The guy who discovered PSA -

Thanks Sonny. Interesting reading and different opinions. All I can say is the test caught my Gleason 8.

Michael

PSA is not the end all in testing but rather an indicator. It's up to the next blood tests that aid in treatment from my readings.

"Ablin, a research professor of immunobiology and pathology at the University of Arizona, called PSA testing a "hugely expensive public health disaster."

The test, he says, is inaccurate and misleading. Worse, it puts many man on a path toward invasive and life-changing treatments that they could easily have lived without. "We're spending $3 billion a year on a test that cannot detect cancer," he says. "

My cancer was detected via a PSA test. My DRE was negative. It was the PSA test that led to having a biopsy and subsequent surgery. So that was a public health disaster? I guess Albin figures it would have been better if I had waited to have a nice fat lump that a doctor could feel on my DRE and then have a biopsy that instead of reading a Gleason 6 would have been a 7 or more. That would have made Albin sleep better at night!

Well Albin, you can stick that opinion where the sun don't shine. Oh, wait that's the DRE test. I am confusing the two exams. Sorry.

My doctor told me the PSA test and subsequent treatment gave me a multiple year head start on treatment. Without the PSA I could have lived in ignorant bliss while my prostate continued to consume itself with cancer. My PSA test was like having a time machine. I was diagnosed in 2010 but as my doctor said, I would have been in serious trouble by 2020. Yea!, just in time to retire and go off into a corner and cry. So having the PSA now was turning back time in a sense because in 2020 I would have begged, borrowed and stolen anything I could for it to be 2010 again so that I could treat my disease while it was still organ confined.

Perhaps Albin just feels guilty because he could not come up with a test that was definitive enough. But we all know that PSA is just a smoke alarm not a confirmation of a fire. It takes further testing via the biopsy to determine what we should do. So even if we know we have a small cancer after a biopsy, can anyone tell how long we CAN wait to treat it. How long the window of curability will remain open before it shuts on us. Sure, Albin might feel remorse that the PSA could never fulfill that question. However for me, it surely provided far more suitable options than a positive DRE in 2018 to 2020 and a biopsy around that time with Gleason 4 or 5 scores in nearly all sample cores. I sure would not be happy with that news in a non-PSA world.

In my opinion, don't discredit PSA. Use it as one of many tools to maintain health. The hard decisions are not driven solely by PSA, It is just a starting point to more questions and further testing. PSA is a great start even though it is not the be all and end all test.

Thanks for pointing out the article. It is extremely interesting reading.

Mike S

As hard as it is for us (being in the front line as we are), let's try and put our own cases aside. NB: I am one of those detected solely as a result of biopsy which came about because of a slightly elevated PSA (3.9/4.1). No symptoms, negative DRE etc. The facts are, whether we like it or not, tumour detection and it's subsequent treatment (involving many millions and millions of dollars) has increased markedly as a result of PSA testing, but has not altered in the slightest the death rate due to PCa. The only way this could have come about is (1) early treatment of PCa is having no effect, or (2) early treatment is saving many lives but the incidence of PCa within the general population is increasing at a matching rate to the lives being saved. If the later is the case then we need to ask ourselves why the incidence of PCa would be increasing so dramatically.
Bill

Dr. Albin sees only the dark side of PSA "screening" where many men with indolent Gleason 6 PC are pushed towards treatment he feels is unwarranted and he might be right..But he ignores the G-7 and up guys who are alive today because of the test he invented...

This is not news..Albin first voiced his objections to how PSA testing and routine screening was being used at least two years ago..

I live in NY State where we are required to have our cars inspected annually for $20 to keep unsafe cars off the road.
Of the 15.5 million inspections given annually, 20% of cars fail inspection the first time.
Using the logic in the above article can I say: " 80%, or 13 million vehicles, were inspected needlessly at a cost of $260 million and untold man hours hours?" Ridiculous.

I wish my first PSA had come back negative instead of 17.8 .
The PSA test saved my life. (No matter what the National Enquirer says.)

Jeff

Post Edited (Worried Guy) : 3/11/2011 12:57:18 PM (GMT-7)

If Dr. Albin had discovered an equivalent serum antigen for breast cancer he would be a Nobel winner and King of the World. And richer than Croesus. Researchers for every lethal cancer would give their body parts for such a valuable marker. That is the context I use to discuss the value of psa.

Interesting premise and question brought up here in this thread.

Is the incidence of diagnosed PCa increasing or are just more folks being diagnosed because of the increased use of drs doing PSA testing? Just one of those stats that can go awry depending on how it is viewed.

Personally, my first indication that something was wrong was urination issues. Then came the PSA test, the DRE and finally the biopsy.

I am still battling the Pca. I seem to have one stubborn and aggressive son of a gun. On the other hand the ED is getting better and I am peeing like a 20 year old. On a lighter note I would trade peeing like a 63 yr old if I had the other aspect of a 20 yr old. LOL

Ah heck, Every Day is A Bonus. I just take them as I get them.

Sonny

The confusion that exists about the value of the PSA test would lead to fewer men to be tested (as a preventive measure). In my previous post, for example, the use of PSA in the USA is well above the 50% figure. In the UK the reported use of PSA is 7%. The PCa mortality rates are quite different in both countries and even when “experts” in the medical field continue to ignore this difference they fail to explain these results. The attribution to better treatments ignores the fact that the PSA test provides choice and early detection leads to earlier, more treatable stages of the disease. Along with this, we continue to see too many men diagnosed with disease that has escaped the prostate and becomes more difficult to treat. Yes, we need a better, more specific marker than PSA but in the mean time let’s tell the story as it is and use the PSA test results to postpone treatment when possible and to treat it when necessary to avoid a cancer escape.

RalphV

Well-said Tony! They are working on better PCa markers. Urine tests are complementary, but until something else is shown to be more specific, PSA results need to be considered. Patients need to be better informed of what PSA can do and not do and if they and their doctors interpret results judiciously, many more men would avoid an advanced disease diagnosis.

I know Dr. Ablin for many years. He has been a speaker at the St. Joseph’s Hospital support group I facilitate since 1993 and we both are members of the AZ Prostate Cancer Task Force. He is one more voice among this group. His opposition to screening is well known, but he accepts the value of PSA testing to monitor treatment results. So at least the glass is half full…

ralfinaz said...


Bill said:
“The facts are, whether we like it or not, tumour detection and it's (sic: its) subsequent treatment (involving many millions and millions of dollars) has increased markedly as a result of PSA testing, but has not altered in the slightest the death rate due to PCa.”

In the USA this is not accurate. From 1992 to 2007 there has been a 40% reduction in the PCa mortality rate according to SEER statistics.
Source: http://tinyurl.com/4qb9nmd

Then he said:
(2) early treatment is saving many lives but the incidence of PCa within the general population is increasing at a matching rate to the lives being saved. If the later is the case then we need to ask ourselves why the incidence of PCa would be increasing so dramatically.”

Mortality is expressed as per 100,000 population and not as per 100,000 men diagnosed.. Incidence tends to increase with more use of the PSA test. In countries where the use of PSA is higher, PCa mortality has dropped. The opposite is true in countries where the use of PSA is low. Examples:

U.S.A.'s rate is 19.8 men per 100K population

Canada's rate is 23.3

On the other hand, where PSA use is low, the trend is flat or even
increasing and more men are dying.

Sweden's rate is 54.8 men per 100K population

Norway's rate is 45.4

Switzerland's rate is 34.7

U.K.'s rate is 34.4


RalphV

I thank RV for posting in a better manner what I would have posted if he hadn't beaten me to it

All I can add is the following quotation from one of the best and brightest PCa oncologists:

"With all of the talk about the hazards of PC diagnosis and
unnecessary treatment, the PSA remains, without any doubt, the best
and most useful biomarker for a common malignancy in the history of
medicine. The problem, dear Brutus, lies within the lack of
perspective of the physicians who abuse the tool or are not sensitive
to the understanding of biology and whether or not invasive
interventions are called for. It is the typical "bull in the China
shop" approach of many of the "scientific" community that screws up
the distinction between the message and the messenger..... So, whatever you do,
say so many doctors, don't order a PSA since a diagnosis of PC may
occur and a physician may remove your prostate or give you radiation
or something else that can harm you.

"The key is to use this outstanding biomarker in the CONTEXT of the
patient's biological milieu. This is not something that is common in
the American landscape. Context is a foreign phenomenon."
--Stephen B. Strum, MD
Medical Oncologist
PCa Specialist

Mycroft/Ralph/Tony- I see Dr. Strum wrote that info you have Mycroft...I think in reading that and the PSa controversies one can see just how wild PCa treatments, choices, and assessments and what they are, it is the wild west phase is a possible comparison.

An38 found a better weblink to Bonkhoff information-Thank You- (this is still not all I saw in a presentation):

http://www.prostapath.org/download/prognostic-predictive-markers.pdf                         (this pathologist is ahead of the rest)- has some photos to see too....

Save your biopsies patho-slides,  they usually are stored for 10-15 yrs.+, call your doc and take possession of them, perhaps. This genetic information is going to be more and more usual in selective treatments, tailored to the patients real issues.

Post Edited (zufus) : 3/12/2011 5:06:50 AM (GMT-7)