Should I Stop Getting PSA Tests?

If it wouldn't have made any difference in the first place, then surely it shouldn't now. Right?

I'm actually not kidding.

Phenom said...
If it wouldn't have made any difference in the first place, then surely it shouldn't now. Right?

The USPSTF's "D" rating does not apply to the use of PSA testing for monitoring patients after a prostate cancer diagnosis or treatment.

The USPSTF recommendations can be found online (free) so that you don't have to guess...

Phenom said...
Why? If it's assumed that 60-70% of men my age have prostate cancer, and that beginning the process of proving that with a PSA test does little to affect the "survival benefit" or "outcome," why would it make any difference now?

I think I am stating the obvious, but there is at best a small potential benefit from prostate cancer screening, and there are substantial known harms...almost all the harms are associated with the treatment.

 

Tony, I'd be glad to reword to more clearly make the same intended point: "I think I am stating the obvious, but there is at best a small number of men who benefit from prostate cancer screening..."

Better? If you agree, I'll gladly go back and edit if this version is more clear.

I think that if you want to make an informed decision to stop PSA monitoring, then you should.  If I were in the practice of giving recommendations, I would not recommend stopping.

Medical professionals have clearly differentiated between PSA screening and post-treatment monitoring. None of the professional organizations have suggested not monitoring PSA after treatment (after the vast majority of harms have been inflicted, frequently on men who did not need to endure the life-changing experiences).

If you need more explanation, email Otis Brawley.

Casey,
Leave it there. I don't like the "at best" part because we truly don't know the repercussions of ending screening or how "informed decisions" would impact the PCa world today. You are a very smart man whom breaks down data well, but I don't like the data we have. It indicates that "at best" losing a few lives is ok. I disagree with that notion. I think that it's quite possible that we see an increase in PCa specific mortality that reverses these points of view. I also think it's possible that to do better we need that all important test that can differentiate between indolent and aggressive prostate cancer and that will shut both of these points out. Until we have it, we have what we have here, varying points of views and I respect yours. If you want to change it do so on your own account. But leave it there, because I can tell you it's better discussion isn't that what being informed is about?

Tony

starr15 said...
Don't confuse PSA screening with PSA for follow-up of prostate cancer. PSA for follow-up for prostate cancer is essential.

I really am confused by this, which I see as a double standard. If it's assumed that at my age any man has a 2/3 chance of having prostate cancer, and the recommendation is to not screen, why does the fact that I did turn out to have prostate cancer change that recommendation now? In fact, the reality that my surgery has substantially reduced the chances that I will have prostate cancer in the future would seem to mitigate even more in favor of no screening now. And even if it hadn't, and supposing my cancer did return, then I'm in the same position as I was to begin with, whereby according to the recommendations, any treatment is going to do more harm than the benefits thereof. What am I missing?

Thanks, Tony, and I'll stop after this, having pretty much beaten it to death: isn't the whole point of screening to divide us into groups according to risk, thereby providing the information we need to make informed decisions as to treatment? So my initial screening is what put me in the risk category whereby I should now continue screening, but if I had followed the recommendations I would never had had that screening in the first place and therefore would have no knowledge of a need for screening now. But since I do have that knowledge, gained by going against the current recommendations, I should continue screening. But there should be no initial screenings to begin with. Uh...OK.

the word on the street is PSA testing doesn't work and it's no longer recommended.  that all joe blow knows.

many of us got here through the back door and later then we would have liked.  thank my lucky stars that my dentist wouldn't put me under until i had my blood pressure checked by my doctor and that my doctor checked the box next to PSA when ordering the blood tests. 

what's wrong with educating the prostate snatchers since they are the problem?  and you know they get their PSA tested regularly because it really is the best way to catch PC early.

ed

 

Phenom,

You PSA checks are to detect a recurrence so you can get early treatment. That what PSA testing was "invented" for. That use of PSA is totally different than screening asymptomatic men.

Medical professionals have clearly differentiated between PSA screening and post-treatment monitoring. None of the professional organizations have suggested not monitoring PSA after treatment (after the vast majority of harms have been inflicted, frequently on men who did not need to endure the life-changing experiences).

Now I am also confused. Why would one need psa screenings after treatments if they did not need psa screenings prior to treatments. How would one know they needed to be treated for prostate cancer if no psa test was performed. When the tumor has reached the advanced stages? I agree with a previous post. "We are all big boys and decide for ourselves what treatment we want". But for "professionals" to make the decision that psa screening is not necessary is not very professional. If psa screening is deemed not necessary, then what will soon follow will be private and government insurance coverage refusing to pay for the screenings. How convienent.

I was screened in my annual physical. The follow up biopsy revealed prostate cancer. My Urologist informed me of the various choices and consequences, watchful waiting, surgery, radiation, etc, and sat back and waited for my answer. What is wrong with that approach? If someone does not want the screening just tell your primary physician not to have the psa test performed.

 

I had a friend have a recurrence 10 years after RP and ART. I don t know the answer, but I would certainly have one with my annual physical exam for the rest of my life/