Neither BPH nor elevated PSA may be indicatosr of cancer, but rather have other causes.. My urologist watches me and has found no cancer, even though my PSA has been relatively high for at least 10 years. He's diagnosed BPH, but I'm able to tolerate the effects without having had to resort to any medication.
.... and yet Medicare and private payers still pay for all this unnecessary testing. And as taxpayers and patients we continue to be hosed.
So much for "evidence based medicine" when the evidence points to adverse financial impact for the relevant clinical speciality and health system cartel.
So much for "evidence based medicine" when the evidence points to adverse financial impact for the relevant clinical speciality and health system cartel.
3
The biggest problem regarding diagnosis of prostate cancer in older men is due to the fact that most older men have prostate cancer. According to a publication of the American Medical Association, an 80 year old man has an almost 100% probability of having cancer cells in his prostate.
If the medical system is looking for prostate cancer patients to treat, they will find them in this group. It's normal for an old man to have prostate cancer.
If the medical system is looking for prostate cancer patients to treat, they will find them in this group. It's normal for an old man to have prostate cancer.
3
All healthcare students are taught a fundamental principle and that is "Non-maleficence" which means one must consider the possible harm that any intervention might do.
1
My 94 year old uncle died last year after breaking his femur in a fall. But two years before that, his doctor's office called him to say that his PSA was elevated and that he should see a urologist. He was frail and had many ailments. Fortunately, he declined to be examined.
According to a publication from the American Medical Association, an 80 year old man has an almost 100% probability of having cancer cells in his prostate. Yet my 81 year old neighbor recently completed radical treatment for prostate cancer. This man who used to be seen out with his wife, now stays at home due to incontinence. I suspect the medical community regards his case as another success story.
According to a publication from the American Medical Association, an 80 year old man has an almost 100% probability of having cancer cells in his prostate. Yet my 81 year old neighbor recently completed radical treatment for prostate cancer. This man who used to be seen out with his wife, now stays at home due to incontinence. I suspect the medical community regards his case as another success story.
6
The cancer industry doesn't give up easily. Doctors are trained to test and send patients to other doctors for treatments they don't need or want. Once people are told they have cancer, even if it won't kill them, it taints their lives with doubt. Many men have prostate cancer which will not kill them. As with breast cancer, certain changes which were formerly diagnosed as cancer have been downgraded. Would these doctors who are over-testing and over-diagnosis want to be the ones who spend the rest of their lives with urine dripping down their legs because of prostate surgery they didn't need. This is a case where the insurance companies should step in and not pay for a tests which will do more harm than good.
6
"30 to 40 %'....that is a significant statistic for fatalities
not a well thought ought article
not a well thought ought article
This is just another sad story documenting the over-diagnosing which leads to the over-treatment of prostate cancer. Eight years ago I opted to change my lifestyle as opposed to agreeing to an invasive procedure to treat my PC. Since
then all diagnostic testing including PSA, color powdered sonogram, and PCA3
show no evidence of a tumor. I have written two books on the subject that can
be downloaded free of charge from my website www.cancerisnotmyenemy.weebly.com. Please remember you must being well informed when dealing with recomendations that result in billions of dollars.
Nelson Berman
then all diagnostic testing including PSA, color powdered sonogram, and PCA3
show no evidence of a tumor. I have written two books on the subject that can
be downloaded free of charge from my website www.cancerisnotmyenemy.weebly.com. Please remember you must being well informed when dealing with recomendations that result in billions of dollars.
Nelson Berman
1
She says "older than 75" should be the cutoff, yet tons of examples about people younger than that. Don't attack the messenger if you can't read properly. Oh, and its prostate not prostrate.
2
Sadly, few understand laboratory tests, their usefullness, and their over-use. The over-use gets headlines, not the rest.
PSA is a blood test; it is referred to as a screening test. Screening test means that it is designed to have high sensitivity. High sensitivity means that it will have false positives, as the test itself tries to identify possible positives. You should never have a screening test that isn't designed this way.
A positive screening test means that your doctor should look at you as an individual with respect to other indicators. If you are over 75, you are much more likely to have a positive than if you were 50 or less. Doctors should examine this relationship, but under today's healthcare edicts out of HHS, together with consumer demand from TV, the Internet, or 'my neighbor said...' it is difficult.
The USPTF provides guidelines, intended ultimately to shape what care and testing we receive, as well as a comment period. They pretty much ignored the last set of comments on their idea to discontinue PSA altogether, regardless of age. That was a mistake, one based on retrospective studies, mostly from Europe. Europe, by the way, restricts testing for a number of disease once one is 'getting up there' so they can cut costs. Sadly, it is the cost cutters making the decision here.
If you are under 60, have a PSA done. Keep the result and have it done again in a year. Look at the difference between the results. The first is your baseline.
PSA is a blood test; it is referred to as a screening test. Screening test means that it is designed to have high sensitivity. High sensitivity means that it will have false positives, as the test itself tries to identify possible positives. You should never have a screening test that isn't designed this way.
A positive screening test means that your doctor should look at you as an individual with respect to other indicators. If you are over 75, you are much more likely to have a positive than if you were 50 or less. Doctors should examine this relationship, but under today's healthcare edicts out of HHS, together with consumer demand from TV, the Internet, or 'my neighbor said...' it is difficult.
The USPTF provides guidelines, intended ultimately to shape what care and testing we receive, as well as a comment period. They pretty much ignored the last set of comments on their idea to discontinue PSA altogether, regardless of age. That was a mistake, one based on retrospective studies, mostly from Europe. Europe, by the way, restricts testing for a number of disease once one is 'getting up there' so they can cut costs. Sadly, it is the cost cutters making the decision here.
If you are under 60, have a PSA done. Keep the result and have it done again in a year. Look at the difference between the results. The first is your baseline.
6
It is hard to acknowledge one's mortality-- forego the PSA test (and other tests) because one expects to expire of something else in only a handful of years.
1
This is ridiculous - screenings save lives. It is interesting now we are just talking about men age 75 and above. When this horse &*(^ started I was informed by my doctor the recommendation was to not screen anyone. Luckily my Doc chose to ignore this, did the screening, found that my PSA had doubled as was higher than 3 with in a year. Biopsy found 10% of the prostate was cancer with a Gleason score of 3/4. Opted for surgery - final pathology was that the 10% was correct and the other 90% was precancerous. I was 48 at the time. Pretty sure I would not have made it to 75 or 80 with any quality of life. As far as I am concerned the psa test and my doctor save my life. Had I been in my 80's and the cancer was slow growing I probably would have opted for watchful waiting - BUT the choose should be mine.
The biopsy does carry risk but I suspect statistically driving the the doctors office is much more hazardous to your health.
The biopsy does carry risk but I suspect statistically driving the the doctors office is much more hazardous to your health.
It is incredibly inhumane, and typically American, to practice this kind of "you're going to die soon, anyway" medicine. "Medicine". Here I thought , "First, do no harm." was the Hippocratic oath. It's more like "Hurry up and die!" if you've over a certain age.
I bet the farm my 84 year old dad is going to be centenarian; he is in great health, and he tells me he still feels like he's in his 30s. The man has a will to live. He recently completed 45 days of radiation for his prostate cancer, and his PSA is now .69. I'm so thankful his doctor didn't have the "something will probably kill you before the cancer does" attitude. Good lord.
I bet the farm my 84 year old dad is going to be centenarian; he is in great health, and he tells me he still feels like he's in his 30s. The man has a will to live. He recently completed 45 days of radiation for his prostate cancer, and his PSA is now .69. I'm so thankful his doctor didn't have the "something will probably kill you before the cancer does" attitude. Good lord.
2
This shouldn't come as a surprise. Men (of any age) seem to tie their worth as humans in with their ability to perform sexually and as they age, while they may be loathe to get a hearing aid or give up driving when it becomes dangerous, they will continue to monitor those parts of their bodies that are their "identity".
1
Are there any circumstances that might make psa testing useful? Can psa testng be helpful in detecting and treating advanced cancers originally assciated with the prosate? Is it not the case that quite a few people, even those over 75, die painful deaths from prostate cancer? The artcle fails to address these questions.
1
4 things: a larger prostrate gland (BPH) produces more PSA=a higher number; in the last two years a new test PHI (prostate health index) can average over time "free" vs "total" PSA levels with a statistical prediction of elevated PSA = cancer or BPH; a biopsy while only 40% accurate also risks infecting healthy areas of the gland during tissue sample extraction; anecdotal evidence suggests nutritional benefits to prostate health generally ingesting "cold pressed black seed cumin oil". Read about it.
1
My dear 75-year-old former neighbor died 10 days ago from metasticised prostate cancer. He had been diagnosed less than 5 months ago. He had been in apparent good health and, I am sure, not one to neglect annual medical exams, where he was probably told not to bother with testing at his advanced age. When I read the article I "got" the attitude that a man of 75 is expendable and not worth testing or treating. However, I understand over 2,000 people attended Fater Brian Fenlon's funeral in Scottsdale AZ and he will be missed by all of us.
1
Just one case, BUT! At 79 my PSA came in at 10.7. The biopsy revealed a Gleason score of 3/4. Radiation brought the PSA down to .01. I am fortunate to have no chronic illnesses and hope to live past 90. Glad I had the test!
What a crock, Paula! Why was the patient you describe already on medication? You know why but left out that part of the story! Let's tell the readers.
He was getting up 2 to 3 times a night to pee. His GP did a PSA test which showed a higher than normal reading. The referred to surgeon actually checked his prostate and bladder for cancer. There was none but his prostate was enlarged which is why he was put on medication to try to shrink it while he continues to be monitored.
Ok, he could have been referred without the PSA test. Better yet, his GP and the surgeon could have ignored the entire thing because he will probably die from something else.
I know, let's stop testing and treating people for anything they could but probably won't die from. So what if the patient has to get up more and more times a night.
Are you kidding me?
He was getting up 2 to 3 times a night to pee. His GP did a PSA test which showed a higher than normal reading. The referred to surgeon actually checked his prostate and bladder for cancer. There was none but his prostate was enlarged which is why he was put on medication to try to shrink it while he continues to be monitored.
Ok, he could have been referred without the PSA test. Better yet, his GP and the surgeon could have ignored the entire thing because he will probably die from something else.
I know, let's stop testing and treating people for anything they could but probably won't die from. So what if the patient has to get up more and more times a night.
Are you kidding me?
3
How do you know this?
Another prejudicial article on this topic. Screening is “hotly controversial” and the task force will revise its recommendations by 2018. Yet the article asserts that there’s too much screening.
The actual problem is not screening, but the behavior of some doctors and patients. No, the remedy is not female doctors as the article suggests!
And how about more screening, not less, with a lower price per test? It’s really a cheap test for which the labs overcharge. My GP screens my cholesterol every year, why not PSA? It takes many years of high cholesterol before much danger. The aggressive prostate cancers are dangerous after a year or two, not ten or more. But how would you know if you have it?
Blame the patient, that’s the unceasing theme. After all, if a man gets cancer, which is only detected after it advances, and has severe treatments such as radiation, surgery, and chemo, and loses his health and maybe his job, and loads of money, he will probably still be alive after 5 years, which puts him in the success category in the statistics. He didn’t die from the cancer, so screening wouldn’t have helped, according to the group that wants less screening. Think that over.
The actual problem is not screening, but the behavior of some doctors and patients. No, the remedy is not female doctors as the article suggests!
And how about more screening, not less, with a lower price per test? It’s really a cheap test for which the labs overcharge. My GP screens my cholesterol every year, why not PSA? It takes many years of high cholesterol before much danger. The aggressive prostate cancers are dangerous after a year or two, not ten or more. But how would you know if you have it?
Blame the patient, that’s the unceasing theme. After all, if a man gets cancer, which is only detected after it advances, and has severe treatments such as radiation, surgery, and chemo, and loses his health and maybe his job, and loads of money, he will probably still be alive after 5 years, which puts him in the success category in the statistics. He didn’t die from the cancer, so screening wouldn’t have helped, according to the group that wants less screening. Think that over.
2
It seems like I read that the US is the only country that does PSA Screenings. Curious if this is true.
I am 65 years old and have been getting these tests for years.
Late last year my Endocrinologist sent me to my Urologist because he thought my PSA was too high.
The Urologist pulled my PSA tests for the last five years and some of them were higher than the one that had alarmed the Endocrinologist. The Urologist said we'd look again in 6 months.
He also told me that when you take the test is important. If you take it within a couple of day after ejaculation the PSA will usually read higher because the prostrate is in overdrive replacing seminal fluid.
There is some concern because my paternal grandfather had had prostate cancer when he was 59 in 1959. The surgery left him incontinent and impotent but he did survive until he was 84 when it metastasized.
Late last year my Endocrinologist sent me to my Urologist because he thought my PSA was too high.
The Urologist pulled my PSA tests for the last five years and some of them were higher than the one that had alarmed the Endocrinologist. The Urologist said we'd look again in 6 months.
He also told me that when you take the test is important. If you take it within a couple of day after ejaculation the PSA will usually read higher because the prostrate is in overdrive replacing seminal fluid.
There is some concern because my paternal grandfather had had prostate cancer when he was 59 in 1959. The surgery left him incontinent and impotent but he did survive until he was 84 when it metastasized.
2
Here we go again. OK, PSA screening for men over 75 may be a bit much, but Ms Hesselberth says the key word herself. "...MOST prostate cancer develops slowly."
Enough already with the criticism of PSA testing. It's not perfect but it's the only test we have. This is about my health, not probability. It's my decision!
And yes, I've had prostate cancer.
Enough already with the criticism of PSA testing. It's not perfect but it's the only test we have. This is about my health, not probability. It's my decision!
And yes, I've had prostate cancer.
2
Recommendations for populations are and should be based on statistics and probability.
2
Anecdotes are not science. Readers (and doctors) who promote prostate cancer screening likely aren't impotent and wearing a diaper due to incontinence for decades -- maladies suffered from well-meaning prostate cancer surgery; without their lives being lengthened, as randomized trials demonstrated. Yes, about 40,000 men die of prostate cancer annually in the US but millions die with asymptomatic prostate cancer that didn't shorten their life. That's the bottom line: number-needed-to-treat to benefit and the number-needed-to-harm to temporarily or permanently injure a patient. The latter, according to the scientific literature on the subject, wildly exceeds the former. Why? Because the biology and behavior of the tumor, while it's still called "prostate cancer" has a different trajectory in different individuals. Therein lies the rub.
10
While I do miss being able to ejaculate I had full bladder with in a month or so and full sexual function with in a year. Robotic surgery 2011.
1
I'm unclear as to what was demonstrated by the randomized trials to which you refer--that surgery confers no gains in longevity--compared to what? Other treatment, or no treatment?
The issue here is screening. The issue of treatment is very different, but probably no less thorny. But for screening, the PLCO trial, which has been so heavily leaned on to demonstrate no increased longevity creditable to screening for prostate cancer, was apparently contaminated by many in the control arm actually having been screened.
The issue here is screening. The issue of treatment is very different, but probably no less thorny. But for screening, the PLCO trial, which has been so heavily leaned on to demonstrate no increased longevity creditable to screening for prostate cancer, was apparently contaminated by many in the control arm actually having been screened.
I find articles like this to be most disconcerting. I am 69 years of age and had a radical prostatectomy 2 years and 2 days ago. Following several digital rectal examinations (DRE's) and PSA blood tests, by my GP and a urologist, I had an MRI scan. This was followed by a biopsy which revealed that I had Gleason 7 cores in the prostate. I had been having DRE's and PSA tests for a number of years before any sign of a problem became evident.
A friend of mine had the same operation only yesterday morning. He is aged 65 years and as recently as two years ago was given a clean bill of health by his urologist following a kidney stone problem. In this time he developed Gleason 8 tumors in his prostate.
Articles like this (and we get them here in Australia too) will discourage men from having the checks that may detect the presence of this disease. It is hard enough to get most men to visit their GP without this sort of discouragement. My strong advice to all men over the age of 50 or so is to have the DRE examination and the PSA test. Even with these checks it is sometimes extremely difficult to pick the cancer up. Often an MRI scan will be necessary and if this indicates trouble then a biopsy is the only real way of establishing whether or not an operation is required.
A friend of mine had the same operation only yesterday morning. He is aged 65 years and as recently as two years ago was given a clean bill of health by his urologist following a kidney stone problem. In this time he developed Gleason 8 tumors in his prostate.
Articles like this (and we get them here in Australia too) will discourage men from having the checks that may detect the presence of this disease. It is hard enough to get most men to visit their GP without this sort of discouragement. My strong advice to all men over the age of 50 or so is to have the DRE examination and the PSA test. Even with these checks it is sometimes extremely difficult to pick the cancer up. Often an MRI scan will be necessary and if this indicates trouble then a biopsy is the only real way of establishing whether or not an operation is required.
2
I disagree with the thrust of this article. Yes, my evidence is anecdotal. But it reveals the pitfalls of not screening. My father in law, who was 87 and in poor health, had not been screened since age 70. He presented with bone metastases and died a terribly painful death. He had weakness in his legs from a stroke and because of the bone pain, was unable to walk for the last six months of his life. He had prostate surgery to correct a urinary blockage, but they did not biopsy the prostate because of his age. Had he had PSA testing, he could have been treated for the prostate cancer and may not have had to die the extended, bedridden, painful death he suffered.
7
The real bombshell about PSA screening was just printed in The New England Journal of Medicine - http://www.nejm.org/doi/full/10.1056/NEJMc1515131 Doctors from NY-Presbyterian revealed that the control arm of the clinical trial used as the basis of the Task Force's recommendation against PSA screening were in fact screened for prostate cancer at a higher rate than the intervention arm - therefore, this explains why there was no benefit found for screening. In simple terms, the study was so flawed that the results are MEANINGLESS. Go look at the letter in NEJM, and look out for the Task Force to change their recommendations soon.
4
I had a friend, a veteran, retired officer, who's VA doctors didn't adequately monitor his PSA. The prostate cancer metastasized to his bones and elsewhere and he died less than two years later. He was in his '60s. If I were a veteran I wouldn't trust VA doctors with these diagnoses and treatments.
2
As a veteran I can tell you I wouldn't trust the VA for any of my medical care.
1
A US study looked at the general effectiveness of a screening program involving both PSA and DRE methods. This was conducted between 1993 thru 2001, in which 76,693 men at 10 U.S. study centers 38,343 subjects received screening (an annual PSA testing for 6 years and DRE for 4 years) and a control group of 38,350 subjects received 'usual care' with subjects and health care providers receiving the results and deciding on the type of follow-up evaluation. 'Usual care' means that some in this group would have received some screening, as some organizations have recommended. After 7 years of follow-up, the incidence of prostate cancer per 10,000 person-years was 116 (2,820 cancers) in the screening group and 95 (2,322 cancers) in the control group. The incidence of death attributed to prostate cancer per 10,000 person-years was 2.0 (50 deaths) in the screening group and 1.7 (44 deaths) in the control group (rate ratio, 1.13; 95% CI, 0.75 to 1.70). The data at 10 years were 67% complete and consistent with these overall findings. The researchers concluded that after 7 to 10 years of follow-up, the rate of death from prostate cancer was very low and did not differ significantly between the two study groups.
1
Does this mean you won't mind being the statistic?
Smitty - This means I would like the odds to be on my side. I am not stupid. Nor do I want to wear diapers for the rest of my life.
I shouldn't be fool enough to challenge you on statistics (or any mathematical subject, for that matter), but...7 years followup seems a bit short for me. I hope they continue to follow up (and come up with a more-predictive test, dammit!)
When I turned 40 I got a PSA because both my father and his brother had prostate cancer, My number came back at 29. It was non-papable. The biopsy results were a Gleason 3/4. I had a radical prostatectomy twenty-one years ago. If these standards were in effect then, I would now be dead from the cancer. Go figure. A PSA is just a blood test that gives one information to make an informed decision.
17
It is more complicated than the article makes it seem. The Preventative Health Services Task Force that made the recommendation contained no urologists in order to avoid "conflict of interest". That makes no sense. Advanced prostate cancer is very painful and doctors who treat the disease should be involved in making the recommendations to their patients.
9
The fear does exist. Doctors and patients share this fear. You cannot be against or in favor of PSA screening test. And the age of 75 cannot be considered as a binary code (what about being 74 or 76 years old ?) .
Sloan Kettering's screening Guidelines for Prostate Cancer, from my personal point of view, represent a wise, evidence based, useful tool for both patients and doctors ,interested to this topic.
Sloan Kettering's screening Guidelines for Prostate Cancer, from my personal point of view, represent a wise, evidence based, useful tool for both patients and doctors ,interested to this topic.
1
There are way too many counter examples in just these comments for Paula to be this complacent.
8
Do you know the term anecdata?
There's absolutely nothing wrong with using PSA tests to screen for cancer. Where the problem lies is in how the results from PSA tests are treated. Fix that and all other issues go away.
Even if all the test does is confirm that some 90 year old has started having (more) trouble peeing it matters not. The tests are not that expensive.
Until such time as the difference between slow growing and aggressive cancers can be positively identified any other way, it's all you've got
Even if all the test does is confirm that some 90 year old has started having (more) trouble peeing it matters not. The tests are not that expensive.
Until such time as the difference between slow growing and aggressive cancers can be positively identified any other way, it's all you've got
6
Agreed, see my other post. Not only are growth rates of the primary cancer important (hence the need for and better validity of results dynamics) but metastases are crucial.
The real question in my mind is why Mri"s are not used for screenings before Biopsies and furthermore why less expensive imaging tests are no used to measure the usually larger prostates of older men. There is a direct correlation between size and psa number yet there is no in between protocol to deal with the millions of men who have BPH and are biopsies for nothing every year. Methinks there is $$$ behind all this madness,
Where are all the stories from people whose lives were ruined by medical tests?
You know from the data that people have had tests, were given false positives, had biopsies or more radical surgeries, contracted infections...and, died.
Where are their stories?
You never hear their stories because they're dead.
You know from the data that people have had tests, were given false positives, had biopsies or more radical surgeries, contracted infections...and, died.
Where are their stories?
You never hear their stories because they're dead.
5
I don't think anyone is being at all glib about the dangers that you describe so well. There is unfortunately a great degree of ignorance, neglect and incompetence in all and every direction.
2
Well my dads primary care told him they were stopping doing PSA tests. He was 80 at the time. While he was not running marathons, his health was fantastic! He travelled all over the world, rode his bike,swam almost every day. My dad was only in the hospital once in his life: tonsils. His dad lived to be 97. His mom died at 100. Needless to say, my dad should have made them keep taking the test. He had some blood work done for something unrelated when he was 86 and the Dr noticed elevated phosphatase in his blood/bones. Sure enough, he
had prostate cancer and it had metasticised to his bones(which it does). He was dead 6 months later. Never would have happened if they had kept up the PSA....and then he was in such excellent health that he could have easily had surgery. He should have lived another 10 yrs at least! Sad
had prostate cancer and it had metasticised to his bones(which it does). He was dead 6 months later. Never would have happened if they had kept up the PSA....and then he was in such excellent health that he could have easily had surgery. He should have lived another 10 yrs at least! Sad
14
Questions for the legal eagles out there - if a man came to you as a malpractice attorney, and said that on the advice of the Task Force, his internist stopped PSA testing at age 70 - but on changing internists, he was indeed found to have metastatic prostate cancer at age 74 - and he was in otherwise good health at age 70, but at 74, is now dying of a treatable cancer that should have been found through PSA screening, as per the urological guidelines - then does the man have a case of malpractice? And can the Task Force be sued for giving poor advice for individuals, based on population statistics, or is it just the first internist who's sued?
At 74, the man may be dying, but it will take him a few years to die, and he probably would be dead anyway. He would lose a malpractice case.
After turning 72, my PCP discontinued the PSA. He also stopped DRE and even stopped hernia checks. What is the advice for DRE?
3
One thing that is clear from the comments...
The average doctor, never mind patient, has no clue as to how to apply medical statistics or epidemiological data in the real world.
People seem to want tests...
They fear cancer more than doctors, partly out of ignorance and partly because they are suckers for the illusion of control.
If you want good health, focus on maintaining a healthy lifestyle.
That's the main thing and the main thing is the main thing.
That's what the data show, too, by the way.
Go to the doctor if you are sick or have troubling symptoms.
Otherwise, stay away.
Just my opinion, but it is a carefully reasoned one backed up with research.
I post on this topic quite often because, unlike most people, I do not labor under the false assumption that what the medical-industrial complex is selling is invariably benign.
The average doctor, never mind patient, has no clue as to how to apply medical statistics or epidemiological data in the real world.
People seem to want tests...
They fear cancer more than doctors, partly out of ignorance and partly because they are suckers for the illusion of control.
If you want good health, focus on maintaining a healthy lifestyle.
That's the main thing and the main thing is the main thing.
That's what the data show, too, by the way.
Go to the doctor if you are sick or have troubling symptoms.
Otherwise, stay away.
Just my opinion, but it is a carefully reasoned one backed up with research.
I post on this topic quite often because, unlike most people, I do not labor under the false assumption that what the medical-industrial complex is selling is invariably benign.
9
"Go to the doctor if you are sick or have troubling symptoms."
That's frightening advice. For many diseases, by that time, it will be too late.
Better to use tests for guidance. Knowledge is better than ignorance, if one can think rationally about test results.
That's frightening advice. For many diseases, by that time, it will be too late.
Better to use tests for guidance. Knowledge is better than ignorance, if one can think rationally about test results.
5
"There’s little medical dispute, however, about stopping PSA screening for men unlikely to live more than nine or 10 years because of their age and health." This is a statistical argument that necessitates the patient be a betting man. However, I find the logic confusing. The real bet is about the treatment not the diagnosis. And it should not be the doctor who places that bet.
5
Right...the patient is the gambler; the doctor takes the vig.
2
I had the good fortune to have just turned 75 when the recommendation not to do PSA in men 75 or older came out. I had for some years had BPH and had regular PSA tests, which sometimes showed wide variation. As a result of this I'd had two painful biopsies, which showed no cancer. I'd also no too long before started seeing a new (to me) urologist, a younger man. He sat down with me and asked if I wanted to continue the PSA testing. I told him I didn't want it unless he thought it desirable. I said that even if the PSA were elevated I would probably not agree to another biopsy. At that he smiled and said that was good because if a biopsy did find cancer, he probably wouldn't treat it.
I later had to have most of my prostate removed because it blocked to flow of urine to a dangerous degree. Tests on the material removed showed no cancer.
'
I later had to have most of my prostate removed because it blocked to flow of urine to a dangerous degree. Tests on the material removed showed no cancer.
'
3
It's a little disconcerting to read comments from doctors, some of them even a little arrogant, supporting the notion that ignorance is good. But on closer reading, this is not about the PSA test itself, but about the various events that may follow a positive score. Shouldn't those various events then be the focus of reform efforts--most of these bad outcomes would appear to be of the iatrogenic variety, not really the fault of the PSA test, but of the doctor or hospital that acted on that information.
3
My urologist agreed with me years ago to forego PSA test. But insists an annual digital text by him regardless as part of annual exam. I agreed with that
I am over 70, and will get a yearly PSA until about age 80 (vide infra). It's an accurate, and cheap (I will self pay for it) test. This test is of the utmost importance if you happen to be the one patient in which it alerts one to a cancer of an aggressive sort.
As I've told many male patients over decades: virtually all old men will have prostate cancer before they die, but you don't want to be the one youngish older man to die OF prostate cancer.
What's good for the herd is not necessarily good for the individual.
As I've told many male patients over decades: virtually all old men will have prostate cancer before they die, but you don't want to be the one youngish older man to die OF prostate cancer.
What's good for the herd is not necessarily good for the individual.
3
“A PSA screen is not just a blood test,” said Dr. Victoria Tang, a research fellow at the University of California, San Francisco, and the lead author of the V.A. study. “It’s signing up for a prostate biopsy if the screening is positive.
Completely untrue, and misleading.
Completely untrue, and misleading.
7
If you are going to make such a statement it might be worth stating your qualifications and reasons for disagreement. Otherwise, your opinion has no worth.
3
Well, true in some cases - the medical reporting in the NY Times leaves a lot to be desired. A high PSA requires follow up investigation, and a prostate biopsy would be a common follow up test in men who still have a prostate - but other blood work and imaging studies are also possibilities. In a man who has had his prostate removed, a high PSA as a monitoring test signals possible recurrence and metastasis of a prostate tumor, so a high PSA in that group of men would require imaging studies and perhaps laparoscopy to sample lymph nodes.
1
This article or very similar appears with disturbing regularity in the NYT. If there were a cheap, easy test that was somewhat effective as an early indicator of the possible presence of breast cancer, would it be discouraged?
The arguments against the PSA test are fundamentally stupid. How many men would not want to know if they might have prostate cancer? A PSA test very simply says, Should we look further to see if you have prostate cancer and, if so, how aggressive is it?
In what other circumstances would such an indicator test be discouraged or denied?
The arguments against the PSA test are fundamentally stupid. How many men would not want to know if they might have prostate cancer? A PSA test very simply says, Should we look further to see if you have prostate cancer and, if so, how aggressive is it?
In what other circumstances would such an indicator test be discouraged or denied?
6
This smacks of "Death Panel" policies. There have been persistent rumors to the effect that there are, or will be, limitations put of cancer treatment for men over 70. Is there any truth to those reports? Curious minds want to know.
2
The USPSTF has recommended mammograms and PAP smears for cervical cancer be discontinued at age 75
1
If I were an 80-year-old man, I would not want to know, because of the likelihood of dying of something else.
Most people would agree that the PSA test is inappropriate for men over 75 if their life expectancy is less than 10 years (older age or another malady). However, for men with life expectancies greater than 10 years, the PSA test is very important. Who wants to die prematurely of a medical issue that could have been prevented?? The issue for such men is: what to do with one positive test result? My answer: nothing! It could be a false positive or due to prostate issues other than cancer. BUT: continue to have a PSA test once every 3 months. This will provide PSA data whereby you can determine a "velocity curve": PSA results as a function of time. Such a curve has real meaning! No false positives here! only clear and accurate interpretation! If the curve goes up, it's time for a biopsy. If the curve goes down, great! If the curve shows a spike, probable false positive. If the curve is high but constant, probably a prostate issue other than cancer. For my money, this is what doctors and others should be recommending ... but don't. Go for a "velocity curve"!
7
I often tell my friends and family I don't want to live too long. They ask me why I would say such a thing. I answer so America's medical system can't rip me off financially or kill me.
15
Blarney of the very highest order!
3
Don't get me wrong BobR, this is not to diss the fine people working in the field from the doctor to the orderly...just that the HMO and Drug barons have turned it into a de facto criminal money machine for themselves..as this article is proof of..
6
That thing that tries to pass for a 'health system' in America is an absolute travesty paul. I understand where you are coming from.
2
I have read that biopsies like PSA tests also yield false positives.
I have to wonder if invasive tests and "treatments" like biopsies and chemotherapy don't contribute to the cancer, as well as CT scans, which can expose you to up to 1000 times more radiation than an ordinary dental X-ray.
I have to wonder if invasive tests and "treatments" like biopsies and chemotherapy don't contribute to the cancer, as well as CT scans, which can expose you to up to 1000 times more radiation than an ordinary dental X-ray.
4
Your not serious are you?
With regard to CT scans, you are essentially making multiple exposures, so yes, the radiation exposure is relatively high. With all diagnostic radiography, the need for the study should always be weighed against the risk.
As far as dental x-rays (full disclosure--I'm a dentist) one of my personal bugaboos is the proliferation of cone-beam CT machines in dental offices. There is a place for them, but unless you're doing surgical implantology all day, that place is very small, IMO, and the temptation to generate revenue for an expensive machine must be great.
But that does not mean there is no place for CT in screening. The USPSTF has recommended "low-dose" CT screening for lung cancer in patients with a long history of smoking:
http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummary...
As far as dental x-rays (full disclosure--I'm a dentist) one of my personal bugaboos is the proliferation of cone-beam CT machines in dental offices. There is a place for them, but unless you're doing surgical implantology all day, that place is very small, IMO, and the temptation to generate revenue for an expensive machine must be great.
But that does not mean there is no place for CT in screening. The USPSTF has recommended "low-dose" CT screening for lung cancer in patients with a long history of smoking:
http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummary...
As an oncologist who practiced in the pre-PSA age, I can tell you there were two main ways of making a diagnosis of prostate cancer at that time. One was the incidental finding at a transuretheral prostatectomy to relieve urinary obstruction and the other was when a man developed intractable back pain and was found to have metastatic disease to the bone, an incurable condition. With PSA determination and physical exam the cancer can be found at an earlier stage when it is possibly curable.
PSA is not a great test, and warrants about a "C" average when it comes to grading its efficacy. But there is nothing much better at the present time.
The most important thing to remember about PSA is that it is just a number. The real impact comes from what physicians do with that number and that is a question of education which involves physicians at all levels of expertise.
There are many men aged 75 who do not run marathons but are healthy and have a life expectancy of greater than 10 years. A discussion with your doctor is appropriate and a finding of a very elevated, rising PSA requires further investigation in healthy men.
PSA is not a great test, and warrants about a "C" average when it comes to grading its efficacy. But there is nothing much better at the present time.
The most important thing to remember about PSA is that it is just a number. The real impact comes from what physicians do with that number and that is a question of education which involves physicians at all levels of expertise.
There are many men aged 75 who do not run marathons but are healthy and have a life expectancy of greater than 10 years. A discussion with your doctor is appropriate and a finding of a very elevated, rising PSA requires further investigation in healthy men.
29
Life expectancy and cancer-risk are not statistically independent. If a 75 year-old man is healthy and fit and has a life expectancy of >10 years, that man is undoubtedly far less likely to have cancer than the man who does not meet those health criteria. The unhealthy population has less to lose from an error of omission but the healthy population has more to lose from an error of commission.
3
The sophistry is breathtaking.
2
taopraxis says: "If a 75 year-old man is healthy and fit and has a life expectancy of >10 years, that man is undoubtedly far less likely to have cancer than the man who does not meet those health criteria."
Except for those 75 year old men who are "healthy and fit" with a life expectancy of greater than 10 years WHO DO DEVELOP PROSTATE CANCER!! Your reasoning is somewhat circular and sophistical.
Except for those 75 year old men who are "healthy and fit" with a life expectancy of greater than 10 years WHO DO DEVELOP PROSTATE CANCER!! Your reasoning is somewhat circular and sophistical.
4
That's because most doctors recognize that the recommendation of the USPSTF is wrong and that some older men develop life threatening prostate cancer that can be treated successfully. The PSA is a grade C test and has to be interpreted wisely and that is the hard part.
I am an oncologist with many older men in my practice and in many cases the PSA was a life saver for them.
There are many men aged 85 and older and all of them were once 75.
I am an oncologist with many older men in my practice and in many cases the PSA was a life saver for them.
There are many men aged 85 and older and all of them were once 75.
14
"For 75-year-olds still running marathons, the test might make sense. For most others, it probably doesn’t."
Paula Span - That is terrible advice from someone who doesn't understand the facts very clearly and distorts the evidence. The FACT is that if you are 75 and have a reasonable chance of living another 10 years having a discussion WITH YOUR DOCTOR is appropriate. Not taking the advice of a staff writer for the New York Times who is looking for a snappy last line for her column!
Paula Span - That is terrible advice from someone who doesn't understand the facts very clearly and distorts the evidence. The FACT is that if you are 75 and have a reasonable chance of living another 10 years having a discussion WITH YOUR DOCTOR is appropriate. Not taking the advice of a staff writer for the New York Times who is looking for a snappy last line for her column!
14
I have taken the PSA test for years. When the rate increased I had a biopsy which showed no cancer. next year the PSA had doubled and a biopsy showed cancer. I had open surgery, and the histology report showed that the cancer was present in the entire prostate gland. I am happy that I took the test every year and that I did the biopsies....minor inconveniences compared to the payoff...
It makes no sense not to test!
It makes no sense not to test!
15
If your PSA rises progressively over 2 years in six month testing and then shoots up 3 points from 9 to 12 in 3 months as mine did, wouldn't you opt for a biopsy (this procedure wasn't so bad contrary to this author)? The Gleason score was high risk at 8 in 4 sites. I was 72 and sought four doctors' advice. As a cancer biologist I knew full well that the PSA test gives false positives but I could see no reason not to have it. Now the PSA test level will serve as an indicator of treatment efficacy.
7
This is just one more reminder that no one should ever simply do what the doctor says without doing some research, too, all the more so if the doctor is a specialist of some kind. There was a study I remember that showed that patients about to have some kind of treatment grossly overstate how helpful the treatment is likely to be AND downplay the potential risks. The study authors weren't sure if this was because patients never fully discussed both of those with doctors or if they selectively heard what doctors said. Probably a mix a both. But beware of that common tendency to be more optimistic than we should about a treatment or test. Seek multiple information sources.
5
http://www.nytimes.com/2012/02/28/opinion/overdiagnosis-as-a-flaw-in-hea...
The chief medical officer of the American Cancer Society once pointed out that his hospital could make around $5,000 from each free prostate cancer screening, thanks to the ensuing biopsies, treatments and follow-up care.
The chief medical officer of the American Cancer Society once pointed out that his hospital could make around $5,000 from each free prostate cancer screening, thanks to the ensuing biopsies, treatments and follow-up care.
3
So don't treat them because they're old and will probably die anyway? Sounds a little cold to me. Would be interested to see if men over 75 feel like their lives are worth extending!
8
It's quality, not quantity that I desire.
Give me 5 joyful years over 10 full of doctors appointments and restrictions.
Give me 5 joyful years over 10 full of doctors appointments and restrictions.
9
Yes but ask what the quality of life will be like!!!! It is not just the number of years you might gain, but in my opinion men need to understand the risk to their quality of life.
The comments highlight why it is so difficult to discuss population based recommendations for cancer screening. We all know one patient, one family member, or one friend who flouted the USPSTF recommendations for cancer screening who was subsequently diagnosed with an aggressive cancer and whose life was saved. I understand and am grateful along with you for that extra time/health. However, all geriatricians have seen patients who received screening despite advanced cardiopulmonary disease, marked functional decline, advancing dementia or other clearly life limiting issues and the burdens of screening, treatment, or even the psychological harms of knowing about a cancer diagnosis far outweighed any benefit to their quality or quantity of life. At the end of the day, these decisions are being (or should be) made individually, within the framework of the person's functional status, preferences and goals of care. Ms. Span is simply trying to get more of us to understand that testing/screening for cancer because it is available or "I want everything" or "it saved my brother in law's life" may unleash more harm than good, especially as we get older and develop more competing serious medical issues.
34
My father's oldest friend had high psa tests for years. His doctor insisted they meant nothing. Finally, he started having hip pain. When Kaiser investigated, they found stage four prostate cancer. He died three weeks ago at 65.
6
i hope his family sued the doctor and complained to the state medical board about his incompetence. He should have his license revoked.
This trope that prostate cancer is indolent, that "most men die WITH prostate cancer, not OF prostate cancer" obscures the fact that prostate cancer is the second biggest cancer killer of men in the United States (behind only lung cancer).
The USPSTF made a blanket grade of "D" for PSA screening--not stratified for age, nor for any other risk factor.
Furthermore, the USPSTF based its recommendation partly on a large study whose results are now coming into question:
http://www.medpagetoday.com/clinical-context/prostatecancer/57913
Yes, the PSA is an imperfect test. Yes, elderly men are being over-treated. But let's not throw the baby out with the bathwater.
The USPSTF made a blanket grade of "D" for PSA screening--not stratified for age, nor for any other risk factor.
Furthermore, the USPSTF based its recommendation partly on a large study whose results are now coming into question:
http://www.medpagetoday.com/clinical-context/prostatecancer/57913
Yes, the PSA is an imperfect test. Yes, elderly men are being over-treated. But let's not throw the baby out with the bathwater.
9
Steven that is a big misunderstanding of that data. Prostate cancer is the most common form of cancer in men, but it is not the most common form of cancer than actually kills men. ++Lung cancer++ wins that dubious award by a landslide Here is the data from the USA CDC:
Leading Causes of Cancer Death Among Men
Lung cancer (56.2)
First among men of all races and Hispanic* origin populations.
Prostate cancer (19.6)
Second among white, black, American Indian/Alaska Native, and Hispanic* men. Fourth among Asian/Pacific Islander men.
Colorectal cancer (17.6)
Third among men of all races and Hispanic* origin populations.
Leading Causes of Cancer Death Among Men
Lung cancer (56.2)
First among men of all races and Hispanic* origin populations.
Prostate cancer (19.6)
Second among white, black, American Indian/Alaska Native, and Hispanic* men. Fourth among Asian/Pacific Islander men.
Colorectal cancer (17.6)
Third among men of all races and Hispanic* origin populations.
1
Henderson, Steven said prostate cancer "is the second biggest cancer killer of men" after lung cancer. That's what your data show. What's your point?
1
I thought I was clear, and my point was not to parse the data to exaggerate the risk. It was to stress that any disease that kills as many people as does prostate cancer should not be dismissed (as is occasionally the inference drawn from some reading brief accounts of clinical studies in the media). Neither should Ms. Span's point be ignored-that prostate cancer (and almost certainly other cancers) are treated inappropriately in older populations.
Here is useful information on improved PSA testing to supplement Ms. Span's article:
http://www.healthafter50.com/alerts/prostate_disorders/Improving-PSA-Tes...
http://www.healthafter50.com/alerts/prostate_disorders/Improving-PSA-Tes...
1
A bad PSA result doesn't necessarily mean cancer, but it's not something to be ignored either. You can have prostate cancer with no symptoms until it's too late. And you can have a high PSA score without having cancer. Only 25% of men with elevated PSA turn out to have cancer. On the other hand, 25% is not nothing. Drugs taken to reduce BPH also reduce PSA - and thus can give false assurance that you don't have cancer. PSA can be a bit of a mystery.
That's why there are refinements of PSA testing called rate of doubling (how fast the PSA level doubles), velocity (rate of increase per year), and free PSA. In my own case, my PSA doubled in less than a year, and a very low free PSA indicated there was a 95% chance I had cancer - and a biopsy proved those tests correct.
And I would never have known without having that first PSA test.
What really bothers me is the dismissive attitude expressed by medical professionals toward older men - "Well, you're not going to live much longer anyway so don't bother finding out if you might have prostate cancer." Where does that attitude come from anyway - other than arrogance? Prostate cancer can be very aggressive, but it's OK for an 80-year-old man to suffer horribly in his last years? It's OK for him to worry about whether he has cancer without knowing it?
The medical professionals who prefer to see men as a large group instead of as individuals with individual needs and cares need to take courses in empathy.
That's why there are refinements of PSA testing called rate of doubling (how fast the PSA level doubles), velocity (rate of increase per year), and free PSA. In my own case, my PSA doubled in less than a year, and a very low free PSA indicated there was a 95% chance I had cancer - and a biopsy proved those tests correct.
And I would never have known without having that first PSA test.
What really bothers me is the dismissive attitude expressed by medical professionals toward older men - "Well, you're not going to live much longer anyway so don't bother finding out if you might have prostate cancer." Where does that attitude come from anyway - other than arrogance? Prostate cancer can be very aggressive, but it's OK for an 80-year-old man to suffer horribly in his last years? It's OK for him to worry about whether he has cancer without knowing it?
The medical professionals who prefer to see men as a large group instead of as individuals with individual needs and cares need to take courses in empathy.
35
CT, My experience is very much the same as yours.
5
its not being dismissive, it's a fact that as a very old man having surgery to remove the prostate, having radiation or chemo or even the biopsy to confirm the PSA test will do more harm than good, either killing the patient from the surgery or an infection from the biopsy that leads to sepsis. A younger male, (under 60) will fare better.
2
exactly - very well said
1
Let's hear it for geriatricians, in general. (Who knew that women were even better.) They are hard, but not impossible, to find, especially in cities with major medical schools, like NY (Mt. Sinai), Baltimore (Johns Hopkins) and LA (UCLA.) https://www.statnews.com/2016/05/16/geriatrician-alzheimers-aging/
2
When I have my annual physical done, blood is drawn for tests. The PSA test costs less than $40 (I think). It doesn't require any life style changes prior to the blood draw. This is overtesting?
3
It may be. Are you high risk for prostate cancer? It is important to educate yourself on what the true benefit of blood tests are, along with the potential risks.
Why then, hasn't there been as much research to detect prostate cancer as there has been breast cancer? My father died from prostate cancer at age 67 and I assure you it was not a pleasant event to watch. My father had a strong tolerance for pain. The nurses were giving him as much morphine as possible and all he could say was "please let me die." He suffered for about 7 days. Also, this article is very insensitive to those like myself who are more at risk.
9
I'm here today because a PSA test caught my highly aggressive prostate cancer. I'd be dead 10 years if I followed the new guidelines. And the following: "It’s signing up for a prostate biopsy if the screening is positive. And that biopsy can cause pain, bleeding, infection" I found to be entirely untrue. My biopsy was a last resort, not the first, after months of preliminary treatment and tests. What if it were you who were the outlier, not you, Dr. Victoria Tang, but a guy, possibly one of your veterans?
3
Medical errors are third leading cause of death in United States.
Look it up...
Look it up...
7
1
Remember: Medicare recipients are eligible for a free annual Wellness Visit. Just request it when you want your checkup. My Doc asks a variety of questions prompted by reading his computer screen.
Note it does not cover blood tests.
Note it does not cover blood tests.
1
According to the Patient Safety America study, medical error is the cause of up to 440,000 deaths per year in this country, yet all I hear is lefties screaming to disarm law abiding citizens.
Some priorities we have!
Some priorities we have!
1
so don't test or treat further because this man will die anyway from other diseases...makes sense...why treat anyone over the age of 79 or 82 for anything unless they can pay for it themselves...in a car accident need medical treatment, sorry you shouldn't be driving at 85 anyway...just had a stroke at 81, sorry you are dog meat...that way we reduce unnecessary spending and lets be honest...old lives don't matter!
5
It seems advisable for anyone facing a difficult choice or recommendation from a doctor to get a second opinion.
1
I was 77 but after years of a normal PSA (2 or less) in two years my PSA went up over 4 at which time I was diagnosed with advanced prostate cancer. Gleason 9/10. Thanks to excellent medical care I am doing rather well. However without being tested (age 77) I probably wouldn't be here.)
6
Which shows you that the PSA is not a good screening test, your prostate caner had been there for many years, undetected by PSA
3
Thank you, doctor, but I'll rely on my medical team including the SCCA (Seattle Cancer Care Alliance) and the UWMC Prostate Oncology Center for advice and treatment.
4
It is obvious from many of the comments, people do not understand that recommendations of the USPSTF about PSA screening apply only to men without symptoms. Symptoms of both prostate cancers and benign enlargement of the prostate are similar. Men with symptoms should see a urologist to obtain a diagnosis. The USPSTF does not recommend against using PSA testing in surveillance following diagnosis of prostate cancer.
For men of any age without symptoms the odds of dying of prostate cancer are so low whereas the odds of harmful follow-on effects from PSA testing (bleeding, infection, incontinence, ED, bowel dysfunction are so high that the USPSTF does not recommend screening.
Having said that, recommendations are based upon studies of population groups and the probabilities that life-saving or harmful effects will result to the group, not to a specific individual. The odds for men without symptoms are that one more such man not screened with PSA will die compare to such men who are screened. If you don't want to take any chance that you might be that man, you can get a PSA test. But don't expect your insured group to pay for a procedure with such a low probability of success. You will have to pay for it. Fortunately, PSA tests are inexpensive. However, what happens afterward may be expensive.
For men of any age without symptoms the odds of dying of prostate cancer are so low whereas the odds of harmful follow-on effects from PSA testing (bleeding, infection, incontinence, ED, bowel dysfunction are so high that the USPSTF does not recommend screening.
Having said that, recommendations are based upon studies of population groups and the probabilities that life-saving or harmful effects will result to the group, not to a specific individual. The odds for men without symptoms are that one more such man not screened with PSA will die compare to such men who are screened. If you don't want to take any chance that you might be that man, you can get a PSA test. But don't expect your insured group to pay for a procedure with such a low probability of success. You will have to pay for it. Fortunately, PSA tests are inexpensive. However, what happens afterward may be expensive.
15
You skip over the fact that ** even with a biopsy there is still no medical way to indicate that enlargement is fast-growing cancer. ** That is a really important point that few Dr's will say out loud to a patient.
The protate biopsy is "scored" by a trained person but there are lots of documented reasons why that score is given as a range (because they dont know for sure how cancerous the cells are). This means lots of men got the surgery, but they did not actually have a kind of prostate cancer that will kill them. That's the problem.
The protate biopsy is "scored" by a trained person but there are lots of documented reasons why that score is given as a range (because they dont know for sure how cancerous the cells are). This means lots of men got the surgery, but they did not actually have a kind of prostate cancer that will kill them. That's the problem.
We need a more specific test, and we need better risk stratification.
We really don't want insurance companies determining standard of care, do we?
We really don't want insurance companies determining standard of care, do we?
Correction: I should have said "one more man per 1,000 screened"
They discovered my aggressive prostate cancer in my mid-50s uncommonly early, by a routine, annual PSA test. After years of normal levels a near doubling from one year to the next. High Gleason score etc.
I would have been dead now without the PSA testing, but only a statistic of one they missed.
There certainly may be issues with how PSA tests are interpreted, but dealing with that problem doesn't require the abandonment of something that saved my life.
I would have been dead now without the PSA testing, but only a statistic of one they missed.
There certainly may be issues with how PSA tests are interpreted, but dealing with that problem doesn't require the abandonment of something that saved my life.
6
This article addresses overtesting in men 75 and older. It does not advocate against PSA screening for men in their 50s.
4
I am a 61yo oncologist and won't have a PSA test and neither will any of my medical oncology colleagues and most of my surgical colleagues. Here is an article that I wrote some time ago and nothing has changed since then. "Four reasons I won't have a prostate cancer blood test" — https://theconversation.com/four-reasons-i-wont-have-a-prostate-cancer-b....
It is a difficult issue for men and their families to weigh up but the elevated PSA/biopsy/ radical treatment continuum makes it a very very difficult 'roller coaster to get off once you strap yourself in' with your first PSA test. An article by Thompson et al in NEJM IN 2003 confirmed that 20-25% of a large group of men with normal PSA for 7 years had prostate cancer on biopsy... Ie every fourth or fifth middle aged man you pass in the street today has prostate cancer, but only 1 in 7 of them will die of it, invariably in their eighties, with no reliable evidence that early treatment now will prevent that outcome for any of the men except perhaps in a very small minority.
Sent from my iPad
It is a difficult issue for men and their families to weigh up but the elevated PSA/biopsy/ radical treatment continuum makes it a very very difficult 'roller coaster to get off once you strap yourself in' with your first PSA test. An article by Thompson et al in NEJM IN 2003 confirmed that 20-25% of a large group of men with normal PSA for 7 years had prostate cancer on biopsy... Ie every fourth or fifth middle aged man you pass in the street today has prostate cancer, but only 1 in 7 of them will die of it, invariably in their eighties, with no reliable evidence that early treatment now will prevent that outcome for any of the men except perhaps in a very small minority.
Sent from my iPad
20
Statistics? Come on, these are real people you are talking about. See my other post. Because of a PSA test I was diagnosed in my 50s with aggressive prostate cancer. 10 years later I'm still alive. I would be just one of your statistics otherwise.
You are part of the problem, not the solution.
You are part of the problem, not the solution.
3
Only when a doctor can accurately tell a man if he has a slow- or fast-growing prostate cancer would I advise skipping ANY kind of test that might flag a possible cancer.
Why? I had been getting the PSA test annually for many years, but the year I turned 65, I skipped it because I was too busy. The next year, a DRE found a lump. A subsequent biopsy revealed a cancer already at 7 on the Gleason scale. The surgeon I selected considered the score to be higher, at 8. After surgery, pathology reported the score to be 9. Definitely not a cancer to be played with.
Message: I had a fast-growing cancer that wasn’t detected early enough so that I could get by with a less radical medical intervention. Yes, I’ve lost functions because of the surgery. But here I am, 13 years later, a 78-year-old with a wife who had advised me she would rather have me alive than potent. She is happy and I am happy.
Having had an essentially zero PSA test result ever since the prostatectomy, I have been free of anxiety all this time. This is worth a lot to my quality of life.
Why? I had been getting the PSA test annually for many years, but the year I turned 65, I skipped it because I was too busy. The next year, a DRE found a lump. A subsequent biopsy revealed a cancer already at 7 on the Gleason scale. The surgeon I selected considered the score to be higher, at 8. After surgery, pathology reported the score to be 9. Definitely not a cancer to be played with.
Message: I had a fast-growing cancer that wasn’t detected early enough so that I could get by with a less radical medical intervention. Yes, I’ve lost functions because of the surgery. But here I am, 13 years later, a 78-year-old with a wife who had advised me she would rather have me alive than potent. She is happy and I am happy.
Having had an essentially zero PSA test result ever since the prostatectomy, I have been free of anxiety all this time. This is worth a lot to my quality of life.
5
Ian E Haines Melbourne, Australia: "but only 1 in 7 of them will die of it, invariably in their eighties". Not so, Dr. Haines. I have had many patients who were diagnosed with aggressive prostate cancer in their 50's and 60's and 70's whose lives were prolonged with expert treatment. Unfortunately, those with aggressive cancer did not "invariably" die in their eighties, but there lives and the quality of their lives were improved. Most of my medical and surgical colleagues do have PSA testing but, fortunately, are the beneficiaries of knowledgeable interpretation of the results.
6
Most likely this isn't a problem Paula Span will ever face.
"Dr. Sammon’s patient probably won’t survive another decade, according to the standard tables used to predict life expectancy." What a screwed up and glib way of talking about this
"Dr. Sammon’s patient probably won’t survive another decade, according to the standard tables used to predict life expectancy." What a screwed up and glib way of talking about this
10
No, Robert, it is a reasonable way to discuss it. Invasive biopsies have risks too. In a pool of 10000 men, the committee determined that more would experience a bad outcome from the biopsy itself than would be saved by treating a cancer that doesn't cause much ill effect for 8-10 years. In the urge to "do everything", don't overlook the possibility of making things worse rather than better. If you have a prostate cancer that won't cause you symptoms, pain or ill effect for the probable rest of your life, why risk potentially deadly infection or other issues from the biopsy?
7
Deidre,
I'm not talking about what a person should or should not do. But there is a whole attitude about it that feels dissociated and compulsively technocratic. 8-10 years is a blink of an eye. It might give you comfort that according to your standard table that it will be 8-10 years before I will likely suffer or die. It doesn't give me much comfort. Given all the options and the various risks it might be the decision I would make. But It does feel like your committee will always look at your standard table first (and possibly the cost effectiveness of treatment) before you actually look at the patient.
I'm not talking about what a person should or should not do. But there is a whole attitude about it that feels dissociated and compulsively technocratic. 8-10 years is a blink of an eye. It might give you comfort that according to your standard table that it will be 8-10 years before I will likely suffer or die. It doesn't give me much comfort. Given all the options and the various risks it might be the decision I would make. But It does feel like your committee will always look at your standard table first (and possibly the cost effectiveness of treatment) before you actually look at the patient.
3
PS. I have a close freind who had virulent form of prostrate cancer and fortunately it was caught and the treatment saved his life. He is particularly bitter when he reads articles like this. But of course in your pool of 1000 men statistically what does his life matter when you look at all that can go wrong by over testing and over treating. Another thing all these
determinations change from one year to another. I have about much as much faith in one determination as I have in another. When so much money and arrogance are involved you can only pray for the best.
determinations change from one year to another. I have about much as much faith in one determination as I have in another. When so much money and arrogance are involved you can only pray for the best.
1
When I got my most recent physical earlier thus year (I'm 57), my doctor gave me the option of declining the PSA -- even though I do have a family history. My thinking was that it's a piece of information, that comes with some known limitations, but information isn't harmful. It's what you do with it that matters. We had a further conversation and I was comfortable that my doctor would not have a knee-jerk reaction if the number came back high, rather we would have a conversation and decide together what to do if anything, so I said go ahead. I realize not everyone has the same level of trust in their primary care doctor and some patients and some doctors want to be told what to do, or have a yes-no, red-green, binary answer. Sometimes life (and medicine) is more complicated than that.
12
A family history of prostate cancer (if aggressive) would change the balance of risk and might indeed be reason to do the PSA test or one of the newer tests. The point is that in the general population of people with no particular risk factors, the downside may be much greater than the upside.
3
I strongly disagree with this article and the recommendation of the United States Preventive Services Task Force since they took aim at PSA testing in 2008 and 2012. I can only wonder what their agenda is. In my late 50's a PSA test ordered by my doctor showed a PSA number higher than the then accepted "normal" level and revealed a very enlarged prostate. Since then I have PSA tests every 6 months and have accepted a stable higher number due to the enlarged prostate. I've had one PSA biopsy in my early 60's when I switched urologists - unpleasant yes, but not a big deal. Your article and the Task force's recommendations are ghoulish - ah!, you're going to die in a few years anyway so why bother and let's do some "watchful waiting" (!) and see what gets you first - heart attack, Alzheimer's, pneumonia, some other kind of cancer or prostate cancer. You're too old to waste a doctor's time, medical resources or insurance money on you for PSA tests or prostate biopsies. You'll soon be in the trash heap anyway. No thanks - I'll stick with the tests and pay for it out-of-pocket if necessary.
5
But you are known to be at high risk because of your history. That is not the same as routine screening.
1
The psa test is so simple and harmless that it is foolish not to get if for those men over fifty or at higher risk. Let the patient and the doctor decide if further tests are necessary. Life and death should not be left to probabilty statistics. Do you want to be the one of how many who could be saved and was not.
7
well said. PSA is indeed a simple blood test. IF elevated the problem that usually anxiety.
The author of this piece, Paula Span, should directly address the findings of this study, which contradicts the point of this article.
"Fall in PSA Screening Resulting in More Advanced Disease"
http://www.medscape.com/viewarticle/860886?nlid=102728_2863&src=wnl_...
"Fall in PSA Screening Resulting in More Advanced Disease"
http://www.medscape.com/viewarticle/860886?nlid=102728_2863&src=wnl_...
3
I think Ms. Span is quite clear that she aims at doctors who still do PSA screenings for the elderly. The USPSTF recommendation was a blanket condemnation for PSA SCREENING, for all men regardless of age.
That would be expected to lead to diagnosis at a later stage, which could ultimately lead to higher death rates (or not).
In any case, I don't know of any professional body advocating screenings of men over the age of 75.
That would be expected to lead to diagnosis at a later stage, which could ultimately lead to higher death rates (or not).
In any case, I don't know of any professional body advocating screenings of men over the age of 75.
1
After reading the Medscape article for which you provided the link, I would say - I would be testing if I were a younger man, and at older ages if I was fairly healthy (and everyone can define old and young for themselves here); not if I was older with multiple other co morbid conditions and was not committed to treatment. which suggests - it would be good idea to review this study in view of the USPSTF recs. It is all about needing refinement and better targeting of those at risk.
But what about outcomes?
Perhaps you might see a change in PSA ordering habits if you gave physicians immunity from lawsuits for failure to detect prostate cancer. The guidelines ignore the fact that elderly men do, in fact, die of prostate cancer. A good friend of mine recently lost a suit for failing to diagnose prostate cancer early in a patient in his mid-80s who sadly died of the disease. The judgement was for well over $100,000.
12
Several years ago Richard Ablin, developer of the PSA test wrote this. Note his comments about commercial interests. http://www.nytimes.com/2010/03/10/opinion/10Ablin.html?emc=eta1
2
Because this article omits discussion of the newer blood or urine tests (genetic and biochemical) for prostate cancer grade, it is somewhat antiquated and therefore misleading. The newer tests do a better job of distinguishing low grade from high grade prostate cancer as well as preventing unnecessary biopsies or surgery. But if your doctor's knowledge is as incomplete as this article, poor treatment decisions will be made. Nevertheless, the basic PSA test is an excellent first screen because it has high sensitivity. The low specificity (false positives) can now be ruled out by further blood tests...no biopsy unless indicated by newer tests.
There are medical centers of excellence in this country, staffed my doctors who are up to date. If you as a patient are confronted with elevated PSA results, seek out knowledgeable information from places like Johns Hopkins Brady Institute which has abundant information written in easy to understand terms.
There are medical centers of excellence in this country, staffed my doctors who are up to date. If you as a patient are confronted with elevated PSA results, seek out knowledgeable information from places like Johns Hopkins Brady Institute which has abundant information written in easy to understand terms.
11
"Screening recommendations" are a public health initiative to reduce medical spending. PERIOD. Not satanical but not necessarily in YOUR best interest.
If I, as a 72-year-old woman, had followed the mammogram screening directive, I would be dead. Instead a stage 1A tumor that had gone from "not there" to almost one centimeter in one year was discovered (by ultrasound only I might add), and after a lumpectomy, intra-operative radiation (one shot on the operating table), I am still writing angrily on this topic.
My brother-in-law at the age of 68 had a jump in his PSA and biopsy showed the manually-undetectable-lump to be very aggressive. He's still with us too.
Look after YOUR OWN interests people. I can suggest a thousand ways to cut medical spending that make sense. These screening recommendations do NOT (yet) offer compelling logical conclusions.
If I, as a 72-year-old woman, had followed the mammogram screening directive, I would be dead. Instead a stage 1A tumor that had gone from "not there" to almost one centimeter in one year was discovered (by ultrasound only I might add), and after a lumpectomy, intra-operative radiation (one shot on the operating table), I am still writing angrily on this topic.
My brother-in-law at the age of 68 had a jump in his PSA and biopsy showed the manually-undetectable-lump to be very aggressive. He's still with us too.
Look after YOUR OWN interests people. I can suggest a thousand ways to cut medical spending that make sense. These screening recommendations do NOT (yet) offer compelling logical conclusions.
13
Patty Mutkowski -
I agree completely. The so-called PSA velocity (rate of increase between tests) is rarely discussed but may be very informative. Competent physicians will rule out most non-cancer related causes that spike PSA levels and then repeat the test.
The abundance of diagnostic and therapeutic options to detect and treat PCa is both a blessing as well as a great challenge, similar to breast cancer.
I agree completely. The so-called PSA velocity (rate of increase between tests) is rarely discussed but may be very informative. Competent physicians will rule out most non-cancer related causes that spike PSA levels and then repeat the test.
The abundance of diagnostic and therapeutic options to detect and treat PCa is both a blessing as well as a great challenge, similar to breast cancer.
4
Only in medicine and politics is this kind of pig-headed incompetence considered normal.
8
Don't forget to include incompetence in business a la Donald Trump.
2
Welcome to our de facto criminal health care system, an aberration re our peer countries, more like the middle ages that put billionaire HMO and drug CEOs over the health of Americans.
It is really a blot on the fine workers in our health care system that these barons have turned the industry into a de facto criminal cartel...
It is really a blot on the fine workers in our health care system that these barons have turned the industry into a de facto criminal cartel...
10
"....The biopsy, taken with a rectal probe, finds cancer in only 30 percent to 40 percent of men with abnormal PSAs, Dr. Eggener said..."
I question the inclusion of the word "only." This use (or inclusion) of modifiers with respect to statistics seems to be a common fault in journalism at all levels. In this case it seems to have been a quote by the doctor, but even so,
30 or 40 percent could also be interpreted as pretty high odds. Why not say "as much as...?"
I question the inclusion of the word "only." This use (or inclusion) of modifiers with respect to statistics seems to be a common fault in journalism at all levels. In this case it seems to have been a quote by the doctor, but even so,
30 or 40 percent could also be interpreted as pretty high odds. Why not say "as much as...?"
8
Let's talk about the real drive of the USPSTF's recommendation: No reimbursement for the PSA blood test. I'm looking forward to the report in 10-15 years on all the money "saved" due to the task force recommendations at the expense of the thousands of men during that time who will present with advanced, incurable prostate cancer.
6
This article ignored two important facts:
1) There are aggressive forms of prostate cancers that can kill in far less than a decade.
2) There are new blood tests that are much better at detecting these cancers including the PHI test and the 4K Score.
It is a disservice to readers of the NY Times not to provide them the most up to date information. Of course, what is worse, is that many urologists also fail to tell you about these alternatives. So, what really causes the greatest number of unnecessary biopsies is ignorance.
1) There are aggressive forms of prostate cancers that can kill in far less than a decade.
2) There are new blood tests that are much better at detecting these cancers including the PHI test and the 4K Score.
It is a disservice to readers of the NY Times not to provide them the most up to date information. Of course, what is worse, is that many urologists also fail to tell you about these alternatives. So, what really causes the greatest number of unnecessary biopsies is ignorance.
29
I would take a softer line with the NYTs. They cannot be expected to provide the most up to date information in highly specialized fields. By the time things are published in the major medical journals experts are already dissecting results and deciding on new questions. At least the Times is fostering discussion in the public sphere.
1
Actually, JSK, I disagree. The role of the science journalist, especially at the NY Times, is to distill a complex topic into a readable form. Creating a simple article that misses important points only does a disservice to the readers.
2
Nowadays,
The Times does not have the experts to stay on top of every medical/scientific moment. Ignorance is built into the process. I was not giving them a complete pass. They are going to miss things and I do not know too many comparable publications that make such diverse attempts.
The Times does not have the experts to stay on top of every medical/scientific moment. Ignorance is built into the process. I was not giving them a complete pass. They are going to miss things and I do not know too many comparable publications that make such diverse attempts.
1
I am presently age 69. Men in my family routinely make it to their late 80s to early 90s. Based on that history, for example, I am holding off on collecting Social Security until 70.
I have been having PSA screenings since age 60. When I hit over 4, we began to watch it more closely. When it got to 6.5, I scheduled a biopsy. The biopsy found evidence of prostate cancer in an early stage. I opted for radioactive seed implantation. Before having the procedure, the last PSA test showed 8.9.
The seeds were implanted, and I was home the same evening. After a couple of months, I no longer had any residual discomfort from the procedure itself.
The cancer was completely knocked out. If I was "watching and waiting", I would be worried constantly. Instead, its now out of my head.
These recommendations are based on statistical analysis of large populations. But the individuals in those populations, and their feelings and emotions, get lost in the shuffle.
I have a friend, now 87 years old, who never went to doctors except when he was in extreme distress. A year ago, he had extreme trouble urinating. So to the doctor he went. He was diagnosed with advanced prostate cancer that has spread to his lungs. At this point, he is beyond curative treatment. All this advice is great for a general population, but there are individuals who fall outside the general statistics. And if you are among those unfortunates, they have nothing to tell you but "bad break"
I have been having PSA screenings since age 60. When I hit over 4, we began to watch it more closely. When it got to 6.5, I scheduled a biopsy. The biopsy found evidence of prostate cancer in an early stage. I opted for radioactive seed implantation. Before having the procedure, the last PSA test showed 8.9.
The seeds were implanted, and I was home the same evening. After a couple of months, I no longer had any residual discomfort from the procedure itself.
The cancer was completely knocked out. If I was "watching and waiting", I would be worried constantly. Instead, its now out of my head.
These recommendations are based on statistical analysis of large populations. But the individuals in those populations, and their feelings and emotions, get lost in the shuffle.
I have a friend, now 87 years old, who never went to doctors except when he was in extreme distress. A year ago, he had extreme trouble urinating. So to the doctor he went. He was diagnosed with advanced prostate cancer that has spread to his lungs. At this point, he is beyond curative treatment. All this advice is great for a general population, but there are individuals who fall outside the general statistics. And if you are among those unfortunates, they have nothing to tell you but "bad break"
25
But your friend was feeling fine until 86. Not 66 but 86. Dont you see the point of the article about life expectancy and complicated incasive surgeries?
There was a decent possibility that your radioactive seed would render you incontinent for life; you were a positive outcome but many dont have that outcome.
There was a decent possibility that your radioactive seed would render you incontinent for life; you were a positive outcome but many dont have that outcome.
11
You kinda sorta failed to mention the possible downsides of treatment for prostate cancer - permanent erectile dysfunction, incontinence, bowel problems, etc.
Also, you should be clear that whatever medical decisions you make for yourself personally are what they are, but it doesn't change the overall epidemiology.
Also, you should be clear that whatever medical decisions you make for yourself personally are what they are, but it doesn't change the overall epidemiology.
2
Funny thing about brachytherapy -- initially there are few adverse effects, but then their incidence creeps up to equal those observed after surgery, and then maybe even surpass them. Radiation damage is slow and insidious. Just because a patient is treated for prostate cancer doesn't mean his life was "saved." In fact, it appears to be a wash: the patient may have a slightly lower risk of dying from prostate cancer, but a slightly higher risk of dying from something else. So overall mortality is basically unchanged. But the adverse side effects from treatment don't go away.
8
Here's the thing:
If you are male and older than 75, statistically, you won't make it past 85. Many won't make it to 80 for that matter, again statistically.
Dr's rarely actually say this out loud to a patient; but the better Dr's are certainly thinking it when they suggest "watch and wait" to an elderly patient rather than risky surgery with complicated recovery.
I have wanted to say something like this to my elderly parents but of course I don't. They want to believe they will live to 100 and they will happily agree to any risky surgery that they think will get them to that age.
If you are male and older than 75, statistically, you won't make it past 85. Many won't make it to 80 for that matter, again statistically.
Dr's rarely actually say this out loud to a patient; but the better Dr's are certainly thinking it when they suggest "watch and wait" to an elderly patient rather than risky surgery with complicated recovery.
I have wanted to say something like this to my elderly parents but of course I don't. They want to believe they will live to 100 and they will happily agree to any risky surgery that they think will get them to that age.
8
If you make it to 75, you can by the acturial charts expect to live 10.94 years longer, at 76, 10.34 years, at 77 9.6.
https://www.ssa.gov/oact/STATS/table4c6.html
https://www.ssa.gov/oact/STATS/table4c6.html
A major reason for the recommendation is that the test gives false positives. False negatives say you're fine when you're not. A false positive gives you the choice of what to do, if anything. A false negative kills you. The specialists who say don't test are assuming that they can make better decisions about an individual's health than he can, including how long you're going to live and the quality of life you want. Paternalistic and arrogant.
14
And, to my understanding, false negatives are rare. I'm 78 and have a detectably enlarged prostate with the usual annoying symptoms. What I don't have is elevated PSA (1.59 mg/ml as of last month's test), so I'm confident there's no malignancy, in that body part at least.
The resulting peace of mind is, to me, worth the hypothetical future dilemma of facing difficult decisions in the absence of complete information, if and when that level rises.
I prefer knowing the test results to willful ignorance.
The resulting peace of mind is, to me, worth the hypothetical future dilemma of facing difficult decisions in the absence of complete information, if and when that level rises.
I prefer knowing the test results to willful ignorance.
2
Correcting my typo, that's ng/ml.
1
The risk of harm due to attempting to deal with a high PSA is greater than the probability that one will benefit. I instructed my physician not to give a PSA test some years ago.
Dr. Richard Ablin, who invented the PSA test, says that it was never intended to be used as a screening test and that its use in this manner is a misuse of the test. Lots of articles on this (Google 'Ablin PSA'), for example this one:
http://www.medscape.com/viewarticle/828854
Dr. Richard Ablin, who invented the PSA test, says that it was never intended to be used as a screening test and that its use in this manner is a misuse of the test. Lots of articles on this (Google 'Ablin PSA'), for example this one:
http://www.medscape.com/viewarticle/828854
6
After reading this article I discovered I, at the age of 77, am in group that I had never heard of until now--"men with limited life expectancy". I find this very disturbing. I knew it but I find they have a term for it disturbing.
28
We all have a limited life expectancy!
5
Tony, it was probably concocted by some twenty something, probably overweight, gal or guy, who thinks 50 is old!
1
The insurance industry bases its estimates on actuarial tables based on life expectancies at different ages. Not a new concept at all.
It is my understanding that normal values for the PSA test increase with age. If that is the case, then why can't the medical profession construct a table showing normal ranges of PSA test values by age? That would help prevent much of the anxiety associated with "high" values.
13
Fascinating that it is recommended to go to a woman doctor to reduce the likelihood of prostate cancer screening. Can you imagine the mirror-image recommendation: "Go to a male doctor for breast cancer screening - he will be least likely to do screening in cases when the American Cancer Society says that such screening is optional." Can you imagine??
10
It's not exactly recommended,MHW. The study at the VA just found that women physicians (along with younger ones) were less likely to screen older men for prostate cancer. One writer has suggested that male physicians may be influenced by "prostate empathy."
16
Would those same women doctors stop checking for breast cancer and doing PAP tests in female patients?
2
Actually, there ARE ages after which mammograms are no longer recommended -- because of some of the same issues as are raised here (likely to cause more harm than good). And not all women need yearly pap tests, either, and some really don't need them at all. So if those women doctors are practicing evidence-based medicine, they would revise the testing plans accordingly.
2
Very very interesting. I would first comment everyone should read," Ending Medical Reversals", written by two noted Physicians with many researches contributing. Basically the authors are advocates of clinical trails, evidence based, before treatments are adopted. So her I go. I have been going to first a GP for yearly physicals for years. PSA and DRE are standard. High PSA twice prompted biopsies both times. Both negative thank the Lord, but waiting two weeks for pathology was the worst part. The first biopsy switched my care to a Urologist from then on. Am now 78. He does DRE and PSA every year, and prescribes Avodart to reduce size of prostate. My father had prostate Cancer so prior medical procedure is, I am high risk. That is how my generation has been schooled. Point is most older men if the choose have a urologist and get tested lots of anxiety over the years but we are used to it, I hope all the testing is not because it is a big big business.
2
Dan, in your last sentence you ask a crucial question. Why do you think that the American Urological Association disagrees with the US Preventive Services Task Force's PSA testing recommendations? These urologists are smart enough to figure out that with every PSA test that they DON"T do, they are losing money which would ordinarily be derived from these tests; biopsies, pathology reports, urological consultations, prostrate surgeries, etc. Given the Urological Association's conflict of interest with respect to the task force's recommendations, men should walk into a urologist's office with their hands tightly on their checkbooks. How else will these doctors pay for their country club memberships?
2
Hate to admit it, but last year when I had my yearly Urologist, PSA and DRE, the waiting room had probably 8 or 9 guys there, all at 8:00 am. Doctors office is run very very efficiently. Wow each guy in and out in minutes. Big bucks I thought. PSA done two weeks in advance.So next visit can be scheduled.
1
These discussions run the risk of giving the general NYTs readership a headache. There is nothing wrong with that, given the need to understand the expanding levels of (good) ignorance about the subject.
A May 5th issue of the New England Journal of Medicine calls into question the entire basis for the USPSTF recommendations to curtail PSA testing: https://weillcornell.org/news/study-used-for-prostate-cancer-screening-g... . At this juncture it is very difficult to know exactly how to make recommendations, and blanket algorithms for primary care physicians may not be advisable: http://www.uptodate.com/contents/screening-for-prostate-cancer#H40 . That latter site, detailed as it is, does not yet incorporate the latest conflicts in data analysis.
A May 5th issue of the New England Journal of Medicine calls into question the entire basis for the USPSTF recommendations to curtail PSA testing: https://weillcornell.org/news/study-used-for-prostate-cancer-screening-g... . At this juncture it is very difficult to know exactly how to make recommendations, and blanket algorithms for primary care physicians may not be advisable: http://www.uptodate.com/contents/screening-for-prostate-cancer#H40 . That latter site, detailed as it is, does not yet incorporate the latest conflicts in data analysis.
5
I hope more people will read the Weill Cornell article. It's very straightforward and shows the bean-counter conclusion up for its flawed logic.
1
This maturing of our digital world, is giving the Medical profession a big fat headache. Wasn't that long ago, most medical data was shrouded in secrecy. Doctors were Gods, and you had to ask their profession for information, all in a time frame of 5 to 7 minutes. Usually you never get through your list, as he or she gets up and heads for the door.
I stopped getting physicals 15 years ago, just before I turned 50.
I was sent for a routine colonoscopy and after hearing a description of the procedure, I immediately concluded that, for me, the risks probably far outweighed the benefits. So, I simply got up and walked out...
I virtually never go to the doctor. I have not taken so much as an aspirin in years. I do not even use sunscreen (horrors).
I analyzed the data on numerous procedures while researching medical insurance costs, which are bankrupting the people.
I concluded that the prostate exam was worse than useless about a dozen years ago. I'm glad to see that the medical field is finally catching on, but there is a long way to go.
Not only are prostate tests worse than useless, but so are countless other tests, as well. And, not only tests, but various prophylactic treatments like daily aspirins and statins and psychotropic medications often do far more harm than good.
I was shocked to learn that a even a relatively huge proportion of major surgeries are unnecessary or ineffective, including back surgeries, knee surgeries, and even cardiac bypass surgeries.
Medicine and insurance are big businesses that need to be reformed, yesterday. Just my heavily researched opinions...
I was sent for a routine colonoscopy and after hearing a description of the procedure, I immediately concluded that, for me, the risks probably far outweighed the benefits. So, I simply got up and walked out...
I virtually never go to the doctor. I have not taken so much as an aspirin in years. I do not even use sunscreen (horrors).
I analyzed the data on numerous procedures while researching medical insurance costs, which are bankrupting the people.
I concluded that the prostate exam was worse than useless about a dozen years ago. I'm glad to see that the medical field is finally catching on, but there is a long way to go.
Not only are prostate tests worse than useless, but so are countless other tests, as well. And, not only tests, but various prophylactic treatments like daily aspirins and statins and psychotropic medications often do far more harm than good.
I was shocked to learn that a even a relatively huge proportion of major surgeries are unnecessary or ineffective, including back surgeries, knee surgeries, and even cardiac bypass surgeries.
Medicine and insurance are big businesses that need to be reformed, yesterday. Just my heavily researched opinions...
38
Colon cancer is responsible for many thousands of deaths annually. A periodic routine colonoscopy reduces the death rate from colon cancer to zero.
18
I hear you, but blood pressure monitoring and colonoscopies are the 2 things worth doing as we age.
For men, cardio issues are 3 times more likely to kill you than any cancer. That is eyeopening.
For men, cardio issues are 3 times more likely to kill you than any cancer. That is eyeopening.
1
@W.A.: Zero sounds fine. Too bad the death rate from the colonoscopy procedure itself is *not* zero.
Just being in a hospital confers nontrivial risks. Those who like to preach so-called evidence-based medicine need to understand that data can tell many different stories.
Statistical averages say nothing about individual needs. One-size fits all medical recommendations are based upon a statistical fallacy.
Just being in a hospital confers nontrivial risks. Those who like to preach so-called evidence-based medicine need to understand that data can tell many different stories.
Statistical averages say nothing about individual needs. One-size fits all medical recommendations are based upon a statistical fallacy.
1
I read this, already familiar with the general advice to men to beware aggressive handling of prostate cancer signs. Yup, they are going to die of something else first. leave it alone.
What is still confusing - [and I get it's gong to be a Dr. patient conversation] - for those who are still very active in their early 80's and who have parents who were centenarians: they are likely to live another 20 years, not 9 years. There are going to be more of them. So what do they do? It's a real dilemma.
The illustration - cute old men? cute isn't appropriate or reflective of the group.
What is still confusing - [and I get it's gong to be a Dr. patient conversation] - for those who are still very active in their early 80's and who have parents who were centenarians: they are likely to live another 20 years, not 9 years. There are going to be more of them. So what do they do? It's a real dilemma.
The illustration - cute old men? cute isn't appropriate or reflective of the group.
4
Several physicians I spoke with said they would recommend screening for very active and healthy older men, Cheryl. If they have no chronic illnesses, take no or few medications, then despite the standard life expectancy tables they may live long enough to benefit.
10
Cheryl the surgery risks of impotence is around 20%, and the risk of life long incontinence is around 20%. You can end with both issues too. So if one is 80 and otherwise healthy, one should still be thinking about those surgery risks.
3
Actually, the sexual dysfunction statistic is significantly higher than that after treatment. The majority of men will suffer sexual functioning loss. Here is an interesting study:
https://prostatecancerinfolink.net/2015/12/14/understanding-the-range-of...
https://prostatecancerinfolink.net/2015/12/14/understanding-the-range-of...
1