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

[akrono]

This is a topic of interest to all of us "seasoned citizens". I am a 67 year old male blessed with good health who tries to make informed decisions and take care of myself. I have an annual physical and my doctor is a down to earth guy exactly my age as well as personal friend. When I inquired about PSA tests he gave me his professional opinion as well as his "personal" view.
He advised the decision to go forth with testing was mine alone to make but feels that due to all the inaccurate results he is skeptical of them. He stated the false positives results often lead to urologists embarking on a treatment program of biopsies, surgery, etc. On a personal level he stated his own decision was that he did not want to take the risks of incontinence, impotence, infections etc. He also supplied me with some reading material which showed the newer body of research which questions the need for traditional testing & treatments.
This, coupled with the experience of a friend who had the needle biopsy done and came within a hair of death from sepsis infection( his advise was (dont f---ing do it!!), convinced me I will take my chances and go without.
We all have to live with our own decisions and for now I am taking a wait and see approach.

[Teacher Terry]

Since my husband got prostrate cancer at 49 the test and biopsy saved his life.

[Midpack]

Quote:

Originally Posted by Teacher Terry Since my husband got prostrate cancer at 49 the test and biopsy saved his life.

Glad to hear it, though that doesn’t conflict with the OP. A needle biopsy is not without risk, and PSA results can be elevated for several (easily controlled or monitored) reasons that don’t indicate prostate cancer. Up to three-quarters of men with a high PSA level who have a biopsy do not actually have prostate cancer. There are much better ways to proceed than the old standard PSA>biopsy. PSA retest (eliminating other causes), MRI assisted, PUR for example. You would think all urologists would be the first to know, evidently not so?

[REWahoo]

Quote without comment:

Quote:

PROSTATE is a ping-pong ball-sized squishy gland inside the male reproductive system PROSTRATE is an adjective or verb meaning to lay stretched out on the ground facing downward

[Offgrid Organic Farmer]

Quote:

Originally Posted by akrono ... due to all the inaccurate results ... the false positives results

I take issue with these statements.

A PSA test DOES NOT test for cancer. It only tests for the presence of Prostate antigens.

I had a PSA of 22, that is not a 'false positive' it was merely stating that my level of those antigens was at 22.

If you were to try to use a PSA test as if it were testing for cancer, then sure it would be a 'false test'.

[Nemo2]

Quote:

Originally Posted by REWahoo Quote without comment:

And supine can be sublime.

[target2019]

The problems may be due to interpreting the results.

It's ok by me if someone doesn't want a PSA. But my up-close view tells me the series of PSA results is very important.

Sepsis is avoided by taking the antibiotic as directed. Of course it also helps greatly to have procedure done at high-quality facility by a top urologist.

And I understand why one would not want to have a biopsy. It's a personal choice.

[Time2]

Quote:

Originally Posted by REWahoo Quote without comment:

Reminds me of a buddy, his wife, with sarcasm tells him "You speak pretty good English, especially if English was your second language".


He is one who speaks like his body part has something to do with laying stretched out!

[Teacher Terry]

It was 12 years ago so not sure if other options were available versus the biopsy.

[6miths]

Quote:

Originally Posted by Offgrid Organic Farmer I take issue with these statements. A PSA test DOES NOT test for cancer. It only tests for the presence of Prostate antigens. I had a PSA of 22, that is not a 'false positive' it was merely stating that my level of those antigens was at 22. If you were to try to use a PSA test as if it were testing for cancer, then sure it would be a 'false test'.

You may take issue with them if you wish but the term 'false positive' is being used correctly in this context. PSA is being used as a screening test for prostate cancer - no one has ever advocated it for any other reason AFAIK. If the PSA level is above whatever the set cut-off is then this is a 'positive' test. If the individual does not have prostate cancer then the result is appropriately termed a 'false positive'.

Most of the 'positive' results for screening tests are in fact 'false positives'. The other concern with prostate cancer is that many of the cancers detected by 'true positive' results were not destined to result in problems. For prostate cancer using a cut-off of 4 ng/mL the false positive rate is approximately 75%. Meaning only 25% of individuals with a positive test have prostate cancer - were 'true positives'. Perhaps more distressing is that in men diagnosed with prostate cancer, via PSA or otherwise, it is estimated that less then 5% will die of the disease. Five year survival for prostate cancer is over 98% while that for lung cancer is 19% and colorectal cancer is 65%. Very few individuals with prostate cancer have their lives saved by the PSA test.

[Midpack]

Quote:

Originally Posted by Teacher Terry It was 12 years ago so not sure if other options were available versus the biopsy.

To my knowledge, the reservations regarding the use of PSA as a reliable indicator of prostate cancer became credible about in 2012, less than 12 years ago. There are many excellent references online, linked earlier.

The point is we know more now, and it’s in the best interests of the patient to be aware. I am simply advocating a $49 retest after 4-6 weeks if your GP or urologist don’t, making sure to eliminate other causes for an elevated PSA result. PSA may be pointing to prostate cancer, but it’s nowhere near as clear as once thought, and unfortunately some GP’s and even urologists still aren’t current.

[Teacher Terry]

My uncle died of prostrate cancer at 72.

[donheff]

Quote:

Originally Posted by Teacher Terry My uncle died of prostrate cancer at 72.

PSc is still a big killer but biopsies themselves pose a serious risk of infection or other serious side effects. Even when taking antibiotics 2,5%-3% of men getting biopsies get series infections. The reason the Preventive Services Task Force recommends caution about biopsies is that the risk of serious problems far outweighs the risk of cancer death. Unfortunately for us, the impact of an unpleasant early death far outweighs the impact of the serious biopsy effects. Where we should come down on the issue of PSA testing is sort of like pegging our AA risk tolerance. The task force says don't bother screening after 70 absent other indicators but some men with low risk tolerance or conservative doctors will not head that recommendation. For most of us waiting for a second test a few weeks after an initial 4+ result is certainly within our risk tolerance. For some skipping the whole PSA test approach is the choice. IIRC the initial Task Force recommendation was that the majority of men should forgo PSA screening and only after a brouhaha did they limit the recommendation to 70+ers.

[bmcgonig]

Quote:

Originally Posted by target2019 The problems may be due to interpreting the results. It's ok by me if someone doesn't want a PSA. But my up-close view tells me the series of PSA results is very important. Sepsis is avoided by taking the antibiotic as directed. Of course it also helps greatly to have procedure done at high-quality facility by a top urologist. And I understand why one would not want to have a biopsy. It's a personal choice.

The number of people getting infections is rising even with antibiotics.

The PSA tests isnt the problem imo. It's what you do after that causes problems.

You can get an MRI. You can get a 4k test. You can calculate prostate density. Those can allow you to avoid a biopsy.

If you need a biopsy then don't get one thru the rectum. Simple as that to avoid infection.

Latest numbers I've seen for biopsy pain in one study was average 2 on a scale of 0..8.

If you're really scared then try to get general anesthesia.

If you do happen to have cancer then at least now you know. You can do nothing, especially if it's indolent, or you can try other stuff. You don't HAVE to do anything. But at least knowing allows you to watch it. Downside? Anxiety. Not trivial.

All this stuff about unnecessary biopsies and overtreatment is real. But it's only real if you blindly follow the advice of a urologist that recommends a biopsy on a bad PSA test (even if bad upon repeat), or recommends serious surgery for less aggressive cancers.

[braumeister]

Quote:

Originally Posted by bmcgonig If you need a biopsy then don't get one thru the rectum. Simple as that to avoid infection.

It's still probably safe for most people. I've had three that way, no infections.

[grasshopper]

2 biopsies through my rectum only used Cipro no infections but. Urologist has a new protocol to do a fecal sample the day before. Doesn't matter won't have another one anyway, next check will be a 3t MRI, but only if my PSA is higher than 4.5.

[RunningBum]

Contrary to a couple of stories here, my neighbor was diagnosed with prostate cancer at 82. His doc told him they would do radiation, and probably in 10 years he would die of something else. He made it 6 or 9 months before the cancer killed him.

Not that any single story should change anyone's view.

[Teacher Terry]

My friend’s husband had a PSA repeatedly over 10 for years. Now at 73 he is fighting for his life. I agree that you have to evaluate risks. I intend to have one more colonoscopy in the next few years and then I am done. My siblings are over 70 and still get them. My mom had stage one colon cancer at 84 and they only found it because she had a polyp rupture and bleed. They did surgery and she almost died. She was in and out of the hospital for 13 weeks and basically lost a year of her life. Then finally well and gets lymphoma 2 years later. No thanks.

[bmcgonig]

It is. Only 3-4% get infection. But it can become sepsis and that is scary.

Quote:

Originally Posted by braumeister It's still probably safe for most people. I've had three that way, no infections.

[Nemo2]

Quote:

Originally Posted by bmcgonig But it can become sepsis and that is scary.

'Scary' is an understatement.