PSA: on PSA Test (for men) - Part 2

[bmcgonig]

I just asked for a source, that’s all.

You weren't reading the post properly, that's all.

The "marked increase" had nothing to do with your 5%

 

[bmcgonig]

It has always been my habit to discount claims of urgency made by people who stand to profit from them. The language quoted in Post 148 is by Jamie Bearse, CEO of ZERO, an organization that raises money to fight prostate cancer. Of course he is going to want everyone to be committed to identifying prostate cancer.

That said, my PSA level is checked every year as part of my yearly physical. If it spiked, I would have it checked again.

Then again every urologist would profit from increased PSA testing so then who could we trust. They're the experts.

 

[aja8888]

Then again every urologist would profit from increased PSA testing so then who could we trust. They're the experts.

Maybe some, but the testing lab would really benefit.

 

[gnawbone]

I was 60ish when it started and I had the Brachytherapy at 62 - it covered about 1.5 years or so

 

[Gumby]

Then again every urologist would profit from increased PSA testing so then who could we trust. They're the experts.

I've got nothing against urologists or any other doctor, but I'd be a fool to ignore the fact that people, all people, respond to financial incentives. I am by nature and training a cynic. If you want to get closer to the truth of any situation, always ask "cui bono?" In modern parlance, "follow the money".

 

[Midpack]

You weren't reading the post properly, that's all.

The "marked increase" had nothing to do with your 5%

I got that. For the third time, where are you getting information to support your statement below?

Since the time screening was deemphasized there had been a marked increase in people finding out in the ER after it has metastatisized.

I haven’t read that anywhere and I’d like to know if it’s true.

 

[donheff]

I got that. For the third time, where are you getting information to support your statement below?
I haven’t read that anywhere and I’d like to know if it’s true.

+1. I would like to know if it is true also. I found this NIH review from a couple of years ago that provides some support but is there any more definitive study?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341610/

 

[Time2]

I thought everyone got their blood work done a week or so before a yearly physical. Otherwise, what will you talk to the doctor about? I guess I was wrong.

It makes sense doesn't it! My wife's doc didn't want her to and then ordered them at the appointment so she had to go back. We will get to the bottom of it if it happens again. My doc always orders blood test before the appointment.
My wife and I have different doc's, I call mine a minimalist, and hers seem to order a lot of tests. We will see if this keeps up, my wife had no regular doc until she was 58, I told her for years she should just go in for a check up, finally she made the decision on her own. So kinda new to the doc, maybe the doc just wants to get a good baseline. She did find a cyst on her kidney and sent her to a specialist and the specialist looked at whatever images they and just said, it's nothing.


Edit to add, We use Quest for blood tests, and I like the fact that they keep all your records and you can graph them on their website and see how test results vary over time. At one time they changed this to a pay service that ticked me off, but last time I checked, it did everything I wanted without a fee.

 

[Time2]

I had to look up the 4K test someone mentioned. It is a test that gives you a Gleason score. It measures 4 proteins and other information and then uses an algorithm to predict the aggressiveness of the cancer. So my thought was, if you have an elevated PSA, why not do a 4K test before a biopsy?
Well after reading just a little further, it says, "Men with a low 4Kscore Test result may safely defer biopsy."
So If you have an elevated PSA, it may be wise to discuss a 4K test before a biopsy.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4444768/
I'm not a doctor and it's been years since I stayed at a Holiday Inn, so
my best advice, do a lot of research before you get a biopsy.
Yes, this has been a very educational thread.

 

[bmcgonig]

I don't have a link for everything in my head. I read it online in a discussion between urologists either on medscape or twitter.

If screening is decreased more cancers are going to be found at a later stage, and since the first sign of prostate cancer is sometimes just severe pain, then it'll be found first in the ER.

Less early screening -> more late detection

Why you think that's controversial?

Edit:


https://www.journalofclinicalpathwa...er-rates-metastatic-prostate-cancer-older-men

I got that. For the third time, where are you getting information to support your statement below?
I haven’t read that anywhere and I’d like to know if it’s true.

 

[Midpack]

I don't have a link for everything in my head. I read it online in a discussion between urologists either on medscape or twitter.

If screening is decreased more cancers are going to be found at a later stage, and since the first sign of prostate cancer is sometimes just severe pain, then it'll be found first in the ER.

Less early screening -> more late detection

Why you think that's controversial?

Edit:


https://www.journalofclinicalpathwa...er-rates-metastatic-prostate-cancer-older-men

It’s plausible or I wouldn’t have followed up, but I’d rather see data than what’s floating in your head. The linked article is decidedly more narrow than your original statement. It shows a modest increase in aggressive cancers for men 75 and older. It doesn’t seem to conclude anything men aged 40-75. That’s a far cry from your original statement. Thanks.

Maybe more accurate...

Since the time screening was deemphasized between 2013 vs 2011 there had been a small [-]marked[/-] increase in men over 75 [-]people[/-] finding out in the ER after it has metastasized.

Decreased PSA Screening Leads to Higher Rates of Metastatic Prostate Cancer in Older Men

The Surveillance, Epidemiology, and End Results Program was utilized to examine data involving incidence rates for 1,107,111 men aged 40 years or older who were diagnosed with pathologically confirmed prostate cancer from 2004 to 2013. Subsequent analysis was stratified by age (<75 vs ≥75 years).

Results of the investigation yielded data indicating that the decline in PSA screening has significantly altered the way prostate cancer now presents. Researchers found 12% of men over the age of 75 were diagnosed with metastatic prostate cancer in 2013, compared with 7.8% in 2011. Proportion of men diagnosed with aggressive cancer increased from 68.9% to 72% as well.

Researchers concluded that a definitive correlation exists between changes in prostate cancer screening guidelines and increased metastatic prostate cancer in older men.

 

[bmcgonig]

It’s plausible or I wouldn’t have followed up, but I’d rather see data than what’s floating in your head. The linked article is decidedly more narrow than your original statement. It shows a modest increase in aggressive cancers for men 75 and older. It doesn’t seem to conclude anything men aged 40-75. That’s a far cry from your original statement. Thanks.

Maybe more accurate...

It’s plausible or I wouldn’t have followed up, but I’d rather see data than what’s floating in your head. The linked article is decidedly more narrow than your original statement. It shows a modest increase in aggressive cancers for men 75 and older. It doesn’t seem to conclude anything men aged 40-75. That’s a far cry from your original statement. Thanks.

Maybe more accurate...

You are certainly welcome to pick as many nits as your little heart desires.

 

[target2019]

I don't have a link for everything in my head. I read it online in a discussion between urologists either on medscape or twitter.

If screening is decreased more cancers are going to be found at a later stage, and since the first sign of prostate cancer is sometimes just severe pain, then it'll be found first in the ER.

Less early screening -> more late detection

Why you think that's controversial?

Edit:

https://www.journalofclinicalpathwa...er-rates-metastatic-prostate-cancer-older-men

That is definitely an area under scrutiny. I'm sure there are associated studies, in-process, and so on.

What this all comes down to is, "Do you trust that your Urologist is up to date, informed, and genuinely cares for you as an individual."

I'm sure there is someone out there who sees a high PSA and wants to cut, but that is probably malpractice. When I was first diagnosed, I had a local group advising me. I grew uncertain of their recommendations, and went to a teaching hospital. I recall meeting a dozen Urologists that day, in three groups. Of course there was difference of opinion between them, but the differences had to do with the treatment I decided upon.

I just want to encourage anyone with a higher test result to get a followup test, read a good book, and visit a larger teaching hospital for free consultation.

The studies will find different outcomes over time, but it is ultimately under your control.

 

[Bongleur]

Anybody over 40 should be getting PSA tests to go along with their testosterone replacement therapy !

https://www.healthline.com/health/mens-health/high-psa-no-cancer#bph

8 Non-Cancerous Causes of High PSA Levels
Age
BPH
UTI
Prostatitis
Ejaculation

Some studies have looked at the effects of ejaculation on PSA levels. One studyTrusted Source published in 2016 found that PSA levels rise in some men after ejaculation. They may remain higher than their typical baseline level for up to 24 hours afterward.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4920563/

Parathyroid hormone
Injury
Surgery
Cancer

 

[Time2]

Anybody over 40 should be getting PSA tests to go along with their testosterone replacement therapy !

https://www.healthline.com/health/mens-health/high-psa-no-cancer#bph

8 Non-Cancerous Causes of High PSA Levels
Age
BPH
UTI
Prostatitis
Ejaculation

Some studies have looked at the effects of ejaculation on PSA levels.

A sperm bank would be a great place for a study on that. Get two free PSA a tests with every donation!

 

[Midpack]

Anybody over 40 should be getting PSA tests to go along with their testosterone replacement therapy !

https://www.healthline.com/health/mens-health/high-psa-no-cancer#bph

8 Non-Cancerous Causes of High PSA Levels
Age
BPH
UTI
Prostatitis
Ejaculation

Some studies have looked at the effects of ejaculation on PSA levels. One studyTrusted Source published in 2016 found that PSA levels rise in some men after ejaculation. They may remain higher than their typical baseline level for up to 24 hours afterward.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4920563/

Parathyroid hormone
Injury
Surgery
Cancer

Good link/resource, though it also says start at age 50. Too bad they neglect to mention directly a simple PSA retest in 4-6 weeks, making sure to avoid the other factors that increase PSA results, as a best first course. I strongly disagree with going straight from high PSA to biopsy with NO other indications.

 

[JJpop]

People.....get your PSA test. Ignore it at your own peril. It is a start and a warning that something MIGHT be wrong.

 

[Midpack]

People.....get your PSA test. Ignore it at your own peril. It is a start and a warning that something MIGHT be wrong.

I'm not sure who said anything about ignoring a PSA test. It's what you do after a potentially high result that's in question.

 

[JJpop]

I'm not sure who said anything about ignoring a PSA test. It's what you do after a potentially high result that's in question.

I believe there were a few posters who pretty much dismissed the PSA earlier.

 

[RetMD21]

Rectal exam probably doesn't increase PSA much. Link:


https://www.jwatch.org/jw199503100000006/1995/03/10/does-rectal-exam-increase-psa-levels

 

[Bongleur]

Rectal exam probably doesn't increase PSA much. Link:
https://www.jwatch.org/jw199503100000006/1995/03/10/does-rectal-exam-increase-psa-levels

I can't reply until I know if this is a PG-13 board or an R-rated board

 

[Ed_The_Gypsy]

I can't reply until I know if this is a PG-13 board or an R-rated board

ER doesn't come that early. [emoji4]

 

[Ed_The_Gypsy]

All this is important. We just lost an old friend to prostate cancer at 88. He suffered for two years. Take care.

 

[Gearhead Jim]

^^^
Do you have any idea when his cancer started?
A very few PC's are fast and aggressive, but most are slow.
I hear people telling me not to get checked/tested once I reach 75 because I'll probably die from something else even if I have PC. But I'm planning on continued checks/testing until I have some other health condition that suggests my expiration date is within a couple of years.

 

[braumeister]

I hear people telling me not to get checked/tested once I reach 75 because I'll probably die from something else even if I have PC. But I'm planning on continued checks/testing until I have some other health condition that suggests my expiration date is within a couple of years.

I believe you're right. The general advice is to not follow aggressive treatment of PC at that age if and only if it's determined to be the slow kind (which most are). Because it really is likely that you'll die from something else.

IMO this is a classic case of hey, do your own research and make your own decisions (with the advice of doctors you trust).