Any New Info on PSA Screening?

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

[FIRE'd@51]

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Originally Posted by Rich_in_Tampa 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]

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Originally Posted by FIRE'd@51 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]

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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.

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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.

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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]

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Originally Posted by tjscott0 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]

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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:

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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.

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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]

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Originally Posted by tjscott0 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]

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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]

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Originally Posted by veremchuka 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".

[veremchuka]

thanks. on both sets of papers from '09 and '10 blood work i don't see anything. i know this test was done because i remember asking about it each year and was told it was ok. odd how it is not on the paper work from the hospital where the blood was drawn and the report issued. i have another check up in a month i'll bring these papers and ask about it.

[Nords]

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Originally Posted by TromboneAl I find the arguments against testing compelling. I know that my prostate is enlarged, and together with all the biking, I'm guessing that my PSA score would be high, even if there's no cancer. ... but I don't want to head down the road to possible false positives. I'm 57 and have never had a psa test.

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Originally Posted by TromboneAl My problem is that I don't know whether to trust my doctor or not. Sometimes he says things that seem pretty kooky to me.

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

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Originally Posted by TromboneAl 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. 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.

Al, we come from different ends of the bias bell curve, but let me share this logic anyway.

First, you need a new doctor. They're everywhere and they keep making more of them. You, one of the most frugal people I've ever met, know how to shop for a quality product. You keep sampling them until you find one who thinks like you and makes you feel better. If you think they're kooky then go find another one. Life is too precarious to waste your time, energy, & emotion dealing with a guy who may or may not have your best interests at heart.

Second, your lottery analogy is flawed. Think of it more as a Russian Roulette analogy. By not having a PSA you do indeed remain blissfully ignorant, but you also limit (or even eliminate) your treatment options.

When my father's tumor was diagnosed, his PSA was part of a "routine" blood test that was ordered for another reason. (It was his first doctor's visit in over a decade.) His PSA was in double digits. The digital rectal exam was an "Uh-oh." The tumor was determined to be a stage IV. The radical prostatectomy was scheduled within a couple of weeks, so he felt he was scrambling to be logistically ready for it-- let alone mentally & emotionally. The word "radical" turned out to affect a couple other functions of that area of your anatomy that you'd prefer to preserve, although these days he's continent again. In other words, life-saving damage control was the priority-- not thoughtful reflection and a conservative treatment plan.

If you get a PSA (free DRE with every blood sample!) and it's 0.5 then you're done. If it's 25 then you certainly don't have to worry about false positives. Even if it's in an ambiguous range, further diagnosis (ultrasound or biopsy) can help-- or you can choose to come back next year to establish a baseline.

Most important of all, you can choose "watchful waiting" or "radiation therapy" instead of "cut this guy open because he's out of time".

When my father was diagnosed then I started the annual routine of PSAs and DREs. After five years of 0.6 or lower I stopped worrying about it, but I'll check it every couple years or so.

I'm just sayin'.

I wonder if Lance Armstrong's doctor said that his testicular-cancer symptoms were "Oh, that's just from all the biking"...

[TromboneAl]

I thought it was kooky to say that the symptom (OK, slow start when peeing), was related to biking, because I've been biking for years. But since then I realized that I've recently been trying to get used to a new saddle that is uncomfortable. The last time the symptom appeared was a few hours after a 40 mile bike ride. There's more related to this that I don't care to share.

I still see no problems with the lottery analogy. You're telling me it's flawed because your dad had a PSA and it saved his life. That's like saying one should buy lots of lottery tickets because poverty-stricken Jane Doe spent half her income on lottery tickets, and won 50 million dollars.

Let's say that instead of a PSA test, your doctor goes in the other room and flips a coin. If it's heads he comes back and says that you may have cancer, and that you should have a biopsy. That coin-flip test could save thousands of lives, but that doesn't mean that it's a good test.

From the link in the OP:

Professor Richard Ablin from Arizona University, the person who discovered PSA, wrote an op-ed in the New York Times on March 9, 2010: “The test’s popularity has led to a hugely expensive public health disaster… The test is hardly more effective than a coin toss. As I’ve been trying to make clear for many years now, P.S.A. testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t. I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of PSA.

The problem with "Give me the data, I don't want to be blissfully ignorant." is:

1. The data are unreliable.
2. Saying that you can decide not to get a biopsy or treatment ignores the fact that emotionally, you may not be able to resist.

[Moemg]

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Originally Posted by TromboneAl I thought it was kooky to say that the symptom (OK, slow start when peeing), was related to biking, because I've been biking for years..

Your Doctor is not taking your concerns seriously and you would be wise to find another Doctor .

[haha]

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Originally Posted by tjscott0 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

Appears that an older gent who wishes to avoid death from prostate cancer should take up smoking. Pass me a Camel?

Ha

[grasshopper]

Maybe Rich will chime in. I have had a PSA and digital done every year for 20 years(60YO). For 15 or more years, during my annual a digital would be done, and right after my blood was siphoned drawn.

Now I am in a new practice and two Physicians have had me wait to to blood work a week or so, after my exam.

Is this new school?

[Rich_by_the_Bay]

Quote:

Originally Posted by grasshopper Maybe Rich will chime in. I have had a PSA and digital done every year for 20 years(60YO). For 15 or more years, during my annual a digital would be done, and right after my blood was siphoned drawn. Now I am in a new practice and two Physicians have had me wait to to blood work a week or so, after my exam. Is this new school?

• A particularly "robust" digital rectal exam (or long bike rides) can elevate the PSA for a day or two.
• There is no evidence that screening DRE saves lives despite some very large decent studies, though it is common practice.
• Of 100 screening PSAs which are roughly in the range of 4 - 10, 3 are right and 7 are false positives. All 10 generally end up referred for biopsy, since you don't know in advance which group you are in (a few just get watched, which begs the question of why were they screened to begin with).
• Some 80% of men who die of non-prostate causes after age 80 have small, non-invasive prostate cancer at autopsy and never knew it in life.
• If you choose screening you should logically follow through with biopsy if positive, knowing it will probably be reassuring (70%) and not knowing whether or not treatment improves survival for the other 30%; if you wouldn't have the biopsy even if positive, it is not logical or useful to have the PSA to begin with.
• It is not "wrong" to implement a PSA screening strategy; rather it reflects your willingness to proceed at high cost with a plan filled with uncertainty. It's like poker -- sometimes you win with a pair of 3's, sometimes you lose with a straight flush but usually the numeric odds play out.

We need a better PSA.

[haha]

I know one thing- it is going to take an act of God to change the way our "preventive medicine" is organized. To me it mostly appears to be a procedure farm.

That link to the rheumatologist who put down testing was interesting. Like, what can it do for him? Find him more people to give aspirin too?

That won't buy many 911s will it?

I hope it will not seem that I think individual doctors don't put patient well being first. I do respect what doctors are trying to do. But the system sure makes it hard to not go along- huge medical school loans, constant pharma pushing, questionably honest journal articles, and just the natural desire to find safety in group consensus.

Ha

[braumeister]

I agree completely. However, IMHO the good ones make up for a lot of the problem. My primary doc is a marvelous diagnostician, and I really think he cares as much about my well-being as I do. He always gives me plenty of alternatives, and outlines the pros and cons (and costs) of each of them. Occasionally, I will challenge him on something, and tell him what I know based on my own research. Whenever I do that, he is always delighted, since he says most people simply nod and agree when he speaks, then ask him to tell them what to do. He enjoys having an actual conversation about a condition or a treatment.

I've been seeing this doc for the last 18 years, and we have a great relationship. Every referral he has given me has been to an equally good specialist. Maybe I'm just lucky, but I have to think that there are a lot of good docs like this out there; you just have to keep looking until you find one.

[Nords]

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Originally Posted by TromboneAl The problem with "Give me the data, I don't want to be blissfully ignorant." is: 1. The data are unreliable. 2. Saying that you can decide not to get a biopsy or treatment ignores the fact that emotionally, you may not be able to resist.

When I made the point that the analogy was flawed, perhaps I should've avoided trying to come up with a better analogy.

You seem to be choosing to be blissfully ignorant rather than have to confront ambiguous information. I can't live that way.