Any New Info on PSA Screening?

[TromboneAl]

This thread from two years ago:

http://www.early-retirement.org/for...er-a-10-year-period-in-large-trial-43229.html

has excellent information on the pros and cons of PSA tests, thanks primarily to Rich's clear explanations. This article is also interesting:

PSA screening is a public health disaster, says cancer doc – Croakey

I'm wondering whether there's any new data out concerning the advisability of the PSA test?

 

[Rich_by_the_Bay]

PSA screening is a public health disaster, says cancer doc – Croakey
I'm wondering whether there's any new data out concerning the advisability of the PSA test?

Not really, Al. There was an important meta-analysis validating the weaknesses of PSA screening; 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 - suggested but not proven at this time (might turn out to be a useful screening strategy by identifying low risk patient who need less intense evaluation).

The decision remains difficult and most doctors (and many patients) lean toward screening despite marginal evidence to support it. Each to his own for now.

 

[GregLee]

I've really never understood the reservations about taking PSA tests, but anyhow, I did get some information about interpretation of results from a talk with my radiation oncologist a couple of days ago. I told him I was a little concerned that my PSA score had pushed up above 4.00, which my lab says is the top of the normal range. But my doctor said a little above 4.00 is perfectly fine for someone as old as me, since there are age adjustments to the normal range. (He didn't recall the exact adjustments, and I'm sorry that I don't have a reference to offer.)

 

[Tiger]

I have a pre-cursor for prostate cancer and get tested every 6 months. After the last test (about 2 months ago) my urologist's office called and told me that my PSA count was edging toward the high side. Two weeks ago I underwent blood tests for insurance purposes and my PSA count was 1.5. I will discuss this with the urologist when I next see him.

By the way my urologist is a believer in PSA testing.

 

[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.

I recently mentioned a prostate-related symptom to my doc, who said "Oh, that's just from all the biking." and didn't pursue it. I don't think it's just the biking, but I don't want to head down the road to possible false positives. I'm 57 and have never had a psa test.

I brought this up in a prostate cancer forum, and of course almost everyone said I should immediately get tested, and fire my doc. But I realized that this is like asking whether I should buy lottery tickets in a forum of lottery winners.

I still haven't decided what to do. I think I'll phone my doctor to see what's behind his thinking.

 

[Alan]

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.

I recently mentioned a prostate-related symptom to my doc, who said "Oh, that's just from all the biking." and didn't pursue it. I don't think it's just the biking, but I don't want to head down the road to possible false positives. I'm 57 and have never had a psa test.

I brought this up in a prostate cancer forum, and of course almost everyone said I should immediately get tested, and fire my doc. But I realized that this is like asking whether I should buy lottery tickets in a forum of lottery winners.

I still haven't decided what to do. I think I'll phone my doctor to see what's behind his thinking.

Thanks for raising this again, it is a very difficult question. During the last 2 years at work ('08 & '09) there were 3 guys in my group who, like me, had all been having annual PSA tests as part of the company physical and had sudden high results. Two of them went in for follow-up biopsies, complained like hell about how much it hurt but were relieved that the results were negative.

The 3rd guy had just received a score of 6.x after the previous years below 1 and the doc was recommending the biopsy, but he declined after hearing the experiences of his workmates plus all the reports of false positives.

I'm sure he'll face tough decisions each year if it stays high. I think also in his case the "velocity" of the change would have me leaning towards the biopsy rather than just the raw score, or possibly request another test to validate the accuracy of the high score.

 

[bbbamI]

Since DH's PSA was a 4, I figured the slight raise in the number was due to him riding his motorcycle. Most of his biker buds thought the same thing. Unfortunately, that was not the case.

 

[GregLee]

Two of them went in for follow-up biopsies, complained like hell about how much it hurt but were relieved that the results were negative.

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.

 

[Alan]

In 2008 I had symptoms of BPH so took myself off to see a urologist in April that year. My PSA scores had never been above 1 and BPH is pretty common in older men, so I wasn't too concerned.

I do/did have BPH and have been on Flomax ever since. The improvement was almost immediate - within 2 or 3 weeks and I have been fine ever since.

My last urologist visit was October, and he said those magic words "you have a normal sized prostate". I'm still taking the medication, no after effects. PSA last test was 0.95.

Hope this helps. I really don't know what to advise, it's a very personal decision.

 

[waltwill8]

Had the PSA last spring. Increased from 2.5 to 3.6 since the year before.
Decided to study it, found out that it could be affected by diet and supplements. Upped vit D3 to 10k iu/day, Very low carb (no wheat, starch, sugars), Vit K2, high dose fish oil (3000 mg EPA+DHA), coQ-10, magnesium, selenium, and niacin for CAD.
Found out that thare is a test for free PSA, and over 25% indicates cancer is unlikely.
Retested in July. It had dropped to 3.2 and free PSA was 37%.
No need for urologists with big knives!!!!

 

[Rich_by_the_Bay]

1. Once you decide to test and the value is 4-10, it is almost impossible to decide against biopsy (after all, why would you test if not to follow through with biopsyif positive). The emotional pressure is too strong to resist.

2. I have had at least two patients (one a physician) die of of sepsis after biopsy, and a dozen more require hospitalization and IV antibiotics.

3. A level of 4 is much different from a level of 9 or 10; if I had a 9 I might consider biopsy; a 4, not so much.

Without definitive evidence and speaking only for myself, I like the strategy of a baseline PSA for a year or two. If both are <1, you might leave it at that. If >= 4, follow closely. This is neither standard practice nor a recommendation. It has not yet been studied prospectively and may be wrong. But it feels sensible to me and is consistent with available data.

You, of course, should discuss with your own doctor. BTW, my guess is that 95% of urologists believe in annual screening PSAs.

 

[SecondCor521]

But my doctor said a little above 4.00 is perfectly fine for someone as old as me, since there are age adjustments to the normal range. (He didn't recall the exact adjustments, and I'm sorry that I don't have a reference to offer.)

This is what is listed on my last lab results:

"Ref range 0.0 - 4.0
Additional interpretative information for PSA:
age 40-49 years: 0.0 - 2.5 ng/mL
age 50-59 years: 0.0 - 3.5 ng/mL
age 60-69 years: 0.0 - 4.5 ng/mL
age 70-79 years: 0.0 - 6.5 ng/mL
Reference: JAMA August 18 1993 vol 270 #7"

Consult the source article or your doctor if you're concerned that I've may have made a typo in any of the above. (yes, on my sheet it does go from 4.5 to 6.5 around age 69/70.)

HTH,

2Cor521

 

[Katsmeow]

A timely thread. DH (age 63) just had routine screenings for done which included PSA. The result was 7.5.

However.....DH has always had a high PSA (varying in how high is high) for years. He has been biopsied at least once (maybe twice). That was several years ago and everything was fine.

I suspect he will end up getting biopsied again. And, of course, something could turn up. PSA tests (for him anyway) seem to be the little boy who cried wolf. So, he is tempted to do nothing. (I don't know if there was any discussion with him as to whether do the PSA or if it was just included in a batch of other tests). Yet, of course, it is entirely possible that the wolf is actually there.

 

[Moemg]

I notice no one has mentioned the digital prostrate test or the ultrasound . Most urologists are going to do these two tests after a high PSA before ordering a biopsy . Al, I would pursue my gut feeling rather than have it ignored .

 

[roger r]

I get my PSA done annually as a part of my routine blood work during my physical. It's not like it's a separate test or any big deal. Just one of the many results from the blood sample. Thankfully, it has come back normal. I have memories of an old work friend who claims his PSA caught his prostate cancer early, but I suppose the articles may argue against the details of his case.

I have had some symptoms of a slightly enlarged prostate and have taken saw palmetto daily for a long time. It seems, as far as I can tell, to help and is cheap.

 

[REWahoo]

I notice no one has mentioned the digital prostrate test...

Actually, Rich and cardude discussed it here...

http://www.early-retirement.org/forums/f38/my-dh-has-prostate-cancer-53678-7.html#post1026303

 

[TromboneAl]

You, of course, should discuss with your own doctor.

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.

 

[REWahoo]

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.

Time for a new doc - unless the 'kooky stuff' is along the lines of "Don't get your prescriptions filled at a garage sale'...

 

[braumeister]

What a delightful topic of conversation!

Personally, I think there is probably a lot of individual variation in this.

My first PSA test was a little over 9, which scared the hell out of me. It turned out that it was the result of prostatitis, which some antibiotics cleared up.

Since then, in the past dozen years I've had two biopsies (both negative), and the PSA has gradually dropped to the 4-5 range where it has been stable for the last 8 years. Nothing has ever been noted in the (at least annual) digital exams.

I have an enlarged prostate (urologist says it's "a big one"), but that's a different matter, with its own symptoms and discussions.

 

[GregLee]

I have had some symptoms of a slightly enlarged prostate and have taken saw palmetto daily for a long time. It seems, as far as I can tell, to help and is cheap.

I take that, too. I can't tell whether it helps my enlarged prostate. I asked my urologist about it, and he said "the jury is still out" on that, but that at least it wasn't harmful. (There was a few years ago a report that saw palmetto could lower the PSA score and thus prevent diagnosing prostate cancer, but subsequent research did not bear this out.)

I had a PSA result of over 7 at age 63, soon after completing radiation therapy for rectal cancer, which, my oncologist said, was likely what caused the high PSA (the RT, that is). Over the next four years, it gradually fell to 3.x. I've had an ultrasound test from a urologist and several digital anal exams, but a biopsy has never been suggested.

 

[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]

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]

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]

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...