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Old 10-12-2011, 05:50 AM   #121
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Originally Posted by GregLee View Post
Every 3 years, since (1) on my last one a precancerous polyp was found (and removed), and (2) 6 years ago, a cancer was found. As to how often, in general, one should have a colonoscopy, I can't pretend to offer an objective opinion, since if I had not had one 6 years ago, now I would be dead, dead, dead.

Edit: By the way, prostate cancer is not detected by colonoscopy, which is for colorectal cancer, not prostate cancer.
Right, it was a 2 part question that kind of ran together.

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Old 10-12-2011, 10:27 AM   #122
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Originally Posted by Dawg52 View Post
Right, it was a 2 part question that kind of ran together.
[Insert colo-rectal prostate punchline here...]


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Old 10-14-2011, 11:34 AM   #123
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Excellent thread. I read the recent draft recommendation of the US Preventive Services Task Force that others referenced. My lay reaction is that they are simply saying that the overall the risks of biopsy and cancer treatment (based on elevated PSA test results) outweigh the benefits. As a result of the tests a lot of men will get painful, dangerous biopsies and treatments that they did not need. A few men will get earlier treatment of dangerous tumors, but, the statistics show that the benefits are minimal or none. The studies found NO advantages from screening for men over 70. And the studies showed marginal if any benefits for men 59-70. From the recommendation: "The evidence is convincing that for men aged 70 years and older, screening has no mortality benefit. For men aged 50 to 69 years, the evidence is convincing that the reduction in prostate cancer mortality 10 years after screening is small to none." If all of this is accurate then most (maybe not all) of the guys who got early treatment due to the test/biopsy would have gotten treatment later due to clinical symptoms and would end up with a similar result. The recommendation is to rely on clinical symptoms, not PSA screening to counsel a biopsy and subsequent treatment if a cancer is found. They are saying we are better off waiting for symptoms before getting a biopsy. Here is another quote:
"The common perception that PSA-based early detection of prostate cancer prolongs lives is not supported by the scientific evidence. The findings of the two largest trials highlight the uncertainty that remains about the precise effect that screening may have, and demonstrate that if any benefit does exist, it is very small after 10 years. The European trial found a statistically insignificant 0.06% absolute reduction in prostate cancer deaths for men aged 50 to 74 years, while the U.S. trial found a statistically insignificant 0.03% absolute increase in prostate cancer deaths (6, 7). A meta-analysis of all published trials found no statistically significant reduction in prostate cancer deaths (10). At the same time, overdiagnosis and overtreatment of prostatic tumors that will not progress to cause illness or death are frequent consequences of PSA-based screening. Although about 90% of men are currently treated for PSA-detected prostate cancer in the United States—usually with surgery or radiotherapy—the vast majority of men who are treated do not have prostate cancer death prevented or lives extended from that treatment, but are subjected to significant harms."
I don't like burying my head in the sand but I feel (at least with the present data) that I am better off risking a small chance of a bad cancer outcome to avoid a much higher chance of a bad unnecessary side effect of PSA testing/treatment. I hope folks around here will be quick to post new information and/or tests that can make the risk/benefit decision easier.
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Old 10-14-2011, 12:30 PM   #124
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It's a difficult decision for me. I knew several guys from my old workplace that had positive tests followed by biopsies that they said were painful, and negative, but I do know one person who found he had prostate cancer and was successfully treated a few years back.

A PSA test comes with my annual physical and it has always been below 1 so I think my reaction would be to proceed with biopsies if it became raised and stayed high.

In the UK there is no routine PSA screening, although you can request one, particularly if there is a family history.

Why isn't there UK PSA screening? : Cancer Research UK : CancerHelp UK

At the moment, there is no single screening test for early prostate cancer in healthy men that is reliable enough to use. There are 3 main ways of finding prostate cancer. Doctors usually combine these, because none of them are completely reliable when used on their own. The tests are
  • The PSA test
  • Digital rectal examination (or DRE)
  • Biopsy
There is information about these tests in the prostate cancer section of CancerHelp UK. It would be very difficult to use the 3 tests together in a screening programme. It would be very expensive and difficult to organise. Biopsy is an invasive test that can have complications. And it may not be acceptable to men to have a test like that when they are apparently healthy and have no symptoms.
Experts are still discussing the use of the PSA test as part of a screening programme in the UK. Below, there is a summary of the arguments for and against PSA screening.
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Old 10-14-2011, 12:40 PM   #125
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I was thinking about the reasons for and against the PSA test and had assumed that it is valuable in catching early cancers if you are someone who would always elect to risk the biopsy if the test is over a certain threshold and always would treat the cancer if the biopsy showed one. Then I thought about false negatives and did a quick Google and found this at the Mayo Clinic: "Some prostate cancers, particularly those that grow quickly, may not produce much PSA. In this case, you might have what's known as a "false-negative" — a test result that incorrectly indicates you don't have prostate cancer when you do." So we get tested to catch aggressive cancers but those are the very ones that may not raise the PSA. No wonder the mortality rates don't change based on the test. We catch a lot of early cancers that don't need treatment and miss some of the aggressive ones that do.
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Old 10-14-2011, 12:53 PM   #126
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By the way, the current skepticism about the value of screening with PSA tests also extends to the DRE. Wikipedia has a discussion covering both: Prostate cancer screening - Wikipedia, the free encyclopedia.
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Old 10-15-2011, 08:24 AM   #127
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Everyone has perspective on this. If you are 70 and PC is early-detected, you probably will not die from it. Of course, that is statement based on what I've read, and does not apply to each individual.

If you are early detected at 50, this discussion means something very different. If you don't get PSA screening, that is a risk you certainly can take. Based on my own experience, I would not suggest that anyone skip the PSA. I would say that the biopsy is a dilemma, for several reasons that don't need to be re-hashed.

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