@jime51 Those issues certainly do create challenges for a new patient having to jump through all the hoops.

I started getting PSA tests when I was 45y and was diagnosed 12 years later. In my case, after spending years (on active surveillance) studying and evaluating various treatment options, I selected proton radiation for treatments. I searched for a center that had expertise and success in treating any solid tumor cancers (including prostate) with proton radiation; and it needed to be a teaching hospital and a research hospital. (As well as within a reasonable distance and also covered by my medical insurance.)

I then searched for a radiation oncologist (RO) within that system who I could work with, and then a medical oncologist (MO) to manage my hormone therapy. (As it turned out, the RO and the MO were in different hospitals.) Basically, I assembled my own team.

If I hadn’t agreed to a treatment protocol pre-treatment, we never would’ve started and I would’ve sought out another provider. Once started, everything was already settled and agreed to. (I was 65y when treatments started; I’m 71y now.)

I sought out 2nd opinions for both my initial and my final biopsies.

It’s true that there’s no way for the oncologists to stay current on all the best treatment protocols or standard of care. That’s the value of doing personal research and learning from groups such as this one.

“Stop testing at 70” is a recommendation, not a hard and fast rule (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening). Simply having PSA added to the other blood assays being tested annually isn’t significant.

Prostate cancer is second to lung cancer in the number of men dying each year only because of the large number diagnosed - not because of the chance of dying from it. Once diagnosed, the risk of dying from prostate cancer is only about 12% - and that’s heavily weighted to those with late-stage disease. (When my brother was diagnosed with pancreatic cancer in August 2024, he had an 80% chance of dying from it; he died in October 2024.) So, from a public policy point of view, prostate cancer has much greater impact due to the numbers. But from an individual point of view, I’d choose a diagnosis of prostate cancer over one of pancreatic cancer any day of the week. One is almost always a death sentence; the other isn’t. (Note that cardiovascular disease kills 10x more men annually than does prostate cancer.)

It’s always a good thing to catch prostate cancer well before it begins to spread. Otherwise, the %s change.