"No PSA Testing" recommendation

Tudpock,

How old was the poster that had the G6?

I only ask because if he was in his 40s, I probably would have been one that wished him well with surgery.  If he was older than mid 50s or so, I would have said that he might be a good candidate for AS.  It's hit or miss as to what threads everyone reads.  I am sure he did not get the consensus of this board, which is a support board, not an advisory board for the masses.

I believe that this forum could have made a much better recommendation for America, probably broken down by age and other factors.

Thanks,

Jerry

david - the point of the survey and research is they don't really know if you (or I) would have been among the very few, for which the PCa is aggressive and becomes life threatening. it's possible/probably that both of us would have been fine.

This seems like a problem where in the individual case, nobody wants to risk being among the unlucky few, so individually we tend to over treat, and also to want/need to believe that our lives have been saved. undoubtable for a very few, this is true. the point of the survey is that as a whole, the overall benefits of lives saved are small in number compared to people tested and to significant side effects of treatment.

as a side note - to those people who see a government/Obamacare plot here, please get real. There is a tremendous economic cost is how we practice medicine here. We spend twice as much per capita as most other industrialized democracies, yet we have lower life expectancies. The current , for profit system is weakening our ability to compete in the world, and will make the country less productive, and less wealthy over time. There's nothing wrong with for profit medicine and insurance, but the incentives of the providers should be in line with the welfare of the patients and population.

davidg said...
i wonder if the damage has been done with this crap or if doctors will be honest enough to continue suggesting the simple blood test.

Guess I should consider myself lucky.

40, no signs, G7. What would have happened if I actually tested at ten years later? I wouldn't have been willing to find out.

What I do not understand, is it only PSA testing that they do not recommend or is it not screening for PC at all?

If we had a perfect cancer detecting test, would it get the green light? Or is it that no matter how we test, current PC treatment will offer more side effects than benefits?

Is it the PSA test or is it screening in general?

In the future, we will look back at this relatively short tragic “blip” of PC one-size-fits-all overtreatment era before the emergence of conscience-based PC treatments and say, “what were they thinking?”   (Thus the creative name of the recent book titled, “Invasion of the Prostate Snatchers.”)   Of course, this comment is addressing only the many thousands of low-risk PC cases that are diagnosed each year, which represents roughly 30% of the total PC diagnosis (but has added up to about a million men living today with likely unnecessary consequences).   We should re-direct our scarce resources that are squandered on aggressive, expensive treatments for men who don’t need treatment by focusing investments in improved modes for intermediate- and high-risk cases.   Start by not calling the low-risk cases “cancer” so that men don’t freak-out and demand overtreatment.   (Although if men want to aggressively treat low-risk PC as an “elective” procedure instead of seeking to manage their disease through effective lifestyle changes,   I would suggest doing so on their own nickel, and not by jacking our insurance rates or taxes (Medicaid) further out of control.) For the roughly 30% of men in the low-risk category—those for whom cancer-specific mortality is unaffected by treatment/non-treatment—they and we would all be better served to be educated in the AS protocols which advocate a good-sense blend of curative treatments and active surveillance, based on the understanding that time can be used as an important prognostic guide (but is unavailable as a tool immediately after initial low-risk diagnosis).   Nobody ever suggested, however, that anyone not clearly “eligible” for AS should pursue AS…nobody; but there are thousands of men per year who should. The focus of screening need to change.   What we are doing now is wrong, but the USPSTF isn’t better.   The focus of screening needs to shift to base lining and monitoring, and the focus of prostate biopsies needs to shift to identifying the risk of high-grade disease, rather than the overall risk of having PC.   The NCCN has the best recommendations for screening and AS:   start early with baseline, then next steps vary depending on what was found in the baseline.   Some men shouldn’t have another test for years, but we have to over-come the reaction to finding what is currently called low-risk “cancer.”   Name change.

Phenom said...
29,000 American men died of prostate cancer last year. According to this study, only 29 of them would have benefited from earlier detection. Put another way, there is no benefit to discovering the presence of prostate cancer before symptoms present themselves. Can these statements possibly be true?

As for overtreatment, that seems to me to be an entirely different proposition, and if true, requiring more sophisticated discussions with the doctor, not the abandonment of early discovery of the cancer.

Your math is wrong
29 people would have been saved if 29000 asymptomatic men were tested
Of the 29000 who died last year compare to how many men were tested overall without symptoms and then how many could have ben saved and beyond that for every one saved 40 others who weren't going to die from PCa have to live with side effects of aggressive treatment

Nobody to blame but the greedy doctors who are in it for the buck and not the patient.

Its pointless to treat a guy over 80 years old but I saw several of them that were that age getting radiation as long as I was.  Just the doctors trying to pay for that 16 million dollar machine is all it was.  Welocme to (no political comments - 142) care and it will only get worse...he is already working on raising my retired military coverage by over triple the payments over the next 7 years....while his welfare buddies and illegal immigrants will get covered free.....Its getting to be a disgrace living in this country lately.

Post Edited By Moderator (142) : 5/22/2012 10:47:39 AM (GMT-6)

Just to chime in - I feel like I'm one of the "poster boys" for PSA screening. I'm only 49 and my PSA wasn't that high, but it kept going up every time it was checked, about .5 ever 6 months to year. No symptoms - one negative biopsy. It was found on the second and the biopsy showed a 3+5 or a 4+5, depending on opinions. Either way, I had a 5 and it would most likely have only gotten worse had I not known about it or done nothing. I had surgery - not even two weeks out - final path shows all contained, 3+3 with tertiary 5 - yes, that's better than the biopsy, but still a 5 is in there lurking and had it not been caught early, I can only believe it would not have stayed confined.

Is there over treatment - yes, absolutely - but that's not because of the PSA, that's because of what happens after the PSA. They need to concentrate on better diagnostics once you've been diagnosed - that's what is missing. Just having gone through this I could not believe there wasn't better imaging available to determine how significant this was. Every test I had, bone scan, CT, etc. came back negative, but with HUGE margins of error. It just seemed to me that they should be able to image the prostate and know before even going in, here's where there's a problem and it's far from the edge or close to the edge and here's what you need to do.

It's funny, when I met with a doctor at MD Anderson - the first thing he said was - all this stuff in the news about over treatment, they aren't talking about you! You have to deal with this. Now, had I not had the PSA tests over the past few years, where would I be in about 5 years?

It's not the PSA, it's what's done after the PSA.

Until experts can distinguish between a cancer that will remain relatively benign and those that are life threatening, I wish these statisticians would simply shut their pie holes. Until they are able to make the designation with real accuracy responsible people will continue to act in a way they feel best increases their chances of long-term survival. At 42, and having always been an informed individual, I'm glad I've always felt the importance for a yearly physical. The Dr who felt the nodule, not the PSA test got the ball rolling. The PSA was an additional indicator.

It seems bizarre to me that non-medical people are making the claim of over-treament. The treatment course is an informed decision between a patient and, hopefully, an expert doctor. Bean counters shouldn't play a role in that decision process.

Political opinions have no place here, and are a magnet for having any thread LOCKED. Please stop.

onthefence, about 40% of men in their 40’s have what we today call “cancer” in their prostate.   It is important to recognize that there IS a small percentage of those men who will have a serious case of PC that shouldn’t be ignored.   A much larger percentage are among the men whose greatest risk factor for being diagnosed with PC is simply that they were tested.   These two facts are why I support the NCCN approach of base lining PSA in men early, but advocating for curtailing the life-altering treatments for those who don’t show any indication of needing it.   If the characteristics are truly low-risk, then adopting good-sense lifestyle changes has a very decent chance of helping prevent future unnecessary action.   And if treatment is indicated later, then outcomes of early-treatment or deferred later-treatment are indistinguishable.