Prostate Cancer Taskforce Finding

[Zero]

This may in part be a reason for me not wanting to get tested. Otherwise, I would feel like John Wayne in one of my favorite movies, "The Shootist" as he didn't hang around for his painful death from cancer. Except that wouldn't work for me because I am no gunslinger and have no scores to settle

Hey, start a blood feud! Get a pistol, a big one.

Last evening I got a call from a friend to let me know that a friend's mom, who "cared" about me when I was a teenager and kinda parentless , had died at 87. For a few moments I "re"-felt her kindness.

Woke up this morning and don't gives a ratsass about PSA.

 

[donheff]

Hey, you must be talking to my best friend, he asked me the same question yesterday. His question was; "5 years of blissfully unaware life doing what you like, versus 15 years of knowledge of health issues and fighting to stay alive one more year."

You friend's question is far off the mark. Was he just being snarky to dismiss people who don't agree with him? There is nothing in the facts behind the recommendation to indicate that people who forgo the test are shaving years off their lives. Nor is the choice to not aggressively fight a stage 4 lung cancer to extend a painful demise by a few more months anything like blissful unawareness vs knowledge of health issues.

 

[Zero]

There is nothing in the facts behind the recommendation to indicate that people who forgo the test are shaving years off their lives.

Can you present those "facts"? Can you give the evidence that not testing for PSA gives a person the same longevity as annual testing?

Not being SNARKY, just asking for your evidence.

 

[donheff]

Can you present those "facts"? Can you give the evidence that not testing for PSA gives a person the same longevity as annual testing?

Not being SNARKY, just asking for your evidence.

I am simply accepting the statements of the panel. Turn the request around. You read the article and show us how anyone can possibly say the test extends average life by any significant period at all, let alone 10 years (as per the quote - 5 vs 15).

 

[eytonxav]

It seems to me for many years the virtues of early detection/preventative care have been espoused by the medical/insurance community. Now a panel comes up with a conclusion that prostate cancer screening does more harm than good and some folks are quickly accepting that conclusion without question. I'm not sure we can rely on anything these days for certain, even if family histories are clear, but personally I would prefer to continue getting tested and then dealing with something I know vs something I do not know is lurking. Of course if I was > 80 yo, I probably would not care.

 

[JOHNNIE36]

Although the annual PSA test is not recommended, isn't the annual DRE recommended?

Did we get to the annual PSA only because men don't like the annual DRE?

Is this a skill that has been lost or was never really good in a GP?

As I mentioned in a post yesterday, my doctor strongly recommends both the psa test along with the DRE. Each "test" on it's own is not is not conclusive (?).

Edited to add the story of my golf buddy. Eight years ago, based on tests performed, had his prostate removed. Also, had chemo. Then last September the cancer reappeared on the stem(?) of the prostate. Not sure how they found this reoccurance. He had to undergo eight weeks of radiation, once a week for a 15 minute treatment. I don't know what to think about that situation.

 

[Zero]

I am simply accepting the statements of the panel. Turn the request around. You read the article and show us how anyone can possibly say the test extends average life by any significant period at all, let alone 10 years (as per the quote - 5 vs 15).

Yeah, I did not see any evidence either, just a "government" funded study that relies on future "governemnt" funding giving a recommendation to stop charging testing to insurance.

 

[Buckeye]

Is this recommendation an example of "evidence-based medicine?" We're not used to that! Isn't evidence-based medicine Rich's specialty/passion?

 

[tjscott0]

What are the facts? Or what are your chances of dying from prostate cancer?

What are one's chances in the population at large?
source:Journal of National Cancer Institute 2008
# of men out of 1000 that will die in next 10 years
age 50=1
age 55=2
age 60=3
age 65=6
age 70=12
age 75=19

So at age 60 [I'm choosing age 60 because I'm age 61
& IT IS ALL ABOUT ME!]; 3 out a 1000 men will die from prostate cancer in 10 years or 450000 out of 150000000 US men. That work out to .3% chance of dying from prostate cancer.

One should weight that chance vs potential complications from prostate cancer treatment or biopsy complications.

Obviously if there is a family history of prostate cancer that tosses the above calculation on its ear. I suppose there must be some data somewhere on how likely prostate cancer will occur in one that has a family history of prostate cancer.

Place yer bets gentlemen. Hey its only a life.

 

[donheff]

The Harvard Med Blog has an article worth reading this morning. PSA screening for prostate cancer: a doctor's perspective.

One quote is relevant to the fears mentioned above by the black helicopter aficionados:

The USPSTF is made up of volunteers from a variety of fields, including internal medicine, family medicine, behavioral health, and preventive medicine. None have financial interests in tests or treatments.
​

The article also notes that the panel looked at many studies but focused on two randomized clinical studies -- "the gold standard of medical evidence." A European study found:

In the outcome that mattered the most—death—there was no difference in overall mortality among men who had the PSA test and those who didn’t, though there was a small decrease in prostate cancer deaths over the 11 years of follow in the screened population. The researchers calculated that 1,410 men would need to be tested, and 48 additional cases of prostate cancer would need to be treated, to prevent one death from prostate cancer. PSA-based screening slightly reduced the rate of death from prostate cancer, “but was associated with a high risk of overdiagnosis,” the authors concluded.
The second trial was the U.S.-based Prostate, Lung, Colorectal, and Ovarian Screening Trial. After 13 years of follow-up, the cumulative death rate from prostate cancer was 3.7 deaths per 10,000 person years in the PSA screening group and 3.4 deaths per 10,000 person-years in the control group. Again, no difference. In contrast to the European study, and in keeping with the practice of medicine as currently practiced here in the U.S., there was no difference in the death rate from prostate cancer in the screened group compared to controls.
​

Those stats certainly don't tell us that forgoing PSA tests is a tradeoff between ignorant bliss and long lived knowledge. As to the question that since we have been relying on these tests for years why change our practices based on a few studies, I would ask why not take advantage of better medical evidence?

 

[eytonxav]

Those stats certainly don't tell us that forgoing PSA tests is a tradeoff between ignorant bliss and long lived knowledge. As to the question that since we have been relying on these tests for years why change our practices based on a few studies, I would ask why not take advantage of better medical evidence?

What would you do if Dr did a digital exam and said your prostate feels a bit large, do you want a PSA test?

 

[TromboneAl]

I woulld like to hear from Rich also. Haven't seen (heard) from him in a while. It always seems like he can put an understanding to the situation. I just like way he always answered the posts.

http://www.early-retirement.org/forums/f38/more-prostate-info-59089.html#post1138505

http://www.early-retirement.org/forums/f38/more-prostate-info-59089.html#post1138435

 

[donheff]

What would you do if Dr did a digital exam and said your prostate feels a bit large, do you want a PSA test?

Very good question and one I wondered about as well. I actually don't know how I would or should react. The article I referenced talked about DRE as still being a useful tool but it didn't address why and how to rationally use the information. For example, it mentioned DRE finding "bumps" but does that mean bumps are a more significant indicator than a simple enlarged prostate that most men develop? I don't know and will rely on my doctor's advice unless and until I think something else counsels ignoring that advice (e.g. as this recommendation does with respect to PSA screening).

 

[eytonxav]

Very good question and one I wondered about as well. I actually don't know how I would or should react. The article I referenced talked about DRE as still being a useful tool but it didn't address why and how to rationally use the information. For example, it mentioned DRE finding "bumps" but does that mean bumps are a more significant indicator than a simple enlarged prostate that most men develop? I don't know and will rely on my doctor's advice unless and until I think something else counsels ignoring that advice (e.g. as this recommendation does with respect to PSA screening).

Don, no question its not a cut and dryed decision.

On a lighter side, I recall the individul that had a DRE from the Dr and was told your prostate is enlarged. He says to the Dr, I want a second opinion, so the Dr says bend over and I'll insert 2 fingers.

 

[Lancelot]

There are more definative tests, like the Free PSA test which compares the ratio of free to total PSA, hopefully avoiding the dreaded prostate biopsy.

I got that t-shirt. Not really painful but oh the indignity!

 

[LRDave]

I should start off this post by promoting cheerful good news: studies have shown one of the best ways to avoid prostate cancer appears to be frequent sexual intercourse.
prostate health and ejaculation

Per the quote & link above, I think we are hiding the real jewel in this thread.

(I kid, I kid.....I know this is a serious topic and thread.... )

Also, DW reminds me that if the washing machine is broken, I can still wash a load or two by hand....

 

[donheff]

Also, DW reminds me that if the washing machine is broken, I can still wash a load or two by hand....

How does that punch line go? Something like, "it was a small load so I did it by hand?"

 

[JOHNNIE36]

As I was having my breakfast this morning, which consists of prescription medication and orange juice, I happened upon the newspaper which contained an article of interest on the editorial page. Titled "Current prostate cancer protocol isn't the answer", it is by Dr. Virginia A. Moyer, head of the U.S. Preventive Services Task Force. It's pretty interesting reading and is where a lot of the remarks in the various posts came from. I think it is a must read for anybody that posted on this thread. It's right from the horses mouth. Try the US Preventive Services Task Force.psa

 

[Richard4444]

Before this thread began, I used to get PSA anxiety just every 6 months.

 

[lynxville]

Very interesting discussion and great posts! Pc seems to be so prevelant lately, many friends have had it and I see many side effects of surgery. One friend had the seeds and now his PSA is 1200.

I have had roller coaster psa tests and dre's for years. I've had two biopsys and the first one was not very pleasant. My question to urelogist (I got two opinions) so if my psa goes up, how many times are you going to biopsy me, every year?

I do think eveyone has to make up there own mind on what is right for them. But I do believe that some doctors are over testing way to much. It is just hard to decide whats best for me, when you read the tests may not be accurate.

I have had way to many tests this year and everyone turned out to be negative. Many of these tests are dangerous and could have side effects and are costly.

One urologist did a dre and had very short fingers, I personally thought he should be a cardiologist. After that experience I found a new dr.

 

[rodi]

Like Nords - I come from a family that lost the genetic dice roll when it comes to cancer. So that factors my opinion on this.

I do think family history should play a part. I'm female so I have ZERO risk of PC. But my cousin beat the odds by being fairly young (was 43 or so) when he had an elevated PSA, and it turned out to be cancer. He's fine after treatment. (And happily married for whatever that works... so it looks like no longterm issues from treatment.)

My dad had PC as his first cancer. Radiation treatment cured him. He was cancer free for another decade, remarried after my mom died, and I know more than a child should know that it did not effect his sex life. (He was so happy when he met my step mom.)

Unfortunately, he got a completely unrelated cancer, Multiple Myeloma.

My brother had melanoma stage 2 when he was in college, after skin grafts and a lymph node removal he was fine. He died at age 48 of an unrelated, very obscure, VERY aggressive Neuorendocrine Carcinoma.

My mother had normal CA125 levels and had raging ovarian cancer. She died age 67.

I flunked a blood occult test at age 41. Sigmoidascope turned up 7 pre-cancerous polyps - 2 were too big to get with the sigmoidascope so I got to go back for a colonoscopy. I'm now on the 5 year plan of colonoscopies. If I'd not had the blood occult test, they might not have found the polyps... I was a decade younger than the normal first colonoscopy.

3 of my 4 grandparents died of cancer. 2 were in their early 60's.

Because of all this I paid, out of my own pocket, for a BRCAA test. Negative thank goodness. Money well spent for peace of mind.

My HMO has guidelines that suggest mammogram every 5 years and pap every 5. But for me- they have me come in every year. My doctor was smart enough to recognize a family pattern.

One of my big reasons for wanting to retire early is because of my mom's age at death, as well as my paternal grandmother (breast cancer, age 63), paternal grandfather (age 72 lung cancer) , and maternal grandfather (age 71 leukemia). I budget for age 100, but realistically know I'll be lucky to make 80.

Statistics are great in general... but specific family history to should be considered as well.
I'll keep getting my mamogram, pap, and colonoscopies. I'd rather catch it early than late.

 

[haha]

Q. How's that thing of not posting on controversial health topics going for you, Al?
A. Not well.

Well diagnosed, Al.

Ha

 

[Katsmeow]

My question to urelogist (I got two opinions) so if my psa goes up, how many times are you going to biopsy me, every year?

That's the thing. DH started getting somewhat high PSAs in his mid 50s. He followed up on on it with the urologist every time. Several times it seemed to be prostatitis and antibiotics helped. A couple of times he did the biopsy and it was negative. He's 64 now and at his last physical once again had a higher than normal PSA so, once again, they told him to see the urologist. That was several months ago and he hasn't gone as from his experience he always has a high PSA and it is never anything. That said -- I do realize that this time it really could be something. He says he will go to the urologist but just hasn't been in a hurry to do it.

 

[lightspeed]

PSA = Patient Specific Anxiety

 

[bentley]

If you truly understand what a Gleason score means, your opinion on this topic will be forever changed.

Does anyone understand that a Gleason 4+3=7 is 3x more aggressive than a 3+4=7 ?

Once you have personal experience with what a Gleason 9 means to your future, your thoughts on screening will adjust.

B