Any New Info on PSA Screening?

[TromboneAl]

I translate these:

• The U.S. Preventive Services Task Force (USPSTF) says that most men should not be given PSA tests as part of routine medical checkups. Instead, each man should talk to his doctor to see if he should have the test.
• The American Cancer Society (ACS) advises men to talk with their doctors about testing and treatment before deciding about testing.
• The American Urological Association (AUA) recommends that men decide with their doctors about screening.

This way:

• If, by chance, you have a doctor who strongly believes in the value of PSA tests, you should get a PSA test.
• If, by luck of the draw, you have a doctor who does not believe in them, you should not get a test.
• If your doctor is on the fence, you should decide for yourself.

[Rich_by_the_Bay]

Quote:

Originally Posted by TromboneAl I translate these:..This way:

My take is that they know the evidence fails to support the test for screening, but also know that patients and advocacy groups are passionate about it and they don't want to get caught in the political cross-fire.

Look what happened when the public health service announced that most screening mammography is of unproven benefit: Armageddon.

[HFWR]

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...

[GregLee]

Quote:

Originally Posted by HFWR So the test is inconclusive, but we should do it anyway.

The test works to detect prostate cancer, but what's not clear is that the test prolongs our lives. After all, you could have prostate cancer, the PSA test could correctly detect it, but then you could die from complications of the operation to remove the prostate. Should insurance have paid for the test?

[HFWR]

Quote:

Originally Posted by GregLee The test works to detect prostate cancer, but what's not clear is that the test prolongs our lives. After all, you could have prostate cancer, the PSA test could correctly detect it, but then you could die from complications of the operation to remove the prostate. Should insurance have paid for the test?

Or you might NOT have PC, and die from infection from the biopsy...

Btw, my doc tests me every year, and it's FREE! Well, $30 copay free...

[Alan]

Quote:

Originally Posted by HFWR 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]

Quote:

Originally Posted by TromboneAl 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]

Quote:

Originally Posted by 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.

Quote:

Originally Posted by REWahoo 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]

Quote:

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

No, I can't.

[Moemg]

Quote:

Originally Posted by TromboneAl 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]

Quote:

Originally Posted by Moemg 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]

Quote:

Originally Posted by GregLee 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]

Quote:

Originally Posted by tjscott0 Here is an article agin PSA testing: Skip These Tests? (washingtonpost.com)

From the article:

Quote:

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.