Any New Info on PSA Screening?

[Alan]

So the test is inconclusive, but we should do it anyway. "Someone" is paying for these tests of limited usefulness. Such are the problems with our medical system...

The cost of the actual test is not bad - my PSA test last year cost me $5 and the insurance company $27.

I would find it hard to refuse one at my annual visit to the urologist since I did have BPH and the medication worked great. I could just not go until I had a problem again but then I'd have a headache from DW nagging me. (The medication is also not a bad cost-wise at $15 for 90 days supply).

 

[TromboneAl]

I talked with my doctor on the phone, and he agrees that I don't need to have any testing on this issue.

Sometimes I think the best thing would be to get a PSA test, but have the results sealed -- no one sees them, even the doctor. But you can open the results in the future, and use them as a baseline.

 

[REWahoo]

Sometimes I think the best thing would be to get a PSA test, but have the results sealed -- no one sees them, even the doctor.

I had the same idea about a paternity test once, but her father vetoed it...

 

[Alan]

I talked with my doctor on the phone, and he agrees that I don't need to have any testing on this issue.

Sometimes I think the best thing would be to get a PSA test, but have the results sealed -- no one sees them, even the doctor. But you can open the results in the future, and use them as a baseline.

I had the same idea about a paternity test once, but her father vetoed it...

 

[Bestwifeever]

Not directly about PSA tests, but this interview with one of the authors of "Overdiagnosed: Making People Sick in the Pursuit of Health," by Dartmouth researchers and physicians H. Gilbert Welch, Lisa Schwartz and Steven Woloshin was in today's online Chicago Tribune: Some doctors dispute benefits of early diagnosis - chicagotribune.com

 

[TromboneAl]

Let me tell you a story.

Twelve years ago Lena had terrible headaches. To find the cause, she had an MRI (MRI stands for "machine that will find something wrong with you no matter what"). It showed a golf-ball sized tumor in her frontal lobe. But the doc said that it was probably slow growing, and not the source of the headaches.

One option was to wait and watch the tumor and see how much it was growing. Maybe she could live a long life with it in there.

She decided to have it taken out. One reason was that maybe the doc was wrong and it was the source of the headaches. Also, we figured that even if it were slow growing, it would be better to remove it while young than when she was 85. And there's always the "There's an alien thing in my body and I want it out now!" aspect. And health insurance.

So, she had the surgery, and there were complications, and five surgeries were required with much time in the ICU. She still has a shunt. The result was OK, but the headaches continued.

Was the surgery unnecessary? Who knows?

The source of the headaches was discovered months later (an unrelated and potentially deadly blood vessel malformation). The brain surgery could have been fatal because of it. The AV problem was fixed at UCSF with a titanium coil inserted into the brain via her thigh.

BTW, at the same time there was a re-occurrence of a bone tumor in Jenny's leg.

Everyone is fine now, but you can see how it influences my thinking, for better or for worse.

 

[Rich_by_the_Bay]

I'm very sorry for what Lena and you have endured.

The "incidentaloma" -- an unexpected finding often diagnosed by a test whose sensitivity and specificity are inappropriate for the diagnostic concern in question. Yes, there are occasional miraculous "saves" due to early diagnosis (even if for the wrong reason), but the rest of the patients sometimes pay dearly for it.

Everyone has good intentions in these situations -- doctors, patients, loved ones -- but it happens.

 

[GregLee]

Everyone is fine now, but you can see how it influences my thinking, for better or for worse.

No, I can't.

 

[Moemg]

Everyone is fine now, but you can see how it influences my thinking, for better or for worse.

Al, I can understand how it influences your opinion but we are not talking about brain surgery here . We are talking about a simple exam and a blood test and maybe an ultrasound .

 

[hornet99]

In my opinion, PSA tests offer another useful data point in diagnosing a potentially life threatening disease. Based on family history of PCa, I followed the conventional advice of getting a DRE and baselining my PSA at age 40. The DRE (performed by primary care Doc) showed no abnormality, but my PSA came in a at 3.7. That, with the family history concerned my primary care Doc enough to refer me to a urologist. The urologist performed a DRE which indicated an slight enlargement and small "protrusion". This lead to a biopsy and a subsequent diagnosis of stage 2 PCa. Without the initial PSA, there's no doubt that the cancer would still be growing inside me today. If anyone reading this has this family history, my recommendation is to get the PSA test annually. Also, while the biopsy is no walk in the part, I'd go through 10 of them if they lead to successful diagnosis.

 

[TromboneAl]

Al, I can understand how it influences your opinion but we are not talking about brain surgery here . We are talking about a simple exam and a blood test and maybe an ultrasound .

Maybe its because of my Post-Medical-Stress-Disorder that I see it as the same thing, just at a different end of the body. If you get a high PSA value, you may have a life-threatening cancer growing inside you. Or maybe not. So you have the biopsy, and wait by the phone for the results. Etc.

With a different set of probabilities, I'd be willing to go through that. I think that not only can you not appreciate that roller coaster unless you've been on it, as BBBAmI is now, but even if you've done it before, you forget what it's like.

A lot of people "win" the PSA lottery, finding an aggressive cancer and getting cured. But stories from lottery winners don't mean that it makes sense to buy a lottery ticket.

 

[BOBOT]

Here's the problem I have with the case against the PSA. I can't understand how there can be a virtue in withholding information from me. I understand that a high PSA score could lead to an unnecessary and painful biopsy, but then it's the decision to have the biopsy that caused the problem, not the PSA test. I understand that a high PSA score could lead to a prostatectomy which doesn't improve survival likelihood, but in that case, it's the decision to have the operation that led to the bad result. The PSA test is not the problem.

I just don't like the idea that my doctor might adopt a policy of keeping me ignorant of test results for fear that I might somehow force him to give me an inappropriate therapy.

Exactly my thinking, GL. Give me the data & let me decide!

 

[tjscott0]

Here is an article agin PSA testing:
Skip These Tests? (washingtonpost.com)

Dr Hadler has a view agin the popular coronary by pass surgery:
YouTube - Nortin Hadler Interview - Coronary Bypass and Angioplasty

He feels there is much type II medical malpractice in today's medicine. Type II medical malpractice is doing the unnecessary very well.

I would recommend checking your local library for any of his books.
http://http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=dr+nortin+hadler&x=0&y=0


Also I would recommend a book "Know Your Chances:Understanding health statistics"
Amazon.com: Know Your Chances: Understanding Health Statistics (9780520252226): Steven Woloshin M.D.M.S., Lisa M. Schwartz M.D.M.S., H. Gilbert Welch M.D. M.P.H.: Books

In the back of this book is a risk chart for men & women for the various diseases in the population as a whole.

The numbers below will tell you how many men out of a thousand will die from prostate cancer in the next 10 years.

Age 50-54 1 in 1,000 for both smokers & ninsmokers
Age 55-59 2 in 1,000 for both smokers & nonsmokers
Age 60-64 3 in 1,000 for both smokers & nonsmokers
Age 65-69 6 in 1,000 for both smokers & nonsmokers
Age 70-74 12 in1,000 for nonsmoker
Age 70-74 10 in 1,000 for smoker
Age 75-79 19 in 1,000 for nonsmoker
Age 75-79 15 in 1,000 for smoker

Personally I been doing the PSA/cholesterol/glucose test every other year since age 50. Which I guess means that while I buy what Dr Hadler sez. I'm not a 100% backer of his views. I probably carry too much property & casualty insurance too. But I sleep better at night.

 

[tjscott0]

Oh And to be fair to doctors; I believe much Type II medical malpractice is performed due to fear of medical malpractice suits. Former Senator Edwards became a multi millionaire in winning medical malpractice suits based on bad science.
Edwards' malpractice suits leave bitter taste - Washington Times

 

[GregLee]

Here is an article agin PSA testing:
Skip These Tests? (washingtonpost.com)

From the article:

But you are not going to make a major difference in death or the timing of your death. You're going to die about the same time of something else and there's a good chance that you're going to spend your post-radical-prostatectomy time coping with impotence and incontinence. The same [general principle] pertains to breast cancer, colon cancer and most heart disease.

As his view applies to colorectal cancer, in my opinion, Dr. Hadler is an ignoramus. A therapy doesn't even make its way into the repertoire of standard treatments unless it extends life. Many people (including me) are successfully treated without such long term side effects as impotence and incontinence. I've seen many stories of people whose early stage cancer was caught by screening colonoscopies (as mine was). And I do think that if stage 4 colorectal cancer is not treated, it will kill you.

But Dr. Hadler expresses himself imprecisely, at least as quoted in this article. What does "die about the the same time of something else" mean, exactly? Does diagnosis and therapy buy you an extra month of life? A year? A decade? What chance of permanent debilitating side effects would be a "good chance"? These details matter.

 

[Tiger]

I've had two biopsies and never suffered pain from either one.

 

[FIRE'd@51]

of interest is that for men who have had 2 normal PSA screens, the risk of dying from prostatate cancer is very low and may obviate the need for further screening

I find this very interesting. Is there a time frame or age above which this is is the case?

 

[Rich_by_the_Bay]

I find this very interesting. Is there a time frame or age above which this is is the case?

I think it was around age 60. Not gospel, just a finding that requires further research.

 

[tjscott0]

A therapy doesn't even make its way into the repertoire of standard treatments unless it extends life.

It is exactly that contention that Dr Hadler espouses. He states that for 97% of coronary-by-pass patients there is no survival benefit from the surgery. The other 3% are patients with Left Main Disease. In those cases coronary-by-pass surgery provise a significant benefit. That opiniion is based on 3 studies done in the latte 1970's to mid 1980's.

What does "die about the the same time of something else" mean, exactly?

He means that an American is likely to live to age 85. And that octogenarians should beware of medical schemes that are offered to prolong your life. One is likely from die from any number of causes. My uncle's prostate cancer has metastasized to the bone. He weighted the side effects of chemotherapy versus the average time gained. He eschewed treatment.

Does diagnosis and therapy buy you an extra month of life? A year? A decade?

Well of course it varies. I think for the population at large one doesn't gain much. If one has a family history of a particular disease; they gain more. One is banking on that the test will be performed just at the right time to catch a disease in the early stages. I'm influenced by the fact that everyone in my family lived to at least 75 & up to 95. That's long enough. And if I turn up my toes prior to that; its the luck of the draw. No one gets out of this life alive.

 

[GregLee]

He states that for 97% of coronary-by-pass patients there is no survival benefit from the surgery.

Perhaps that's so (though it's a rather odd statistic) --- my remarks concerned only colorectal cancer.

 

[tjscott0]

my remarks concerned only colorectal cancer.

In his book he talks about Minnesota Colon Cancer Control Study[1993].
There were 47,000 adults between the ages of 50 to 80 in the study. They divided them into sections. 1)annual fecal occult blood testing[FOBT] 2)
biennial [FOBT] 3)no [FOBT].The test ran 13 years. Annually the number of deaths from colorectal cancer were1)80 2)120 3)120. There was absolutely NO difference, however, in the all cause mortality across the groups-about 3,300 in each group.So out of 47,000 to spare 40 individual required identifying the true positives among the 75% of those tested who had false positives. 12246 colonoscopies were performed. 4 resulted in a perforation of the colon(surgery required) &11 resulted in bleeding(3 requiring surgery.
Dr Hadler:

If we rely on FOBT as a screening method, we would have to screen 1,000 people over the age of 50 for a decade to spare 1 death by colorectal cancer. In doing so, we would not affect mortality from all causes. And if we relied on colonoscopy to determine if a FOBT was a true or false positive, for every person spared death by colon cancer, a person with a normal bowel would suffer a serious non fatal complication during diagnosis.

Dr Hadler also addresses the accuracy & thoroughness of a colonoscopy.

One study recruited 183 patients with a positive FOBT to undergo two colonoscopies by two different experienced colonoscopists on the same day. The first colonscopist removed all polyps and adenomas that were discovered. The second found another 89 that the first missed.

The odds of dying from colon cancer according to the chart in "Know Your Chances":
how many out of 1,000 men will die in the next 10 years from colon cancer.
50-54-2 for smokers & nonsmokers
55-59-3 for smokers & nonsmokers
60-64-5 for smokers & nonsmokers
65-69-8 for nonsmokers, 7 for smokers
70-74-10 for nonsmokers, 9 for smokers
75-79-13 for nonsmokers, 11 for smokers

 

[GregLee]

50-54-2 for smokers & nonsmokers
55-59-3 for smokers & nonsmokers
60-64-5 for smokers & nonsmokers
65-69-8 for nonsmokers, 7 for smokers
70-74-10 for nonsmokers, 9 for smokers
75-79-13 for nonsmokers, 11 for smokers

And these figures tell us what? That people shouldn't get FOBTs or colonoscopies? Does it really follow? By the way, I've never had a FOBT -- I'm not sure they're still recommended for screening. The nice thing about colonoscopies is that they can not only detect cancer, but sometimes prevent it, when the doctor finds and removes a pre-cancerous polyp. At my colonoscopy last Fall, such a polyp was found, and my gastroenterologist also found and fixed a problematic blood vessel in the colon wall which might eventually have given me a problem.

 

[tjscott0]

And these figures tell us what?

These numbers put your risk into perspective.
A nonsmoker aged 75-79 has a 1.3% chance of dying in 10 years from colon cancer.
A nonsmoker aged 50-54 has a .2% chance of dying in 10 years from colon cancer.
The more data & differing points of view available allows an individual to make a decision.

One's medical treatment is likely to be influence by where a person is in the country than a set standard nationwide.

The map below shows the wide variation of per patient spending in the US.
Medicare Reimbursements - Dartmouth Atlas of Health Care

The data is that medicare patients with less care is better care.
Below is a link of a thread on TMF about the above statement with alot of good info & links.
TMF: The Cost Conundrum / Macro Economic Trends and Risks

 

[veremchuka]

i just had a physical and blood work done so i pulled out the papers for the blood work. i can't find any test that is called psa. i know i had the test done in 2009 and again last fall but i can't find it on either set of papers. is this test called something else, there's a lot of tests with 3 letters but no psa. i was told it was normal both times tho my prostate is slightly enlarged.

 

[GregLee]

is this test called something else, there's a lot of tests with 3 letters but no psa.

I've just checked my copy of my most recent labs. There is a separate page titled "Immunology" with two test results. In the "Procedure" column, one is CEA and the other is named "PSA Prostatic Specific Antigen Screen".