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USPSTF advises against all PSA screening in healthy men

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Posted 10/8/2011 2:40 AM (GMT 0)
The big complaint about PSA testing is that it frequently leads to unnecessary treatment that poses the risk of severe side-effects..

That statement is simply not true..Any medical specialist that calls himself or herself a Urologist, their job is to make sure that does not happen..Lets take this step by step...

You have your PSA tested and it's higher than normal...The first step is to determine WHY your PSA reading is high..If no benign cause can be found, a biopsy may be recommended.. Over 50% of first time biopsies come back negative, no prostate cancer found and no treatment is given..If the biopsy proves positive for cancer, the grade and the extent of the cancer will be noted and discussed at length and the patient will be offered several options, depending on the biopsy findings and the results of other scans and tests..If the biopsy shows a small amount of Gleason 6 grade cancer, which is the case about 40% of the time, most of these patients will have the option of "AS", Active surveillance" where the cancer will be closely monitored but no direct treatment will be recommended at that time...Depending on the patients age and luck, active treatment may never be needed..

But many men are being diagnosed in their 40's and 50's through screening. Twenty or thirty percent of these men will be diagnosed with aggressive, fast growing prostate cancer or cancer that has advanced to the point that it requires aggressive treatment if they are to survive any length of time...THIS is the group of "healthy Men" that depends on PSA testing to detect their cancers while the disease is still treatable and their numbers are not insignificant..Tossing them under the bus by eliminating routine PSA testing is insane...A far better solution would be to educate Urologists as to the proper treatment pathway to follow when prostate cancer is detected...If men DEMAND to be treated, fine, they need to be better educated about the risks and side-effects associated with the aggressive forms of treatment and to the projected benefit of that treatment.. As JohnT pointed out, why are we performing $125K treatments when a $5K treatment works just as well?? The way we pay for our medical services, it's turned cancer into a feeding frenzy for medical practitioners..

I bet after all the dust settles over this, regardless of the outcome, the number of PSA tests performed every year will increase, not decrease..

Speaking of PSA tests, my last one, 3 days ago, <0.1


PSA at age 55: 3.5, DRE negative.
65: 8.5, DRE " normal", biopsy, 12 core, negative...
66 9.0 DRE "normal", BPH, (Proscar)
67 4.5 DRE "normal" second biopsy, negative.
67.5 5.6, DRE "normal" U-doc worried..
age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA 0.0

Post Edited (Fairwind) : 10/7/2011 8:44:16 PM (GMT-6)

Posted 10/8/2011 2:56 AM (GMT 0)
Sorry, but being a moderator does not give any special merge functions. The only option is the lock a thread or

delete it altogether.

NO POLITICS guys. This thread is pitting one country's system against another's.

That is politics. Keep it civil.

Posted 10/8/2011 6:29 PM (GMT 0)
I'm extremely distressed by the nytimes article, trying to wrap my head around it. As a whole, the 10 year survival rate of asymptomatic men who take a PSA test is no different that those who don't. So does that mean the number of lives saved by treating PCa in the tested group, is about equal to those lost to treatment complications? And then the untested group has a survival rate of higher PCa deaths but fewer treatment deaths? So if I survive treatment, I'm better off than not having the test at all?
This is discounting all the side effects of treatment of course, which is why the recommendation is what it is, I think...
Posted 10/10/2011 3:40 PM (GMT 0)
This news has caused me to second guess my orginal decision, but it has also caused me to do more research since my diagnosis.  I had PSA screenings as part of my annual physical for years (59 years old).  My PSA this year was 4.0 (no screening of free PSA).  I was referred to urologist for further exam...he noted abnormal lump on right side of prostate and did a biopsy.  Apparently only submitted 7 cores, 3 from the right and 4 from the left.  Pathology showed adenocarcinoma on right side only with only 25% of cores (3) showing cancer.  The Gleason was 3 + 3 = 6.  There was no staging done.  Doctor recommended surgery and ordered a CT to determine lymph node involvement....there was none.  CT did show large kidney stone 2 cm x 1 cm and I just had lithotripsy procedure for that.  This alone delayed an absolute decision about the prostate treatment.

I am now considering active surveillance for a few months and give myself time to lose some weight, currently 40 #'s over ideal.  I also feel like the biopsy might not have been as in-depth as what I read as needed...10 to 12 cores and reports from each core to give a better (or comparable) measure of the cancer and it's possible aggression.  The CT scan showed the prostate mildly enlarged with central calcification (?).  The margins were sharply defined, not qute as well visualized on the right side, but very similar to the left.

Anyone else opting for surveillance as an original decision or in lieu of this new information?

Posted 10/10/2011 4:57 PM (GMT 0)
Here is their complete statement.

http://www.uspreventiveservicestaskforce.org/uspstf12/prostate/draftrecprostate.htm

 

Posted 10/10/2011 5:17 PM (GMT 0)
Dusty, your U-doc suspected cancer from his DRE..He knew where to look when he did the biopsy. There was no need to take more samples than necessary. The biopsy found and verified that you have PC..Taking 5 more samples would have only added to the risk of the biopsy...
Posted 10/10/2011 5:23 PM (GMT 0)
it's a good thing surgeons, oncologists and urologists are mounting a campaign y going directly to Congress.
Posted 10/11/2011 4:52 AM (GMT 0)
I think John T's comments are certainly true. For the vast majority of us psa testing and subsequent treatment have probably not improved our life span at all. However, approximately 30,000 men in the America died last year from prostate ca. Certainly this is a small number in relation to how many men have prostate cancer. Except if you are one of the 30,000 that died and could have been save with psa and early detection. As a society with limited resources for health care do we spend so much money on saving so few lives? A really tough question isn't it. I've often thought its similar to people with heart or liver transplants. Think of the enormous cost for these procedures. Is it worth spending hundreds of thousands of dollars to save a life? Probably not, but when you're the one facing the bullet in the head it's hard to be altruistic and say spend the money on somebody else.........
Posted 10/11/2011 5:14 AM (GMT 0)
Look at how much money we spend on ridiculous military programs like Star Wars. How much money we send in aide to countries like Pakistan. We spend billions on all sorts of rubbish. Providing good health care and health options to our citizens is a moral duty of a country as rich a sours in my opinion. We waste the money in so many other areas.

I got my psa news at 40. Following some guidelines I should have waited until I was 50 to have the test ( a simple blood test ). This means I would have had cancer in me for 10 years minimum before doing anything about it. I really doubt things would have gone this smoothly for me had I waited. Btw, I think that report is for men over 50.

PSA tests save lives and allow men to become empowered and to reacted to their disease. this recommendation is purely driven by the health insurance companies and uninformed people who either have an agenda, and some do, or just don't get it.

www.foxnews.com/opinion/2011/10/07/risky-business-men-cant-afford-to-skip-psa-test/?cmpid=cmty_twitter_Gigya_Risky_Business_--_Men_Can%27t_Afford_to_Skip_the_PSA_Test

Post Edited (davidg) : 10/10/2011 11:20:19 PM (GMT-6)

Posted 10/11/2011 11:14 AM (GMT 0)
Papa Dusty,

You asked if anyone else was considering AS as a result of this decision. I decided on AS a year ago because I read all of these statistics then and I for one put alot of faith in statistics. What this has convinced me of is, I won't use the PSA test any longer for any decisions, I won't even have it done. If they can find something through DRE or MRI I'll consider a non-invasive treatment. Alot of folks here are convinced treatment saved their lives, but the statistics do not bear that out, statistically speaking, they would still be alive today without treatment. What the statistics do tell us is 5% of men treated will die from the treatment, 7% will develop serious debilitating complications and 30-50% will develop ED, Incontinence etc (I guess those are not considered "serious" because they are non-life threatening). You have to define for yourself what living is, none of that fits my personal definition.

Dave
Posted 10/11/2011 11:30 AM (GMT 0)
What do they say about 40 years old men trying to live long enough to see their grand kids one day?
Posted 10/11/2011 12:19 PM (GMT 0)
Sorry, typo, forgot the decimal points, .5% (5 in 1000) and .7% (7 in 1000)

Dave
Posted 10/11/2011 12:49 PM (GMT 0)
Davidg,

What the statistics say to a 40 year old is if your cancer were growing, and there is no way to tell if it was, eventually it would have been found and you could have been treated then with no difference in outcome. Statistically, it did you little or no good to treat the condition at 40 years old based off a PSA test. You may believe differently, but that is what the statistics say.
Posted 10/11/2011 1:09 PM (GMT 0)
Don't the statistics show that 50% of those in the 40 year range who opt for AS end up having surgery within 4 years? Because that pro AS study was posted here.

And how do you monitor that progression, an expensive monitoring cycle with Stoltz?

And what is the accuracy of such monitoring in ensuring it doesn't escape the capsule?

And what do they suggest for people who simply can't deal with living with untreated cancer in them a that age?

Every study I've seen on this very board, including pro AS studies pointed out that age is a significant factor and that if you're under 50 it isn't suited for you. They also show that within a few years people end up having surgery or radiation anyway. And certainly, everything I had read here before last week mentioned that since PSA testing had been introduced lives had been saved.

Considering that I am physically back to to where I was prior to surgery, which is basically "stud like", I'd say I played my cards properly and that the advice every single oncologist, urologist and surgeon gave me was spot on. Either that or it's a big conspiracy about money. Which of course couldn't be the case with this panel that is now telling people that PSA testing doesn't save lives.

www.foxnews.com/opinion/2011/10/07/risky-business-men-cant-afford-to-skip-psa-test/?cmpid=cmty_twitter_Gigya_Risky_Business_--_Men_Can%27t_Afford_to_Skip_the_PSA_Test
Posted 10/11/2011 5:21 PM (GMT 0)
sutter,

welcome here. with your posted stats, i think your plan of starting with AS is sensible and safe. with your prostate size, and the minimal amount of cancer found with a saturation biopsy, you would be a great candidate for seeding in my opinion.

good luck as you continue, and please keep us well posted

david in sc
Posted 10/11/2011 5:59 PM (GMT 0)
Purgatory,

I'll try not to post in the middle of other threads in the future. Does radiation always precede or follow seeding or is seeding alone a viable option for treatment?

Thanks,

Sutter
Posted 10/11/2011 6:15 PM (GMT 0)
Sutter,

I've created a new thread for you. Look for "For Suttersmill" in the titles. It will make it easier to pick up responses.

It also helps the moderators, as it is against forum rules to post the same message in multiple threads. Understanding that you are new, I'm just trying to consolidate them.  

Posted 10/11/2011 7:59 PM (GMT 0)

qualityoverquantity said...
Davidg,

What the statistics say to a 40 year old is if your cancer were growing, and there is no way to tell if it was, eventually it would have been found and you could have been treated then with no difference in outcome. Statistically, it did you little or no good to treat the condition at 40 years old based off a PSA test. You may believe differently, but that is what the statistics say.

That's not what the stats say, they say overall the death rate over 10 years is the same with and without treatment. But that's because of the small pct of deaths overall from PCa in 10 years vs the small number of deaths from treatment.

If you are 40 and are treated at 40 , you are better off than waiting till age 50, provided you survive the treatment. The statistics cover a sample population, and are not a longitudinal study per individual
Posted 10/11/2011 8:59 PM (GMT 0)
Qltyoverqty,

You said, "I won't use the PSA test any longer for any decisions, I won't even have it done. If they can find something through DRE or MRI I'll consider a non-invasive treatment. Alot of folks here are convinced treatment saved their lives, but the statistics do not bear that out, statistically speaking, they would still be alive"

I can't imagine any G 7-10 not wanting to know their PSA.

If you wouldn't mind me asking, what is your gleason and last PSA?
Posted 10/11/2011 10:33 PM (GMT 0)
I have pondered the screening controversy for a few days before commenting. The statistics aspect of the screening controversy reminds me of MBA school when we covered Bayesian decision theory (which generally makes my head hurt, but here I go anyway) -- assigning an a priori probability to an event that is revised as one obtains better data .. but the data is obtained at a price. In the business world, one can spend $ to get better data and then update the probabilities at each step. The trick is deciding when to spend the extra $ and assigning a value to the new and better data. It is not always worth paying for the extra data, but sometimes it is worth it.

Prostate cancer screening is somewhat like that. A PSA test is easy and cheap in terms of "paying for it" -- no side effects. It gets you somewhat better data and updated probability about the likelihood you have prostate cancer. The next step is a biopsy. Not too bad but it has more side effects. But, it gets you a much more accurate probability on having cancer (or not), including a probability on the Gleason grade. The ultimate step is surgery -- one "pays for it" with risk and a lot of side effects, some permanent. But, you get great data and much more accurate information through the pathology report.

For me, my PSA was high (54.9) so the first step was almost 100% confirmation of cancer, even without the biopsy. The biopsy was pretty simple, 6 samples, since the cancer was easily observed on the ultrasound. The biopsy came back G7 (3+4). I elected to proceed with surgery, especially since I was 50 years old at the time. Post-surgery pathology, however, was G9 with seminal vesicle invasion but clean lymph nodes. I argue, for me, the post-surgery pathology was invaluable to me and definitely worth the cost of the surgical side effects since it provided a clear imperative to be aggressive and also a clearer treatment path beyond that.

I guess my argument is, as each man takes a step toward more knowledge about their personal PCa situation, the probabilities, for him, change. Information becomes more accurate and personal. The broad statistics lose meaning.. he has "paid" for more accurate information about his situation through medical procedures. However, each man has to decide what he is willing to "pay" for in terms of risk and side effects at each step. A G6 man may decide to stop at a biopsy and do AS. Or, may decide to have surgery (or radiation) to know that he will likely never be bothered again by worrying about cancer. A G9 man, however, knows aggressive action must be taken or trouble is coming. And, yes, sometimes a man has surgery based on the best information available, and in retrospect (pathology and SEs), it was not worth the price he paid. With statistics and PCa, that is always a possibility. But, it does not mean the decision process was wrong or flawed.


I think broad, blanket recommendations for or against PSA screening miss a lot of nuance and valuable information that is absolutely worth something to each man. The decision on how far to go (PSA, biopsy, surgery) to get this information is very personalized and depends on the information received at the preceeding step.

 

Posted 10/13/2011 2:48 PM (GMT 0)
Hi Guys:

I have followed this thread and this topic with interest.  Other than davidg's inappropriate political blather, this thread offers excellent insight (IMHO) into  this very important subject from an informed group that has been affected by the implications of this recommendation.

I am on record as supporting PSA testing and I still believe it is appropriate.  For me, knowledge is power but it's what one does with that knowledge that may be at the root of this issue.  I had an appointment for a physical exam with my new internal medicine doc this week and we discussed PCa during the exam.  When it came to the USPSTF recommendation my new physician said he was not surprised.  He feels this is the natural extension of a medical establishment, particularly urologists, who are unable to control themselves and that has led to widespread overtreatment of PCa.  He says he sees the results of this every week...patients who have urinary or sexual problems due to their PCa treatment that may not have been necessary.

This physician pointed to the training of urologists ("cut it out") and the great financial incentives to do so.  He feels that AS is appropriate for a large number of men but feels that urologists are not trained nor incentivized to consider that option.  So, the unsurprising answer to this epidemic of overtreatment is a panel saying just don't test, therefore that will slow the epidemic.

I don't necessarily totally agree with this position because of my personal experience.  That is, because of a PSA test, I found out I had cancer and then was able to sort thru the crap and make an educated decision.  I certainly want that right for my younger brothers.  However, this one physician's perspective is interesting to note and I think there may be some truth in it.  Let's face it, those of us who have been around this forum and others for awhile have certainly seen the G6 guys with minimal cancer and low PSA's rush off to surgery because they have to "get it out".  Individually, one may not consider that overtreatment.  But, taken collectively, there is some reasonableness to that position.

Tudpock (Jim)

Posted 10/13/2011 4:19 PM (GMT 0)
good reply, tud, i agree with most all you posted.

my oncologist strongly feels that men jump to fast into treatment, espcially with low grade gleason 6 numbers. he supports AS whenever its appropriate. also, he even feels stronger. that men rush themselves into secondary treatments, i.e. SRT, HT, or a combination of both. He said its based, not so much on doctors pushing additional treatment, but the irrational mind set of many men patients, that obsess over small rises post primary treatment. He said that SRT is so overdone, when it either isn't going to work (like in my case), or comes with serious side effects (also like in my case). He said that had he been my doctor at the time, he would not have encouraged me to have SRT at that point, because it was doomed to fail. i live now in a damaged and crippled body for life as the result of the failedd SRT.

so not all doctors are guilty of pushing treatments, the fears of the patient often push for immediate treatments as well.

and I agree on the davidg political stuff, has absolutely no place here on HW. not only is it against the rules, its rude and annoying at the least. i am sure most of us have strong political view, and religious views, but for the most part, we have the good taste to keep it off of a prostate cancer support site.

good post.

david in sc
Posted 10/13/2011 4:48 PM (GMT 0)
Pur - didn't see the other answer. More than one person posted we don't have money to testing or treatments that int heir view are a waste of time. That is a political statement that I was responding to.

You didn't say anything about that political statement, did you?

I responded by saying that this, like healthcare in general, is in my opinion a moral issue rather than an economic one and that if we waste money on other stuff, like the two examples I gave, why not spend on this?

Don't you think that our country should spend much more money on finding cures for such things and on improving the quality of life of its citizens rather than any number of programs that cost far more?

Think about it.
Posted 10/13/2011 4:51 PM (GMT 0)
dont need to think about it at your urging, have well formed opinions of my own, but don't feel they are appropriate to discuss here on HW as to the respect of the site's owner and his mission statement
Posted 10/13/2011 4:52 PM (GMT 0)
Which one was the original political statement? And was mine a response to that? You know, analytically speaking...
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