3 ms·

> but at the cost of delaying the identification of high risk cancers. This is visible in the falling rate of newly diagnosed prostate cancer patients in the US

by DanBC 6y ago

> but at the cost of delaying the identification of high risk cancers. This is visible in the falling rate of newly diagnosed prostate cancer patients in the US. Importantly, it doesn't seem to affect mortality rate of prostate cancer, nor all cause mortality. People focus a lot on 5 year survival rate, but sometimes they don't really understand what this means. If I die at 75 does it matter if my cancer is detected when I'm 68 vs 73?

pintxo 6y ago
I tend to agree that this is not such a relevant topic for the average prostate cancer age group which is 70+. Here most might die with prostate cancer but not from prostate cancer. But in the lower age groups 40-60 early detection should IMHO be the aim.
thaumasiotes 6y ago
> If I die at 75 does it matter if my cancer is detected when I'm 68 vs 73? Yes, it matters in both directions. One way is that the cancer might cause you to suffer in other ways, e.g. by metabolizing all of your food, causing you to lose large amounts of weight. If this is addressable (not at all a sure thing!), then knowing earlier is probably better. The other way is that you might not be suffering. In that case, given that your death is fixed, knowing earlier is obviously worse. I've never seen someone die of cancer without being treated beforehand. I understand it's a horrible, painful death. That said, the treatments we apply to someone dying of cancer also make for a horrible, painful death; there definitely is a point at which the treatment is worse than the cancer. Another wrinkle is that treatment may give you a few horrible months, then a few not-so-bad-years before your cancer comes back, and then the horribleness resumes. Those years in the middle are worth something, even if the time at which you die is fixed. If we ignore brief-to-medium remissions, and the hypothetical patient's time of death is fixed, then the obvious recommendation is to avoid all treatment and commit suicide when your quality of life drops too low. But the uncertainty we have in reality makes that difficult.

by DanBC 6y ago

pintxo 6y ago

I tend to agree that this is not such a relevant topic for the average prostate cancer age group which is 70+. Here most might die with prostate cancer but not from prostate cancer. But in the lower age groups 40-60 early detection should IMHO be the aim.

thaumasiotes 6y ago

> If I die at 75 does it matter if my cancer is detected when I'm 68 vs 73? Yes, it matters in both directions. One way is that the cancer might cause you to suffer in other ways, e.g. by metabolizing all of your food, causing you to lose large amounts of weight. If this is addressable (not at all a sure thing!), then knowing earlier is probably better. The other way is that you might not be suffering. In that case, given that your death is fixed, knowing earlier is obviously worse. I've never seen someone die of cancer without being treated beforehand. I understand it's a horrible, painful death. That said, the treatments we apply to someone dying of cancer also make for a horrible, painful death; there definitely is a point at which the treatment is worse than the cancer. Another wrinkle is that treatment may give you a few horrible months, then a few not-so-bad-years before your cancer comes back, and then the horribleness resumes. Those years in the middle are worth something, even if the time at which you die is fixed. If we ignore brief-to-medium remissions, and the hypothetical patient's time of death is fixed, then the obvious recommendation is to avoid all treatment and commit suicide when your quality of life drops too low. But the uncertainty we have in reality makes that difficult.