PSA test false positive rate 70%?

[molly312]

Doctor told my husband that he didn't need PSA test after 70. Dead one year later from prostate cancer. Discovered because he had a pain in his hip. GET THE TEST! It is worth the aggravation even for false/positive. He had a digital exam..

 

[Time2]

I've always found it amusing that a "digital" exam is actually an extremely analog experience.

OH, po, po!

 

[RetMD21]

Doctor told my husband that he didn't need PSA test after 70. Dead one year later from prostate cancer. Discovered because he had a pain in his hip. GET THE TEST! It is worth the aggravation even for false/positive. He had a digital exam..

That's sad. Unfortunately there are no early warning signs so it is a matter of screening or just hoping.

 

[chassis]

The information in this thread is helpful to add to the knowledge and understandings posted in watchman3135's thread on this topic.

 

[Midpack]

Doctor told my husband that he didn't need PSA test after 70. Dead one year later from prostate cancer. Discovered because he had a pain in his hip. GET THE TEST! It is worth the aggravation even for false/positive. He had a digital exam..

As one who has had two false positive PSA results*** and have therefore spoken about this a lot, I’m not recommending doing away with PSA testing at some frequency. I’m saying don’t act based on the results of one elevated PSA - educate yourself on the many known other factors that lead to elevated PSA, eliminate them and get a retest. If you get two elevated tests after eliminating the known other factors, then I’d see a urologist. It’s good to track your PSA velocity too, the threshold for concern rises slightly with age, something some/many doctors don’t seem to acknowledge.

*** and in both cases I had to get a retest against the recommendations of (two different) PCPs, and in both cases I (not the doctor) identified the likely cause (the first doctor unknowingly caused the elevated PSA!). The second event was in 2019 so there are still plenty of doctors who don’t understand PSA testing issues.

 

[Koolau]

As one who has had two false positive PSA results*** and have therefore spoken about this a lot, I’m not recommending doing away with PSA testing at some frequency. I’m saying don’t act based on the results of one elevated PSA - educate yourself on the many known other factors that lead to elevated PSA, eliminate them and get a retest. If you get two elevated tests after eliminating the known other factors, then I’d see a urologist. It’s good to track your PSA velocity too, the threshold for concern rises slightly with age, something some/many doctors don’t seem to acknowledge.

*** and in both cases I had to get a retest against the recommendations of (two different) PCPs, and in both cases I (not the doctor) identified the likely cause (the first doctor unknowingly caused the elevated PSA!). The second event was in 2019 so there are still plenty of doctors who don’t understand PSA testing issues.

So the less reliable the test, the more important the reliability of your PCP. It's a shame we can't find a more reliable test. YMMV

 

[chassis]

The less reliable the test, the greater is the information asymmetry between patient and practitioner. In this case the tables get tilted against the best interests of the patient. Not a good trade off.

 

[Koolau]

The less reliable the test, the greater is the information asymmetry between patient and practitioner. In this case the tables get tilted against the best interests of the patient. Not a good trade off.

That's why the judgement of the PCP is so important. The PCP is supposed to be that interface between the raw data and the patient. A good PCP will put the interests of the patient first. Once again, it screams for a better test. YMMV

 

[chassis]

That's why the judgement of the PCP is so important. The PCP is supposed to be that interface between the raw data and the patient. A good PCP will put the interests of the patient first. Once again, it screams for a better test. YMMV

@Koolau agree that a better practitioner may give a better outcome. Finding "good" practitioners is not how I choose to spend my time. It perpetuates the asymmetric information imbalance. Rather, I choose to educate myself on topics like this one, and close the asymmetric information gap to the greatest extent possible.

I'm investing my time in my own health; I encourage everyone to do the same.

Consider the sea change in the legal profession and financial/accounting profession, as it relates to "knowledge". Simple contracts are easily downloadable for free or a de minimis charge. Previously a lawyer was needed. Similar situation for tax preparation software and forms. Today these are either free or have moderate price tags. No tax professional required as in the past.

Complicated legal and financial situations require professionals. These, however are the minority of situations.

This is the future for medicine, a parallel path as the legal and financial/accounting domains. Open heart and brain surgeries are unlikely to be self-administered at home. Professionals are needed for that.

At the same time, educating, preventing and treating oneself for the vast majority of complaints should be more the norm today than it is.

 

[Midpack]

@Koolau agree that a better practitioner may give a better outcome. Finding "good" practitioners is not how I choose to spend my time. It perpetuates the asymmetric information imbalance. Rather, I choose to educate myself on topics like this one, and close the asymmetric information gap to the greatest extent possible.

+1. Two different PCPs didn't know what to do with my high PSA result, and the first one was an otherwise excellent doctor we'd been going to for years - just turns out he was not up to speed on the shortcomings of the PSA test. He was after his experience with me.

So again my point was it's in the best interest of the patient to educate themselves to the best of their ability - easy to do these days with internet resources as long as you confine your reading to well known credible resources, there are all too many bad sources out there unfortunately. We can't know much about more complex medical situations, but PSA is one most people can understand. And I am not advocating discounting what doctors tell us, or arguing with them, just to make sure we make some effort to understand.

 

[target2019]

PCP's should not be the first line. Find a Urologist with good ties to a teaching hospital.

Internet resources are one thing. A specialist who deals with 1000 cases is much more capable IMO.

 

[chassis]

@target2019 what is your opinion of the patient-practitioner information asymmetry? Is it real? Does it warrant anyone (patient or practitioner) doing anything about it?

 

[JP.mpls]

Not a guy - but have a lot of men who've had prostate cancer in my family.

Dad had prostate cancer, first detected with PSA. Treated with radiation and considered "cured". He later died of an unrelated multiple myeloma. (Yep two distinct cancer malignancies.) My cousin had a high PSA at age 41 - and follow up determined it was an aggressive prostate cancer. Had the prostrate removed. Continued periodic exams with his urologist/oncologist where they discovered testicular cancer. 5 years after his prostate cancer (Yep, two distinct cancer types, not metastatic). In both cases of my dad and cousin the PSA was the first sign of their prostate cancer.

But then again - my family is a cancer cluster. In addition to the 4 cancers among 2 people listed above, my brother had melenoma in his 20's - surgery fixed it. Then in his late forties got a super aggressive neuroendocrine carcinoma (super rare, and very deadly). Who knows, he might have developed prostate cancer later if the other cancers didn't get him first. So that's the third male in my close family that had two separate cancer types, not metastatic.

Mom died of ovarian cancer. Like the PSA test, there is a CA125 test that acts as an 'trend line' for ovarian cancer. Mom had numbers in the 'normal' range while she had full blown, stage 3 ovarian. After surgery and chemo her numbers dropped a bit. But then jumped up - sure enough - it had metastaticized. The CA125 isn't considered diagnostic/definitive - but it's a great indicator that things are changing. Because of her history I have CA125 tests done every few years... just to be a canary in the coalmine if I ever get ovarian cancer... they have a baseline to compare. Blood tests are fairly non-invasive and ovarian cancer can be symptom free in early stages when it's treatable. Like PSA tests, they are now discouraging annual mammograms and pap tests.... But I still get them. Like I said - my family is a cancer cluster... I have Kaiser which tends to only do the recommended - but my doctor, given the family history, has me ok'd for more frequent mammos and paps.

I agree completely with the idea to follow up with a second test before moving forward to a biopsy... But not sure I'd encourage my husband or sons to skip the tests altogether.

Rodi,
I'm sorry to hear about all of the agony your family has had to experience regarding cancer.
My wife died of ovarian cancer. I often wonder if she wouldn't be alive, if they had done the CA125 blood test on her periodically.
I'm assuming this isn't done, because insurance doesn't want to pay for it.
I recently talked my partner into getting this test done as part of her physical.
FYI: Women who have never had children have a higher rate of getting ovarian cancer.
Take care,. JP

 

[Midpack]

PCP's should not be the first line. Find a Urologist with good ties to a teaching hospital.

Internet resources are one thing. A specialist who deals with 1000 cases is much more capable IMO.

The urologist my PCP sent me to did a DRE, and recommended we schedule a needle biopsy after less than 5 minutes.

When I asked if a PSA retest might be good idea, he said “why, the results won’t change?” Dead wrong, and this is a urologist?

When I asked what a needle biopsy typically cost, he was visibly offended and answered “I have no idea what they cost, but what do you care, you have insurance?”

At the time the PSA retest cost $50, a needle biopsy was supposedly $3000-$6000, not to mention the significant risks with needle biopsies. [My retest was about half the 4.0 ng/mL threshold. I had to get a retest on my own as my PCP, his nurse and the urologist all refused.]

That’s when I decided to educate myself. And the urologist had 4-5 star ratings online with good reviews.

It’s hard enough to find a good PCP, harder still to find specialists when needed, where personal experience is unlikely…

 

[chassis]

The urologist my PCP sent me to did a DRE, and recommended we schedule a needle biopsy after less than 5 minutes.

When I asked if a PSA retest might be good idea, he said “why, the results won’t change?” Dead wrong, and this is a urologist?

When I asked what a needle biopsy typically cost, he was visibly offended and answered “I have no idea what they cost, but what do you care, you have insurance?”

At the time the PSA retest cost $50, a needle biopsy was supposedly $3000-$6000, not to mention the significant risks with needle biopsies. [My retest was about half the 4.0 ng/mL threshold. I had to get a retest on my own as my PCP, his nurse and the urologist all refused.]

That’s when I decided to educate myself. And the urologist had 4-5 star ratings online with good reviews.

It’s hard enough to find a good PCP, harder still to find specialists when needed, where personal experience is unlikely…

Thanks for sharing @Midpack.

Practitioners are the "salesmen/saleswomen" of the healthcare world. They generate revenue. What other examples are there of salespeople who don't know the price of what they are selling? I can't think of any.

 

[RetiredHappy]

Mom died of ovarian cancer. Like the PSA test, there is a CA125 test that acts as an 'trend line' for ovarian cancer. Mom had numbers in the 'normal' range while she had full blown, stage 3 ovarian. After surgery and chemo her numbers dropped a bit. But then jumped up - sure enough - it had metastaticized. The CA125 isn't considered diagnostic/definitive - but it's a great indicator that things are changing. Because of her history I have CA125 tests done every few years... just to be a canary in the coalmine if I ever get ovarian cancer... they have a baseline to compare. Blood tests are fairly non-invasive and ovarian cancer can be symptom free in early stages when it's treatable. Like PSA tests, they are now discouraging annual mammograms and pap tests.... But I still get them. Like I said - my family is a cancer cluster... I have Kaiser which tends to only do the recommended - but my doctor, given the family history, has me ok'd for more frequent mammos and paps.

Have you considered having the ovaries removed?

I had a botched reading by the radiologist indicating that I had a mass in one of my ovaries. I had Kaiser. My OBGYN suggested removing that one ovary and we both agreed to get them both out while she was doing it. On the morning of the surgery after I was already hooked up, my OBGYN showed up and said she reviewed the films with the radiologist and they decided it was just a cyst on the fallopian tube and not a mass on the ovary. She said when I reached menopause, the cyst would go away. I said since I was all hooked up, to just go through with the surgery to remove possibility of ovarian cancer further down the line even though I did not have family history of ovarian cancer. After the surgery, the ovaries were found to be very healthy and it was indeed a cyst on the fallopian tube. I did get on estrogen supplement to help with bone loss from lack of estrogen and I have been on it for 6 years. I have no regrets getting the surgery done.

 

[watchman3135]

Reading of all the inaccuracy's and false positives of PSA with mine going from 2.1 in late of 2019 to 3.64 in March 2021 and then 3.97 in May 2021, my primary referred me to a Urologist. I was diagnosed in 2013 with BPH by symptoms and a rectal ultra sound. Prior to my Urology visit I did some research and found 3T Multiparametric MRI as the preferred next step after confirmed back to back elevated PSA rather than a TRUS biopsy so that if something is found, it could be overplayed to the TRUS for targeting. My doctor agreed with me when I asked if I could have the 3T MRI as the next step but said he usually just does the TRUS biopsy due to some insurance companies not wanting to approve it over the TRUS biopsy. I told him I'd pay out of my pocket if the insurance company resisted however they did end up covering it all be it with a higher out of network PPO deductible since it was not yet started for the year.

Several days latter the Urologist assistant called me with my MRI results and said they didn't find anything and the Doctor want's to do a biopsy. I initially responded let me think about it because from all my initial research, the 3T MP MRI seemed as good with the benefit of being less evasive, less risky to a biopsy. It is also the "Gold Standard" as a stopping point if nothing is found in Europe however US Physicians in the field are not in agreement with this and as my doctor said a Biopsy is still currently the only way to confirm the MRI which is a bit ironic of a statement as it is well known that a "random" 12 core TRUS biopsy can and does miss problem area within the prostate. My Urologists is highly rated and seems younger maybe in his late 30's early 40's but maybe he seen something on the MRI when he looked that the the reading Radiologist missed? I'm not sure because if he did, he didn't say anything. Or it could just be caulked up to this statistic.

My 12 core biopsy came back Gleason 6 in two left upper and lower areas as well a HGPIN and ASAP in a few others.

While the digital rectal exam seems to be disappearing due to evidence as to it efficacy in detecting early cancers, PSA is a viable tool and is the equivalent to the "check engine light" meaning not necessarily something major, just need further diagnoses.

I have never seen the point of burring ones head in the sand with your health other than the fear of a new diagnosis yet given the above clip statistics in nearly 50% of men 50 and and older I still ask if knowing is better than not knowing because worry can become more incapacitating than than the disease in this case. This is day six of my results and I am still currently trying to rap my head around the doctor's recommendation of Active Surveillance rather than just getting treatment over with now at age 55 not to mention the continual obsessiveness thought of having cancer in the body. It is 4:14 am as I type this in the mid west and in the past six days it has been the "new" norm for me of falling a sleep in the recliner in front of the TV and wake up around 2:00 am and doing more research.

 

[target2019]

@target2019 what is your opinion of the patient-practitioner information asymmetry? Is it real? Does it warrant anyone (patient or practitioner) doing anything about it?

I don't understand what you've asked, but I'd like to know more.

 

[chassis]

@target2019 Do you believe information asymmetry exists in the patient-practitioner relationship?

 

[target2019]

@target2019 Do you believe information asymmetry exists in the patient-practitioner relationship?

I do not understand. Is there some context for your question?

 

[COZICAN]

My norm was 1.4 - 1.6 then a 4.4 appeared recently. Dr said it was likely an anomaly. 30 days later 1.6 again.