annual physical, no more prostate exam

[fh2000]

I went to my annual physical yesterday. Everything is normal. My doctor told me (2nd year now) that the prostate exam will only have 1/1000 chances of catching the potential cancer, whereas colonoscopy has 1/3 chances.

The rectal exam, and PSA value thru blood test might do more harm than good, because it creates false positive. He showed me in his computer my PSA values for the last 5 years which hovers around 3.0 and 3.9. He recommends not to do the exam and not to check PSA value this year. I followed his suggestion.

Your Doctors told you the same? I am 58.

 

[ImThinkin2019]

I had prostate cancer and am now prostate free, 6 years post op. No cancer recurrence. Some of my friends are in the same boat as me.

My own opinion, and that of my friends, is that PSA tests should be done every year. They are cheap and easy. If your PSA starts to rise that's a sign that you may need more evaluation.

In my own case I did not have a PSA history, because I did not go to the doctor for a bunch of years. Wish I did. But when I went, I had a slightly elevated PSA and during my rectal exam the doc felt some asymmetry. That led me to a biopsy and surgery.

When I hear all the media hype about PSA tests being inaccurate I remain convinced that even though they are not perfect they still are the best indicator we have. I urge all my male friends to start getting them at 40 just so they have a baseline.

In my experience doctors are not infallible.

 

[Dash man]

I'm also 58 and had a physical earlier this year. My doctor do both the PSA and rectal exam. Everything was fine and I don't have any high risk factors. I've been going to her for years and she's always thorough.


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[Onward]

My dad's prostate cancer was found by the finger alone. His PSA was normal.

For that reason I will always insist on the finger.

 

[imoldernu]

Sometimes, we rely on the doctor to tell us when we have a problem, when our own bodies give us warnings.
I believe that reading this article could provide an early warning... even when tests are not definitive.
Prostate Cancer Symptoms & Signs | CTCA

Even the symptoms don't necessarily indicate cancer, as in more cases than not, the source is BPH...

Benign Prostatic Hyperplasia: Get the Facts on Symptoms

 

[6miths]

Sorry but I couldn't get it from your post, have you had a colonoscopy in the past?

 

[fh2000]

Sorry but I couldn't get it from your post, have you had a colonoscopy in the past?

OP here.

My doctor had rectal exam and PSA test for me for the past 5 years. Maybe he saw that my data was consistent so he suggested that I do not need to do the test this year. Looking at your responses, I will ask for the exam again next year.

As to colonoscopy, I had my first done 5 years ago (age 53), 4 polyps were removed. I had a second one done 3 years after that (age 56), one polyp removed. My doctor said to do a 3rd one 5 years after that to see if I am all clear.

 

[jfn111]

I'm 58 also and last years physical he did not do the rectal exam.

 

[kcowan]

I get the PSA every year as well as the DRE. PSA is elevated but steady and well below concern level. Had a colonoscopy at age 60 and no polyps. Also do the annual stool test.

 

[MichaelB]

A couple of older threads on this, still relevant

http://www.early-retirement.org/forums/f38/prostate-cancer-taskforce-finding-61494.html

http://www.early-retirement.org/forums/f38/10-tests-to-avoid-71103.html

 

[marko]

I'm 62. Had a normal/low PSA (1.0-1.6) until I got a UTI where it suddenly shot up to 8.0 or so and has stayed there for 6 years now. (my last was 13.0 and I have a follow up in two weeks)

A biopsy a few years ago almost killed me with a sepsis infection (but results came back negative). All other exams are normal.

Dr and I have pretty much agreed that the high PSA is a false high due to the original UTI, but I still take a test every year.

 

[fh2000]

A couple of older threads on this, still relevant

http://www.early-retirement.org/forums/f38/prostate-cancer-taskforce-finding-61494.html

http://www.early-retirement.org/forums/f38/10-tests-to-avoid-71103.html

Thanks, Michael.

I have great faith in my doctor whom I have gone to see for at least 15 years. He cited the exactly the same conclusion as in the first link:

"one man in every 1,000 given the P.S.A. test may avoid death as a result of the screening, while another man for every 3,000 tested will die prematurely as a result of complications from prostate cancer treatment and dozens more will be seriously harmed."

 

[Corporateburnout]

I'm 62. Had a normal/low PSA (1.0-1.6) until I got a UTI where it suddenly shot up to 8.0 or so and has stayed there for 6 years now. (my last was 13.0 and I have a follow up in two weeks)

A biopsy a few years ago almost killed me with a sepsis infection (but results came back negative). All other exams are normal.

Dr and I have pretty much agreed that the high PSA is a false high due to the original UTI, but I still take a test every year.

The prostate biopsy almost killed my brother too. He developed sepsis and was hospitalized for 10 days.

 

[Rich_by_the_Bay]

IMHO, the issue is best summarized by comparing the overall relevant outcomes from groups which are randomly assigned blindly to get periodic PSA testing or not, all other issues similarly divided (age, symptoms, other morbidities, etc.) by statistical happenstance in populations of appropriate size.

This means generally that abnormal PSA patients get referred for additional tests, some of which have their own risks (e.g. biopsy related infection and bleeding), risks of treatment (surgery, radiation, etc.).

This is no small task, and studies are ongoing. To date, current screening strategies have either no benefit or have net harm. Personal circumstances and values need to be incorporated case-by-case but do not serve well for determination of health policy at large. I have had patients die of sepsis following prostate biopsy, and others who were diagnosed early and had no recurrrence. Still others had positive PSA and elected to watch and wait, only to have no progression and die of unrelated causes. Those are anecdotes of every shape and form, and while I support patients' preferences as strongly as I can, I feel obliged to point out that if their decisions run contrary to prevailing evidence-based guidelines they may be stacking the survival odds against their own interests.

Just food for thought. Pending a better screening test than PSA, the best policy may be as simple as checking screening PSA less often (say every 2-5 years).

 

[razztazz]

I feel obliged to point out that if their decisions run contrary to prevailing evidence-based guidelines they may be stacking the survival odds against their own interests.

The Bolded part. Simply undermines the entire school of thought. Evidence as group-think or flights of misinterpreted fancy. "Latest studies show....." Too bad about all those Whoopsies we killed people with because we thought the "Evidence" was good when it wasn't.

I feel obliged to point out that if their decisions run contrary to prevailing evidence-based guidelines they may be stacking the survival odds against their own interests.

The bolded part. So, how does anybody know? Answer: They don't. How can anyone say then that their survival is as risk when the very yardstick they're using is equivocal and only "prevailing" (later to be proven wrong) not actually known? Six o' one half a dozen o' the other.

 

[MichaelB]

IMHO, the issue is best summarized by comparing the overall relevant outcomes from groups which are randomly assigned blindly to get periodic PSA testing or not, all other issues similarly divided (age, symptoms, other morbidities, etc.) by statistical happenstance in populations of appropriate size.

This means generally that abnormal PSA patients get referred for additional tests, some of which have their own risks (e.g. biopsy related infection and bleeding), risks of treatment (surgery, radiation, etc.).

This is no small task, and studies are ongoing. To date, current screening strategies have either no benefit or have net harm. Personal circumstances and values need to be incorporated case-by-case but do not serve well for determination of health policy at large. I have had patients die of sepsis following prostate biopsy, and others who were diagnosed early and had no recurrrence. Still others had positive PSA and elected to watch and wait, only to have no progression and die of unrelated causes. Those are anecdotes of every shape and form, and while I support patients' preferences as strongly as I can, I feel obliged to point out that if their decisions run contrary to prevailing evidence-based guidelines they may be stacking the survival odds against their own interests.

Just food for thought. Pending a better screening test than PSA, the best policy may be as simple as checking screening PSA less often (say every 2-5 years).

Rich, thanks for the thoughtful post and sensible advice.

 

[Midpack]

I had a bad experience with a PSA test on last years annual physical http://www.early-retirement.org/forums/f38/psa-on-psa-applicable-for-men-70814.html. After a urologist scheduled a biopsy, had I not done my own subsequent research and as a result insisted on a retest (my GP & his nurse discouraged it), I would have had an unnecessary prostate biopsy.

I assume my GP will probably continue to recommend DRE & PSA, and there's no harm in that as long as he a) doesn't perform the DRE immediately before the blood draw and b) the patient is aware of other activities that can temporarily increase PSA results. I am OK with the DRE & PSA, but I wouldn't casually agree to a biopsy and the costs & risks associated. Patients should be respectful of medical professionals while participating in their treatment decisions. I'd suspect a good doctor would welcome a patient that takes some ownership as long as he/she doesn't waste the professionals time. My 2 cents...

 

[Live And Learn]

Our PCP insists on a visit every 6 months since we are on cholesterol reducing drugs. The visit is overkill if you ask me, since all that is required is bloodtest. However - PCP also did a PSA every 6 months on DH. DH's PSA doubled from from 1.0 to 2.0 in 6 months (age 51). Although a 4.0 is usually deemed normal, because of the rate or rise, the PCP suggested a visit to a urologist. Yep - prostrate cancer. In the 6 weeks between the biopsy and surgery it had jumped to the other side of the prostate).

Without those repeated tests it may have been years before we found out about the cancer.

 

[Live And Learn]

I had a bad experience with a PSA test on last years annual physical http://www.early-retirement.org/forums/f38/psa-on-psa-applicable-for-men-70814.html. After a urologist scheduled a biopsy, had I not done my own subsequent research and as a result insisted on a retest (my GP & his nurse discouraged it), I would have had an unnecessary prostate biopsy.

Excellent point on the retest. DH's PSA had been rising over 3 exams so that was enough for us to go with the biopsy.

 

[springnr]

I had a bad experience with a PSA test on an annual physical, recommended followup with biopsy......

A search online turned up, your PSA score will be elevated if taken after a digital exam!!!! Guess what the next PSA was fine.

 

[ERhoosier]

I had a bad experience with a PSA test on an annual physical, recommended followup with biopsy......

A search online turned up, your PSA score will be elevated if taken after a digital exam!!!! Guess what the next PSA was fine.

Unfortunately, this is a common story. Makes me wonder if many false positives in some of these studies were due to this.

The other issue with evaluating prostate screening is that all prostate cancer does not act the same. It tends to be more aggressive in younger men.
Prostate Cancer More Aggressive in Younger Men : U.S. Medicine
I wonder if future screening 'guidelines' may include more age-specific testing after taking this into consideration.

 

[grasshopper]

Dad had PCa brother had it, go figure, I was diagnosed with "prostate cancer" age 62. i have been on a plant based diet for 20 years, 10 years after my first PSA test. PSA went from 1.0 to 4.5 in one year. Biopsy 1 little spot of non normal cells. Second biopsy same like as the first. I just came back from my 6 month visit after a PSA test of 2.7. My urologist says, in his words "you don't have cancer". you have some non normal cells that need no treatment. But I will continue on Active Surveillance. Get PSA test and DRE every 6 month and a PSA test every 2 years unless my PSA goes through the roof. I am a pretty happy camper.

 

[Senator]

A long time ago, when I was a few years into the computer industry, I had a physical. I saw that they were doing a "digital test". I just assumed it was a computer screening, some digital test.

Little did I know what was about to happen... When I joined the service I had one, but it was a bit of a shock the first time.

 

[marko]

The prostate biopsy almost killed my brother too. He developed sepsis and was hospitalized for 10 days.

Probably the most terrifying event of my life. Every time a Dr came into the hospital room, I was afraid he was going to tell me "we tried everything and nothing is working"...in the end I got the right antibiotics and came out ok, but...for a few days, it was pretty scary.

On the plus side, DW went on a 'life is short' crusade and made me buy a new car!

 

[Midpack]

7 Non-Cancerous Reasons Your PSA Levels May Be High - Prostate Cancer Center - Everyday Health

"Ejaculation can cause a mild elevation of your PSA level, and so can having a digital rectal exam," explains Milner. "These types of PSA elevations are usually not enough to make a significant difference unless your PSA is borderline. PSA should return to normal in two to three days." Doctors will usually draw blood for a PSA level before doing a rectal exam. Ask your doctor if you should avoid ejaculation for a few days before a PSA test.

"Mild?" No "significant difference?"

Last year my PSA level dropped from 4.38 to 1.37 when I eliminated DRE (and sex?) before the PSA blood draw just to put some actual numbers to the text, albeit only one example. I was unnecessarily left worrying if I had PC for months, DW was even more worried, not fun.

He never commented or acknowledged my "surprising" PSA retest last year, so my GP and I may have a "debate" when my annual physical comes up in Dec, but I won't allow them to draw blood for a PSA after a DRE again. FWIW