books available for sale online (Amazon, Abe Books) but the prices are crazy ($80-120 – for a used book!) Why don’t you consider submitting your own customer review on Amazon?

I hope Dr. Horan does consider releasing another edition.
Stay healthy!
regards,
C.

LikeLike

By: Rozier

Rozier — Mon, 12 Mar 2012 06:45:51 +0000

I was diagnosed 7 years ago with a Gleason 9 (4 plus 5), which to date has not been treated at all. I’ve done the prerequisite scans, MRSI’s, Color Dopplers, PSA’s etc,,,,but no further biopsies(believe they can be very harmful to my health,,,,sepsis and all. And to date I am doing very well, but PSA is a bit high and of some concern.

Some 2 years ago I purchase my first copy of The Big Scare by Dr. Horan; subsequently purchased many more that I present to members of our local support groups. This book gave me confidence of my strategy to basically ignore this disease, first because I had long believed that treatment was of zero or almost zero value, and 2nd that even without treatment my chance of surviving this disease long enough to expire from some other disorder was close to 80 plus percent and I would rather enjoy an excellent QOL for my remaining years and not to be incontinent and impotent; additionally not wish to die from some treatment related morbidity such as surgery related or hormone related complication.

Now I find that the book The Big Scare is no longer available except at extremely high used pricing and too that the Kindle version (was available for a short time as such) was unavailable.

Did Dr. Horan step on a few too many toes, was he bought off or just what? Any ideas from anyone as to why this very important book is gone? The facts and statistics were outstanding in presenting information that was not available in any other book that I have read… and I’ve read them all, ranging from Dr. Sturm’s to Scholz’s, to Scardino and Walsh.

I’ve called Dr. Horan. He was extremely polite but non-responsive as to my query as to if there would be a re-print of the book.

Another point of interest was that most all books had numerous reviews on Amazon, but this book in 2 years only engendered 3 reviews. What is this all about?

Any comments or information would be welcome.

LikeLike

By: Royale

Royale — Sat, 09 Oct 2010 03:55:44 +0000

“PSA-based screening reduced the already low rate of death from prostate cancer by 20%, but was also associated with a high risk of overdiagnosis and overtreatment.”

That makes it sound like these researchers are saying a 20% reduction in death rate is not considered significant!? Anti-screening advocates like this author have a long way to go to win the PR war waging over the benefits of early detection – much like the breast cancer awareness movement that urges the equally controversial screening mammograms.

LikeLike

By: M. Meagher

M. Meagher — Tue, 17 Aug 2010 20:05:44 +0000

Luiz, I’m betting you have never been diagnosed with cancer yourself. Let’s see how willing to do nothing you’d be if you were one day diagnosed or if you had symptoms consistent with prostate cancer. My guess is that both you and the guy who wrote this book would be demanding both the test and then immediate treatment.

LikeLike

By: Pat

Pat — Sun, 07 Mar 2010 14:55:16 +0000

This is an outstanding book, yet I fear its very thesis will frighten off men and their doctors. There is a very powerful lobbying faction out there snowballing out of control in an effort to raise awareness of this diagnosis and then the “need” for treatment. Thanks for helping to share the experts’ opinions of the other side of this issue.

LikeLike

By: Lou Ferriss

Lou Ferriss — Wed, 20 Jan 2010 03:07:26 +0000

Oh, yeah, it’s a business alright. And what a business! A license to print money for many doctors. I’ve read this book and I encourage everyone to read this – especially men who have bought into the growing demand for routine PSA testing (a movement largely funded by industry and for-profit medicine).

Thanks for helping to spread the word – it’s an uphill battle.

LikeLike

By: Luiz in Barcelona

Luiz in Barcelona — Fri, 15 Jan 2010 18:36:49 +0000

I absolutely agree with the Doctor who wrote this book, but my suspicion is that if a man hears the C-word, he is unlikely to tolerate cancer of any kind, no matter how benign, to go untreated inside his body.

LikeLike