Any New Info on PSA Screening?

[Rich_by_the_Bay]

I'm glad to see that this panel agree with my evaluation:

An discussion hidden in this meta-analysis study (but not included in the excerpt) supports the fact that if you have just one or two baseline PSAs under 1 or so around age 60, your risk of dying from prostate cancer are low enough that screening thereafter is of no mortality benefit.

Apparently that eliminates the "first pass" effect of picking up the early positive results (mostly false alarms) when screening is started, which then drops drastically thereafter.

I agree with the science behind the USPHS recommendations.

 

[Nuiloa]

That's good. After rising to 5.11 last March, my PSA result has gone back down to 4.72 in June and then to 4.5 in September. And, probably unrelated, I switched from taking plain saw palmetto to a product called "Prostate Health Complex" which also contains zinc, lycopene, and pumpkin seed. I don't know anything about it -- just grabbed it off the shelf at Costco. I did tell my urologist about the change -- he had no comment.

Be very careful about self-medicating. There was a product on the shelves called PC-Spes a few years back - it cost hundreds of dollars a month but seemed to work against prostate cancer. Turns out that the main ingredient was a type of estrogen which could be purchased for 50 cents. It mimicked standard androgen ablation therapies and seemed to shrink tumors. It was false hope and eventually the stuff was pulled from the shelves.

 

[kcowan]

I rely on the annual DRE but let the doctor have the added assurance of a negative PSA. Compared to an annual DRE, give me a colonoscopy every 10 years! Oh wait. I get them both!

 

[BigMoneyJim]

I opened this thread confusing PSA screening with TSA screening. It took a few posts to get really confused.

 

[GregLee]

Be very careful about self-medicating.

I'm pretty careful. I Google-search for side-effects, and for saw palmetto, I asked my urologist two years ago about it before popping the first soft-gel. On benefits, he said: "The jury's still out." When I asked him about harmful effects, he said no problem. (We didn't go into it, but I had seen a report that saw palmetto might cause a PSA test result to be artificially low and thus conceal the presence of prostate cancer. But several subsequent experiments provided evidence that saw palmetto extract doesn't actually do this.)

I think this health game is much like investing. We want to invest so as not to lose our money, but also not to miss out on opportunities for gain. We need to balance out the danger of taking a supplement/medication which turns out to be harmful and makes us sick, with the opposite danger of failing to take some available elixir which could keep us healthy.

Modern medicine is very good at curing illness, but I have little confidence in my doctors' abilities to keep me from getting sick. It's not what they're trained for.

 

[grasshopper]

I opened this thread confusing PSA screening with TSA screening. It took a few posts to get really confused.

So hows your TSA?

 

[grasshopper]

One thing I learned that like a long bike ride, a DRE can cause your PSA to rise. I have blood work done a week after DRE

 

[M Paquette]

I opened this thread confusing PSA screening with TSA screening. It took a few posts to get really confused.

Next year random selectees will be able to receive their DRE results from their TSA screener as part of the new Project Jellyfinger screening process.

 

[JOHNNIE36]

So I take it that I would be a low risk for prostate cancer. All my PSA tests have been in the low range and my doctor checks my oil as a secondary check. At 75 am I considered a prospect to never have it checked again? If something was discovered down the road, they probably wouldn't do anythng this late in life. Friend of mine had his prostate removed eight years ago and now the cancer is back. He is just starting radiation treatments. 15 minutes a day, 5 days a week for 8 weeks. That sucks!

 

[GregLee]

So I take it that I would be a low risk for prostate cancer. All my PSA tests have been in the low range and my doctor checks my oil as a secondary check. At 75 am I considered a prospect to never have it checked again? ... He is just starting radiation treatments. 15 minutes a day, 5 days a week for 8 weeks. That sucks!

Ah, checks your oil? As with transmission oil? Having a low PSA result is a good sign, of course. I have no idea whether you should have further PSA tests.

Radiation treatments aren't necessarily so bad. I had 6 weeks of radiation treatments after a rectal cancer was cut out (resected, as they say). It was inconvenient and a little irritating, but nothing more. (I have the impression that women typically have a worse time with radiation therapy.)

 

[Nords]

At 75 am I considered a prospect to never have it checked again? If something was discovered down the road, they probably wouldn't do anythng this late in life.

I think the consensus is that any prostate cancer at this point in life would be so slow-growing that something else would get you first.

Or the treatment would involve such a large risk to your health/survival that it wouldn't be worth the procedure... in terms of dollars, anyway.

But for all my [-]sniveling[/-] kvetching, I'd rather know than be blissfully ignorant. My father got nailed at age 66 mainly because he had not been having regular DREs or PSAs. As in "not for a decade".

 

[GregLee]

I think the consensus is that any prostate cancer at this point in life would be so slow-growing that something else would get you first.

I never heard this. You seem to be saying that a prostate cancer is more likely to be slow growing for a 75 year old than it is for a younger man. Are you sure?

I found a discussion of whether 75 year old men should be screened, but it's from back in 2008 and seems rather inconclusive. For what it's worth: For men over 75: The Iowa Prostate Cancer Consensus « THE "NEW" PROSTATE CANCER INFOLINK.

By the way, at the same site as the above, there is an interesting discussion of the recent USPSTF panel recommendation:
http://prostatecancerinfolink.net/2...stf-recommendation-about-psa-based-screening/

 

[kcowan]

We are burying another workmate on Tuesday. He got prostate cancer at age 45 died at 52. I think it propagates faster at a younger age.

 

[TromboneAl]

Is there a non-invasive way to quantify the size of a prostate tumor so that you can go back in a year and see how much it has grown?

 

[target2019]

Is there a non-invasive way to quantify the size of a prostate tumor so that you can go back in a year and see how much it has grown?

Here ya go, Al.

In addtion, I recently participated in tail-end study of reducing blood flow to the benign tissue to better target the bad guys.

Tiny bubbles!!!

 

[Dawg52]

I have had annual PSA test done for several years now and the manual exam as well. My PSA has always been around 1. My Dad didn't have prostate cancer so should I continue with the annual PSA test? I go in for my annual physical next week. I will of course discuss with my doc but I feel sure he will say yes. He's all for 5 year colon scopes too, but I tell him 10 years is good enough for me. No family problems there, otherwise I would agree to 5 year exams. Plus my insurance only pays for 10 year colon scopes under the wellness benefit. Anything under that goes through the deductible which would all come out of my pocket since I have a 10k ded. So how often do you guys do colon scopes?

 

[Nuiloa]

Once prostate cancer metastasizes, the average life expectancy is ~ 18-19 months and there is, at present, no cure. There are some drugs in clinical trial that are extending survival by 7 months or more, but that's about it. Metastatic prostate cancer typically attacks the bones, and is extremely painful.

An annual poke or two (by DRE or syringe) is a small price to pay for catching prostate cancer early.

 

[GregLee]

So how often do you guys do colon scopes?

Every 3 years, since (1) on my last one a precancerous polyp was found (and removed), and (2) 6 years ago, a cancer was found. As to how often, in general, one should have a colonoscopy, I can't pretend to offer an objective opinion, since if I had not had one 6 years ago, now I would be dead, dead, dead.

Edit: By the way, prostate cancer is not detected by colonoscopy, which is for colorectal cancer, not prostate cancer.

 

[Nords]

So how often do you guys do colon scopes?

When I turned myself in the periodicity was every 10 years. When they found out my Dad had polyps the recommendation dropped to five years. When they found one small one in me it was affirmed at five. When the biopsy came back negative they raised it to seven.

You could always negotiate with the authorities for a fecal occult test. That might buy you a few years' parole on good behavior.

Once prostate cancer metastasizes, the average life expectancy is ~ 18-19 months and there is, at present, no cure. There are some drugs in clinical trial that are extending survival by 7 months or more, but that's about it. Metastatic prostate cancer typically attacks the bones, and is extremely painful.

... and after my Dad's prostatectomy over a decade ago, he's currently awaiting the test results on suspicion of multiple myeloma.

 

[GregLee]

An annual poke or two (by DRE or syringe) is a small price to pay for catching prostate cancer early.

It's not that simple. If you do catch it early, (1) it may kill you, anyway, (2) it might not have harmed you even if you hadn't caught it, (3) you may be tempted to undergo a therapy which doesn't extend your life but has harmful side effects.

So hard to be a guy.

 

[Dawg52]

Every 3 years, since (1) on my last one a precancerous polyp was found (and removed), and (2) 6 years ago, a cancer was found. As to how often, in general, one should have a colonoscopy, I can't pretend to offer an objective opinion, since if I had not had one 6 years ago, now I would be dead, dead, dead.

Edit: By the way, prostate cancer is not detected by colonoscopy, which is for colorectal cancer, not prostate cancer.

Right, it was a 2 part question that kind of ran together.

 

[Nords]

Right, it was a 2 part question that kind of ran together.

[Insert colo-rectal prostate punchline here...]

 

[donheff]

Excellent thread. I read the recent draft recommendation of the US Preventive Services Task Force that others referenced. My lay reaction is that they are simply saying that the overall the risks of biopsy and cancer treatment (based on elevated PSA test results) outweigh the benefits. As a result of the tests a lot of men will get painful, dangerous biopsies and treatments that they did not need. A few men will get earlier treatment of dangerous tumors, but, the statistics show that the benefits are minimal or none. The studies found NO advantages from screening for men over 70. And the studies showed marginal if any benefits for men 59-70. From the recommendation: "The evidence is convincing that for men aged 70 years and older, screening has no mortality benefit. For men aged 50 to 69 years, the evidence is convincing that the reduction in prostate cancer mortality 10 years after screening is small to none." If all of this is accurate then most (maybe not all) of the guys who got early treatment due to the test/biopsy would have gotten treatment later due to clinical symptoms and would end up with a similar result. The recommendation is to rely on clinical symptoms, not PSA screening to counsel a biopsy and subsequent treatment if a cancer is found. They are saying we are better off waiting for symptoms before getting a biopsy. Here is another quote:

"The common perception that PSA-based early detection of prostate cancer prolongs lives is not supported by the scientific evidence. The findings of the two largest trials highlight the uncertainty that remains about the precise effect that screening may have, and demonstrate that if any benefit does exist, it is very small after 10 years. The European trial found a statistically insignificant 0.06% absolute reduction in prostate cancer deaths for men aged 50 to 74 years, while the U.S. trial found a statistically insignificant 0.03% absolute increase in prostate cancer deaths (6, 7). A meta-analysis of all published trials found no statistically significant reduction in prostate cancer deaths (10). At the same time, overdiagnosis and overtreatment of prostatic tumors that will not progress to cause illness or death are frequent consequences of PSA-based screening. Although about 90% of men are currently treated for PSA-detected prostate cancer in the United States—usually with surgery or radiotherapy—the vast majority of men who are treated do not have prostate cancer death prevented or lives extended from that treatment, but are subjected to significant harms."​

I don't like burying my head in the sand but I feel (at least with the present data) that I am better off risking a small chance of a bad cancer outcome to avoid a much higher chance of a bad unnecessary side effect of PSA testing/treatment. I hope folks around here will be quick to post new information and/or tests that can make the risk/benefit decision easier.

 

[Alan]

It's a difficult decision for me. I knew several guys from my old workplace that had positive tests followed by biopsies that they said were painful, and negative, but I do know one person who found he had prostate cancer and was successfully treated a few years back.

A PSA test comes with my annual physical and it has always been below 1 so I think my reaction would be to proceed with biopsies if it became raised and stayed high.

In the UK there is no routine PSA screening, although you can request one, particularly if there is a family history.

Why isn't there UK PSA screening? : Cancer Research UK : CancerHelp UK

At the moment, there is no single screening test for early prostate cancer in healthy men that is reliable enough to use. There are 3 main ways of finding prostate cancer. Doctors usually combine these, because none of them are completely reliable when used on their own. The tests are

• The PSA test
• Digital rectal examination (or DRE)
• Biopsy

There is information about these tests in the prostate cancer section of CancerHelp UK. It would be very difficult to use the 3 tests together in a screening programme. It would be very expensive and difficult to organise. Biopsy is an invasive test that can have complications. And it may not be acceptable to men to have a test like that when they are apparently healthy and have no symptoms.
Experts are still discussing the use of the PSA test as part of a screening programme in the UK. Below, there is a summary of the arguments for and against PSA screening.

 

[donheff]

I was thinking about the reasons for and against the PSA test and had assumed that it is valuable in catching early cancers if you are someone who would always elect to risk the biopsy if the test is over a certain threshold and always would treat the cancer if the biopsy showed one. Then I thought about false negatives and did a quick Google and found this at the Mayo Clinic: "Some prostate cancers, particularly those that grow quickly, may not produce much PSA. In this case, you might have what's known as a "false-negative" — a test result that incorrectly indicates you don't have prostate cancer when you do." So we get tested to catch aggressive cancers but those are the very ones that may not raise the PSA. No wonder the mortality rates don't change based on the test. We catch a lot of early cancers that don't need treatment and miss some of the aggressive ones that do.