PSA test false positive rate 70%?

[Car-Guy]

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.

I need to slow down skimming these threads...

The key words I picked up in your response were "dig around" then "Cologuard" and then "float in the pool"... I had to stop and fully re-read your response to understand what you were really saying. My bad, but I'm glad I re-read it.

 

[TexasPE]

In my case, Urologist felt something 'different' in DRE. Subsequent bone scan was negative. Biopsy found one incidence of cancer cells in the eight samples they took. Low Gleason. Had sample genetically tested to see what type of cancer it was. Turned out to be very slow growing. At my age (late 60s), the consultant (head of robotic prostate surgery at a major medical center) said watchful waiting was his recommendation (PSA and DRE every 6 months). It's now been 4 years and PSA results are within 0.1 of each other, no detected prostate physical change. Watchful waiting made sense to me.

 

[razztazz]

JRon[/B] 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. .

If it is that says something about worrying about cancer in general, maybe? At least if you don't smoke cigarettes, chew tobacco, drink like a fish, or repeatedly get sunburned.

 

[T-Minus]

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.

Thank you for posting this. Coincidentally, this almost exactly mirrors my personal experience…right down to the age and Gleason score. My PSA score that raised concern was 5.3, three months later it had increased to 7.19 then, when I had my procedure five months later, 8.5. Without those PSA tests, I would have been blissfully ignorant until too late.

BTW - there are two types of PSA tests. The one I now take annually is a high-sensitivity test that measures PSA into the hundredths. Also, in addition to the dietary considerations mentioned earlier, bicycling and sex (NOT at the same time) in the few days before a blood test can create artificially high readings.

 

[6miths]

Yes many threads on this.

No family history. Never had a PSA and won't be getting one based on my view of the evidence and expert recommendations.

 

[Rambler]

Thank you for posting this. Coincidentally, this almost exactly mirrors my personal experience…right down to the age and Gleason score. My PSA score that raised concern was 5.3, three months later it had increased to 7.19 then, when I had my procedure five months later, 8.5. Without those PSA tests, I would have been blissfully ignorant until too late.

BTW - there are two types of PSA tests. The one I now take annually is a high-sensitivity test that measures PSA into the hundredths. Also, in addition to the dietary considerations mentioned earlier, bicycling and sex (NOT at the same time) in the few days before a blood test can create artificially high readings.

Exactly on the BTW. Not to get into much detail, but my PSA was 6.7…but I didn’t know I was going to have a PSA test and didnt refrain from certain of those activities. A follow up test showed 4.7, but still much too high for my age. I had actually gone to see the doc that day because I’d been noticing my BP rising. Had I not been monitoring my BP, I wouldn’t have gone in, and likely the PSA test would not have been done. My wife had been going thru some health issues, and I’d been so focused on her for about 18 months that I had missed my own check ups. I’m also now on the ultra sensitive tests, but a recent concerning increase (not yet considered biochemical recurrence) has the docs being a bit more vigilant.

 

[Koolau]

My PCP has suggested I cease PSA testing as it CAN lead to dangerous biopsies. At my age, he suggests I'm much more likely to die WITH PC than of it - though a case of aggressive cancer and all bets are off. I have learned to trust him and advice is what I pay him for.

Additionally he suggests going with the Cologard test instead of the next Colonoscopy. Since I've passed the last 3, I figure I'm good to go - especially at my advancing age. It's definitely playing the odds, but it makes sense and, again, I'm trusting a professional - not to suggest I don't read up on stuff myself and make my own decisions. YMMV as always.

 

[Teacher Terry]

My ex was having erection problems even using a prescription at age 49. The urologist did a PSA test and it was high for his age. The doctor wanted him to do surgery after watching it raise for 3 years. He choose the radiation seeds. It left him with difficultly holding his urine, being able to totally empty his bladder and totally impotent. He’s 62 now and it saved his life. My uncle died from it at 72. I think it really depends on what age you develop it if you treat or ignore.

 

[target2019]

I wouldn't rely on an un-attributed article found on a practice website. Even beyond that it is impossible for a lay person to properly assess test results. After 15-20 years of living with this I know PSA tests indicate something worthwhile to know and track. Biopsies can be very informative too.

Follow the money. On one side are insurance companies and shills who want to eliminate tests to help their bottom line. On the other side are real-life urologists and researchers.

It is prudent to get a PSA every year. Most of the test results over a longer period of time are significant.

What we're seeing is the acceleration of science and it takes more than one mind to keep up with trends. If you have a medical problem get to specialist(s) at university-affiliated department. Pronto!

 

[chassis]

I wouldn't rely on an un-attributed article found on a practice website. Even beyond that it is impossible for a lay person to properly assess test results. After 15-20 years of living with this I know PSA tests indicate something worthwhile to know and track. Biopsies can be very informative too.

Follow the money. On one side are insurance companies and shills who want to eliminate tests to help their bottom line. On the other side are real-life urologists and researchers.

It is prudent to get a PSA every year. Most of the test results over a longer period of time are significant.

What we're seeing is the acceleration of science and it takes more than one mind to keep up with trends. If you have a medical problem get to specialist(s) at university-affiliated department. Pronto!

Thanks @target2019 When you say follow the money, where do practitioners stand in the chain/flow of funds, specifically relating to the PSA test topic?

 

[target2019]

Thanks @target2019 When you say follow the money, where do practitioners stand in the chain/flow of funds, specifically relating to the PSA test topic?

In a 20-year period I've been with two urology practioners. #1 was in a local suburban urology practice. I went to him when PSA first rose. After a few years (PSAs, biopsies, gleason score, etc.) I switched to a urology department at top hospital. I was introduced to 3 specialists, each had a different approach. I've been with one of those for the past ten years or so. I've personally known others in the field.

My urologist is a surgeon, so I imagine the rewards are spectacular. Others I've known had spectacular homes at the shore. It's a byproduct of how US has tooled healthcare, and I don't judge those who've acheived high status in their field.

What I know is that a test is in the medical toolbox. Some take the position that a healthy individual needs no tests, but I think that is too risky.

 

[Koolau]

I am losing 2 friends to PC. One got very poor diagnosis and treatment beginning about 4 years ago. He may live another year with lots of issues (now in bones, etc.) Because he is virtually indigent, he has to accept the dregs of the medical community to assist him through the mine field of treatment options. His cancer is very aggressive.

The other friend has received very good care (and probably advice as well). He believes he has less than a year to live as his bones are affected. He's recently begun another round of chemo which may help or may not. His cancer is also quite aggressive, but he has survived over 10 years.

There are a lot of variables involved and it seems the "experts" disagree as much as they agree about treatment of the aggressive forms of PC. YMMV

 

[REWahoo]

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.

American Cancer Society

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 41 will die of prostate cancer.

 

[OldShooter]

This is a situation where a statistical approach to public health clashes with the reality that the stats are irrelevant when only one individual is involved.

As I recall, the public health argument is that chasing down the false positives cause a lot of health care expense, hence it is better from a macro point of view to avoid triggering the expense by eliminating the test. Never mind that some of the positives are not false.

My PCP orders the test every year and reviews the results with me. It is my decision, not the decision of some public health statistician, that is relevant to me.

 

[bmcgonig]

The problem with false positives is that it sometimes leads to biopsies. And these biopsies can be random and cause issues as a side effect and still not catch a cancer.

However there’s no need to jump into biopsies straight away.

Rather get one of the bio marker tests like 4K score, SelectMDX or the one mentioned earlier in the thread. They assess your potential for serious cancer. You can also get an MPMRI that looks around for the cancer. This MRI will also give you an exact size of your prostrate. If either of those are iffy then it’s worth pursuing. The MRI can show the urologist the area to biopsy rather than just randomly taking a dozen samples.

Knowing the size of the prostate allows a rule of thumb that the urologist uses for determining risk. If your PSA is less than 1/10 of the size of your prostate (measured in cc’s if I remember correctly) then they consider you ok. Eg if your prostate size is 60 and your PSA is under 6 then you’re seemingly ok.

I went thru all of this a couple years ago. Granted I was in Europe where an MRI was cheap. But the message should be that there’s quite a few things that can be done before they stick a needle up your bum!

 

[bmcgonig]

I hate when this happens. I write the last reply about bio marker tests and then upon looking at Facebook ..they knew! So I got an ad for the following bio marker. Useful to look at.

https://www.exosomedx.com/

 

[RetireeRobert]

The problem with false positives is that it sometimes leads to biopsies. And these biopsies can be random and cause issues as a side effect and still not catch a cancer.

However there’s no need to jump into biopsies straight away.

Rather get one of the bio marker tests like 4K score, SelectMDX or the one mentioned earlier in the thread. They assess your potential for serious cancer. You can also get an MPMRI that looks around for the cancer. This MRI will also give you an exact size of your prostrate. If either of those are iffy then it’s worth pursuing. The MRI can show the urologist the area to biopsy rather than just randomly taking a dozen samples.

And here I am fourteen years later to tell you all this whole sad tale of what I consider urologists' overprescribing procedures.

.

Yes, seems urologists love those needle biospsies, that's what they were trained to do! 14 years ago I had some higher PSA scores and GP referred me to urologist. Went to urologist for a couple years getting PSA tested the whole time, every six months. He from the start wanted to do needle biopsies, and, get this, he said he wanted to do 20 samples! To get "all areas sampled" was his thinking. I declined any biopsies at that time. Psa's stabilized last time i went to urologist. Finally quit going there because he kept urging needle biopsies. I did follow up PSAs with GP for a few more years, and PSAs subsided to more normal lower levels and stayed there. Fast forward another five years or so. GP quit recommending even getting the PSA scores. And he said they had revised their thinking about the whole subject (i.e., they concluded "first, do no harm").

If I had let that urologist take that 20-sample needle biopsy, how much of my prostate would have been left? I only imagine i avoided a lot of unpleasant side efects from biopsies which I have read about. Not to mention needless expense and worry.

 

[chassis]

Thanks again @RetireeRobert

Are there any urologists or insurance professionals that can provide information on this thread on the reimbursement protocol for PSA tests and biopsies?

What is the menu or schedule of dollars reimbursed to the provider for these procedures?

 

[6miths]

Follow the money? There is no country that does more PSA testing per capita and related follow-up imaging investigations, biopsies and surgeries and other treatments than the US. Almost all other OECD countries do not recommend routine PSA testing. The US does not have better prostate cancer survival numbers than other developed countries. They do have higher treatment related complication rates. And yes urology is one of the highest paid medical specialties and the sponsored junkets for urologists are sweet. If you are going to get a PSA test done you had better go into it with your eyes open and as well educated as you can be as to implications and options.

 

[OldShooter]

Yes, seems urologists love those needle biospsies, that's what they were trained to do! 14 years ago I had some higher PSA scores and GP referred me to urologist. Went to urologist for a couple years getting PSA tested the whole time, every six months. He from the start wanted to do needle biopsies, and, get this, he said he wanted to do 20 samples! To get "all areas sampled" was his thinking. I declined any biopsies at that time. Psa's stabilized last time i went to urologist. Finally quit going there because he kept urging needle biopsies. I did follow up PSAs with GP for a few more years, and PSAs subsided to more normal lower levels and stayed there. Fast forward another five years or so. GP quit recommending even getting the PSA scores. And he said they had revised their thinking about the whole subject (i.e., they concluded "first, do no harm").

If I had let that urologist take that 20-sample needle biopsy, how much of my prostate would have been left? I only imagine i avoided a lot of unpleasant side efects from biopsies which I have read about. Not to mention needless expense and worry.

Why would you go to a doctor you don't trust and feel a need to second-guess? (In asking this question, I assume you have no formal training in the field.)

 

[bmcgonig]

Here’s a good link (45 minutes) detailing the issues with PSA from UCSF Urologist. And it ends with his reasons for using the bio marker tests, in particular the one I referred to earlier. It’s worth a listen if you are really interested in the subject.

It’s sometimes portrayed as foolish or arrogant to second guess your medical pro since of course most of us aren’t medical professionals. However the issue is that there are many ways these problems can be approached. As a simple example some urologists go straight to random biopsy on a PSA of 2-10. Others would never do that. Given what I’ve learned in this process it’s very appropriate for me to second guess the former guy who wants an immediate biopsy.

Your PCP knows much more about medicine that the rest of us ever will, but he may not know the latest and greatest about a particular issue that interests us, or in my case, pretty much consumed me for a month or two.

https://youtu.be/TwhSo7IgJIg

 

[RetireeRobert]

Why would you go to a doctor you don't trust and feel a need to second-guess? (In asking this question, I assume you have no formal training in the field.)

You must have missed the part where I said: "I finally quit going" to that urologist.

 

[RetireeRobert]

(In asking this question, I assume you have no formal training in the field.)

You don't believe in patients (i.e. clients, i.e. customers) getting multiple practitioner inputs while at the same time educating themselves via reading of the latest procedures, standards, studies, practices, clinical trials etc.? You just blindly forego any personal study and decision making, and let the (high paid) white coat do your thinking for you?

 

[Midpack]

Why would you go to a doctor you don't trust and feel a need to second-guess? (In asking this question, I assume you have no formal training in the field.)

There’s no profession that doesn’t have good and bad practitioners, and everything in between. Most patients don’t know which when they go to a specialist for the first time. And some patients are interested enough to research whatever condition they’re facing, while hoping they won’t learn anything that the specialist has/is telling them. In 2013 I would have had a completely unnecessary needle biopsy if I’d listened to my PCP and the urologist he sent me to. Both were highly insulted that I even asked about a PSA retest before a needle biopsy. In retrospect I can say with 100% confidence they were both dead wrong. Patients who blindly trust doctors no matter what could be making a mistake. I can’t imagine not looking out for yourself.

 

[chassis]

Agree with @Midpack and @RetireeRobert.

It's like the Service Advisor at the car dealership. I'm not being facetious. SA says, "You need new brakes." You say, "No I don't, I just measured the pad thickness and there are 20,000 miles left on them." Service Advisor looks at his/her shoes.

Medical treatment is no different, and the stakes are much higher. It's your health, or your life, rather than your vehicle that is at stake. So the customer, rather the patient, has a duty to him/herself to educate him/herself and suggest his/her own treatment plan. The word "suggest" implies the medical professional-patient relationship is collaborative and based on mutually beneficial outcomes.

The United States, with its egregiously costly and poor relative outcome health system, has tremendous resources available to citizens/patients, paid for by taxpayer dollars. Spend time reading papers on the NIH site. That will keep you entertained for quite a long time, again not being facetious. There are innumerable resources, you/we just need to use them. And bring them into the consultation room with the medical professional recommending your treatment.