PSA test false positive rate 70%?

[chassis]

For the gentlemen, but ladies chime in if you like.

The linked article (no sources, but hosted on a medical group's website) suggests 70% false positivity rate for the PSA test. Really? How can a test be offered with such a high false positive rate. If the article is true.

I googled a bit and found many examples talking about whether doing a PSA test is, or isn't, the best choice for the patient. I haven't found an NIH or FDA document that quantifies the false positivity rate.

What is everyone's view on the high false positivity rate claimed for the PSA test? Thanks.

https://www.ncfmg.com/wp-content/upl...-screening.pdf

 

[RAE]

I couldn't get your link to work, but I've read other articles about the PSA test that question its usefulness. I do have the PSA test done every year, as insurance covers it, and my numbers have been pretty low so far. If the trend in the number ever starts to increase rather rapidly, that would get my attention. It's just one piece of information, though, and certainly not infallible. Something like 20% of men with prostate cancer have low PSA's, so that tells you that a higher PSA test number is not always indicative of a problem.

 

[RetireeRobert]

linked article (no sources, but hosted on a medical group's website) suggests 70% false positivity rate for the PSA test. Really? How can a test be offered with such a high false positive rate. If the article is true.

[/url]

Not really sure I understand what is meant by "false positives"?

I always thought the PSA test was a scale of amount, a measure--one has a low PSA number, medium number, higher number. "Not" yes you have PSA or no you don't have PSA, which is what "false positive" implies.

And as well, I thought all men have "some" PSA number. Most have a pretty low number, and many with prostate cancer or with BPH have higher PSA numbers.

So, idea of "false positive" in regard to PSA seems nonsensical to me.

 

[jollystomper]

The link does not work for me, so I'll assume that by "false positive" it means "A high PSA number than might indicate a problem".

I get my PSA tests done annual during my physical. My doctors look for trends. Twice it has jumped up high, one was due to a UTI (whenever it tests high the doctors do a UTI check to rule that out), the other time was likely due to, shall I say, not much abstinence before test time. In both cases a followup test a month later (after UTI treatment in the first case and a longer pre-test abstinence in the second) showed results well in the normal range.

As was mentioned, it is one number that first has to be looked in context with other actions or health issues before getting concerned.

 

[Bflotomny]

PSA or Prostate Specific Antigen is an enzyme produced in the prostate and found in men's blood. Normal PSA levels range from 0-2.5ng/ml. As males age the prostate grows leading to higher PSA numbers. But an elevated number does not indicate Prostate Cancer. Higher numbers can be caused by enlarged prostate (BPH), prostate inflammation, infection, or trauma.
Any Urologist worth his rubber glove will tell you that its not the absolute number that is concerning as much as the trend in the number. Example: If you have a consistent PSA number of 2ng/ml its high BUT your normal. If you number is historically 1ng/ml and you suddenly have a 2.5ng/ml. Now we have something to investigate.
Additionally a Urologist told me that prior to your PSA blood draw AVOID for a few days or a week RED meat, red wine. These can lead to higher then normal numbers
There have been some controversy about doing the test. I have told my physician that we are doing the test till I'm COLD & STIFF. If insurance doesn't pay I'll pay cash. It's a blood draw that could save your life!

 

[chassis]

Thanks for the comments. I used google and the link came up in the search results, and worked fine. Here it is again, and I attached the document.

https://www.ncfmg.com/wp-content/uploads/2018/04/Prostate-Cancer-screening.pdf

The article doesn't give a ringing endorsement for the PSA test in my view.

 

[RetireeRobert]

What is everyone's view on the high false positivity rate claimed for the PSA test? Thanks.

[/url]

More generally, what is the view of helpfulness at all of PSA test for detecting prostate cancer?

Medical profession has undergone a sea-change on this issue over the last five to ten years.

Long story short, profession has not found any significant "help" to patients from PSA detection of prostate cancer, as compared to harms caused by over-diagnosing and quality-of-life side effects of treating.

To quote from your linked article: "Many prostate cancers detected with screening are unlikely to cause death or disability. Thus, a number of men will be diagnosed with cancer and potentially suffer the side effects of cancer treatment for cancers that never would have been found without prostate cancer screening...".

So, the medical profession's mantra---"First, cause no harm" they have now applied to PSA tests and prostate cancer. Over diagnosing prostate cancer was "not" demonstrating more good coming from it than harm caused by it.

Generally, prostate cancers are most often very slow growing, and men die of other causes before they ever die of the prostate cancer.

My own doctor swallowed his owns words from twelve years ago when he had constantly urged PSA tests (which I got). The evidence had piled up of more harms than good coming from treating any diagnosed present prostate cancers, and he decided to switch his philosophy on this subject. He no longer urges the PSA tests.

 

[chassis]

More generally, what is the view of helpfulness at all of PSA test for detecting prostate cancer?

Medical profession has undergone a sea-change on this issue over the last five to ten years.

Long story short, profession has not found any significant "help" to patients from PSA detection of prostate cancer, as compared to harms caused by over-diagnosing and quality-of-life side effects of treating.

To quote from your linked article: "Many prostate cancers detected with screening are unlikely to cause death or disability. Thus, a number of men will be diagnosed with cancer and potentially suffer the side effects of cancer treatment for cancers that never would have been found without prostate cancer screening...".

So, the medical profession's mantra---"First, cause no harm" they have now applied to PSA tests and prostate cancer. Over diagnosing prostate cancer was "not" demonstrating more good coming from it than harm caused by it.

Generally, prostate cancers are most often very slow growing, and men die of other causes before they ever die of the prostate cancer.

My own doctor swallowed his owns words from twelve years ago when he had constantly urged PSA tests (which I got). The evidence had piled up of more harms than good coming from treating any diagnosed present prostate cancers, and he decided to switch his philosophy on this subject. He no longer urges the PSA tests.

@RetireeRobert thanks, that is the line of thinking I was headed down, but wanted to get others' insights into the topic.

It makes me think of other frequently recommended screening tests, and whether or not they are beneficial for patients. For example, colorectal cancer screening. I need to do more reading on that one.

 

[Sunset]

They are cheap, and if you get a high reading, just get another PSA test to confirm / correct the first reading.
Then investigate further.

How accurate can the digital (not electronic ) test be considering the doc sees a patient once a year, so unless the thing is suddenly the size of a grapefruit there is realistically no way to know cancer has started. And if it's a grapefruit size, it's too late.

Probably one of the better indicators is the stream when going pea. If it stutters a lot like a bad movie, then there is a problem.

 

[Jim59]

I get PSA measured annually, always measures around 1. However, my brothers have both been diagnosed and cured of prostate cancer. I’m trying to build up courage to have the dreaded “invasive “ examination.

I intend to pay close attention and document to my peeing habits over next month and probably get examined. Sometimes flow is ok, sometimes flow is non existent but feeling is I need to pee.

 

[Mark1]

More generally, what is the view of helpfulness at all of PSA test for detecting prostate cancer?

Medical profession has undergone a sea-change on this issue over the last five to ten years.

Long story short, profession has not found any significant "help" to patients from PSA detection of prostate cancer, as compared to harms caused by over-diagnosing and quality-of-life side effects of treating.

To quote from your linked article: "Many prostate cancers detected with screening are unlikely to cause death or disability. Thus, a number of men will be diagnosed with cancer and potentially suffer the side effects of cancer treatment for cancers that never would have been found without prostate cancer screening...".

So, the medical profession's mantra---"First, cause no harm" they have now applied to PSA tests and prostate cancer. Over diagnosing prostate cancer was "not" demonstrating more good coming from it than harm caused by it.

Generally, prostate cancers are most often very slow growing, and men die of other causes before they ever die of the prostate cancer.

My own doctor swallowed his owns words from twelve years ago when he had constantly urged PSA tests (which I got). The evidence had piled up of more harms than good coming from treating any diagnosed present prostate cancers, and he decided to switch his philosophy on this subject. He no longer urges the PSA tests.

I had my annual physical last Monday and for the first time in many years I stated "No" when my doctor asked if we were doing a PSA test this year. He looked relieved.

He stated that his dad has been asking what he should do as his PSA numbers have been increasing. My doctor said he told his dad the solution was to "Just quite looking at them". I'm not sure his dad is on-board yet.

 

[Midpack]

There have been several threads on this, PSA false positives (results over the screening threshold) are all too common. There are at least a half dozen well documented conditions that can result in a false positive. IME the first thing to do when you get a PSA result above threshold is, don't panic, but read up on the conditions to avoid, avoid them for 2-4 weeks, and get a retest. I’m not saying ignore a positive, but I am saying get a more careful retest before proceeding to a needle biopsy or anything invasive - regardless of what your PCP recommends.

In 2013 the first doctor, his nurse, and the urologist they sent me to were outright insulted that I even asked for a retest - I basically had to defy all three. Instead of a $6000 needle biopsy, with significant risks, I demanded a $50 retest. They all went silent when I sent them my perfectly normal PSA retest results. That PCP stopped doing DREs and PSA testing altogether later, said he'd stopped with most patients, not just me. And it turns out he may have actually caused by performing a DRE minutes before the blood draw used for my PSA, he wouldn't comment on that.

In 2019, the second time my PCP was even more alarmed, but I knew she didn't know what she was talking about...

In both cases, my PCP was VERY alarmed, which scared the living %^# out of DW and I the first time - before we knew more about PSA testing, still an issue in 2019 with some PCPs and urologists (inexcusable) even though the issues have been known for many years.

Here’s link to my journey with two false positives and reputable PCPs who didn’t know what they didn’t know about PSA testing.

https://www.early-retirement.org/forums/f38/psa-on-psa-test-for-men-part-2-a-101992.html

I'll even share my actual PSA history to show how far off false positives can be.

 

[Time2]

Let's not confuse the symptom of BPH. restricted flow, start and stop etc, "50 percent of men who are age 50 or older may have symptoms. This increases 10 percent for each additional decade of life: 60 percent of men age 60, 70 percent of men age 70."

"The probability of developing prostate cancer is 13.7% in men between 60 and 79 years."


Odds are that those symptoms are BPH.


Info from these two sites.

https://www.lifespan.org/lifespan-living/what-men-should-know-about-bph



https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483315/

 

[Car-Guy]

I've stated this before on other "PSA" threads. Every male on my fathers side of the family had PSA's over 10 and none ever developed prostate cancer (or any cancer for that matter)... All of them lived well into their late 80's or early 90's.. One is still kicking and he is in his mid 90's. They all also had various "related" problems, and IMO those problems were likely made worse by some of the medical interventions/procedures. (I came to that conclusion after hearing some of their stories)

 

[GTFan]

How accurate can the digital (not electronic ) test be considering the doc sees a patient once a year, so unless the thing is suddenly the size of a grapefruit there is realistically no way to know cancer has started. And if it's a grapefruit size, it's too late.

Yeah I had my annual a couple of months ago and my doc doesn't do the rectal exam anymore, he said that studies have shown it's not a good predictor and leads to more unnecessary treatment and worry than any actual issues.

I've been seeing him for over 20 years, he's part of a large med conglomerate here in the ATL (Wellstar) so I know it's more of a communal decision than his own.

 

[RetMD21]

The nature of PSA is that you can't distinguish between high risk prostate cancer, low risk cancer or something totally unrelated. New tests like this urinary biomarker test may help actually detect the cancer that you would want to find in time to do something about it. Usually best to follow your doctor's advice for your individual situation.

https://labblog.uofmhealth.org/lab-...mise-for-detecting-aggressive-prostate-cancer

 

[RAE]

Let's not confuse the symptom of BPH. restricted flow, start and stop etc, "50 percent of men who are age 50 or older may have symptoms. This increases 10 percent for each additional decade of life: 60 percent of men age 60, 70 percent of men age 70."

Yes, I was just going to say the same thing, but you beat me to it. LOTS of older guys experience restricted flow of urine, typically due to BPH. BPH is not prostate cancer.


With regard to the PSA test, I still have it done yearly, as it's just a cheap blood test. If I got a somewhat higher score than past years, I'd probably ask for another test to be done, just to see if there was any consistency. There is no way I would agree to a prostate biopsy after one high PSA test.

 

[Midpack]

The nature of PSA is that you can't distinguish between high risk prostate cancer, low risk cancer or something totally unrelated. New tests like this urinary biomarker test may help actually detect the cancer that you would want to find in time to do something about it. Usually best to follow your doctor's advice for your individual situation.

While I agree in general, that has not been my experience with PSA. I would have been misled, including a totally unnecessary needle biopsy in 2013. Patients should educate themselves as much as possible, to understand their options - without being a nuisance or self appointed medical expert. It’s a fine line.

 

[marko]

FWIW, I have an elevated PSA (11) but it's a long story on why it's a very false positive.

But here's the danger: I did go for a biopsy at one point 10 years ago due to the high number. By 11PM that night I was in the hospital with sepsis and was there for 5 days and on antibiotics the size of your thumb for a full month after that.

Good news: biopsy was negative
Bad news: biopsy almost killed me. Literally.

Subsequently I went for a prostate MRI this winter. Much better than the biopsy and again, no issues of concern. (DW threatened to kill me way before the prostate would if I ever went for another biopsy)

 

[Rambler]

All I can say is that a PSA test helped raised a significant red flag for my doc, which lead to other tests and a biopsy that showed significant cancer…at age 55. It indicated Gleason 4+3=7, which is on the bad end of a medium grade cancer, in 50+% of the organ. This was 4 years ago. Had I not acted on it, chances are pretty good that I’d either be gone by now, or maybe have about a year left. Yes, Biopsies have risks. But, not doing them also has significant risk.

 

[Golden sunsets]

In 2012, DH's PSA exceeded 4 (4.7) for the first time. It had gone from 2 to 3.2 to 4.7 over the prior 2 years. He was retested with similar results. He then had a biopsy( actually 10 snips) and received a Gleason score of 10 (5+5), the highest possible score. But only one of the biopsies showed any cancer, that one biopsy being a 10. So he definitely had PC, presumably an aggressive variety in a small portion of his prostate. Because of another preexisting condition, his Docs recommended hormone therapy and radiation. Over the next 2 years he had the hormone shots(a version of chemo), every 6 months, 4-6 weeks of radiation therapy, 4 days a week and then nothing since. It was by no means a walk in the park, (with numerous unpleasant side affects) but compared to a radical prostectemy and the after effects, it was easier, for him, I believe. Two of his close friends had the surgery around the same time and complain about the permanent after effects to this day. DH has had PSA tests every 6 months since 2014. It's always nail biting time waiting for the results but as of 2020 his Doc was satisfied enough that he is only tested once a year now. It has been 9 years. He still has some PSA in his system. It bounces around well under 1. If it ever reaches 2, it will be considered reoccurence.

So his experience points to having the annual PSA test. YMMV.

 

[JRon]

My doc was glad to hear I didn’t want PSA test. He said the chance of dying from prostrate cancer is like a 10th of 1 percent (a lot of old men will get it, but it won’t kill them). However, the chances of lifelong problems from prostrate surgery are much higher.

 

[ExFlyBoy5]

I would have to dig around but I recall an FDA paper on the use of Cologuard (at home test) and it had an error rate in the 14-16% range (for actual cancer, not polyps). If it wasn't time to go float in the pool, I would dig around a little for it. Maybe tomorrow.

 

[Golden sunsets]

I would have to dig around but I recall an FDA paper on the use of Cologuard (at home test) and it had an error rate in the 14-16% range (for actual cancer, not polyps). If it wasn't time to go float in the pool, I would dig around a little for it. Maybe tomorrow.

DH got a positive test with cologuard in 2019. A colonoscopy was scheduled and the procedure determined "no cancer".

 

[Golden sunsets]

My doc was glad to hear I didn’t want PSA test. He said the chance of dying from prostrate cancer is like a 10th of 1 percent (a lot of old men will get it, but it won’t kill them). However, the chances of lifelong problems from prostrate surgery are much higher.

Isn't prostate cancer one of the top causes of death amongst males in this country? I could be wrong, but I recall reading this somewhere.