Is the PSA test ineffective?

Yep, the recommendations against it throw people like me under the bus just because Dr's do knee jerk over treatment in some cases.

IMO the process of deciding on where to go after a jump in PSA may need revising but to advise against a test that saves lives is not the answer.

A simple answer to your question: NO

The PSA blood test is very effective in monitoring for recurrent PC after a primary treatment.

Casey, in the question what was the context for accurate? Accurate as to the number itself or to something else?

 

Besides the overtreatment issue, maybe the problem is the "S" in PSA was not "specific" enough.

The study used screening, single digit, analyzer results from years ago.

Relax.... There are so many companies working on better and better analyzers and detection methods: PSA-3, PSA- X, Free PSA, ...., electrochemilluminescence, ... 2 digit, 3 digit, ....

In 5 years the argument will be moot.

Jeff

  Jeff, my crystal ball says that the testing difference-makers in the next few years will be biomarkers which help to further distinguish indolent PC tumors.   Indolent tumors are well-characterized today—we understand how they act, and how to monitor them—but our current method uses time as a key measurement dimension.   A biomarker test (SNPs in genes) will be faster, and can help reduce the “get-it-out-now cancer hysteria” which for generally slow-growing PC works counter-productively to the benefit of time & drives many men today to un-necessary aggressive treatment.   The ability to distinguish patients at elevated risk for having aggressive, life-threatening PC at the time of diagnosis could help avoid overtreatment.         Post Edited (Casey59) : 5/29/2012 1:21:34 PM (GMT-6)

clocknut said...
I would hope that most PSA readings are "accurate".

An underwhelming 50% of Primary Care Physicians (PCPs) feel the same as you about the accuracy of PSA screening...(see my post from this morning)

Casey. When I said that PSA screening is accurate, I obviously meant that a reading obtained through screening of 4.3 is likely an accurate measurement. Isn't that what's being asked? If mine is found to be <0.01, that's likely accurate and credible. So, are you saying that only 50 percent of Primary Care Physicians think that's a true statement. I think something's being misinterpreted here.

The question asked was, is PSA screening accurate. That's a different question than asking if an elevated reading is an accurate predictor of prostate cancer.

The question was so poorly worded that I would toss it out. If the intent was to ask whether prostate cancer screening accurately detected prostate cancer, that's one thing, But to simply ask whether prostate cancer screening is accurate is ambiguous, to say the least.

If they intended to ask whether PSA screening is an accurate and beneficial tool in assessing and treating prostate cancer, they should have asked the question differently.

I agree. Effectiveness and accuracy are two distinct concepts.

You have to look at sensitivity and selectivity to evaluate the usefulness of PSA as an early detector of prostate cancer.

"The sensitivity of the PSA test as an indicator of the presence of prostate cancer is known to be about 80 to 90 percent. In lay terms, what this means is that 80 to 90 percent of men who actually have prostate cancer cells in their prostate will have an elevated PSA level compared to men who show no sign of prostate cancer after having at least one biopsy. (Why 80 to 90 percent? Because it depends where you draw the cut-off line for an “elevated” PSA level — at 4 ng/ml or at 3 ng/ml, or at 2.5 ng/ml. The lower the cut-off line, the higher the sensitivity.)
The selectivity of the PSA test is about 50 percent. In lay terms again, this means that an elevated PSA level (again compared to PSA levels of men who show no sign of having prostate cancer after at least one biopsy) is a complete toss-up. You could have some prostate cancer cells … but you could just as easily have none."
prostatecancerinfolink.net/2010/11/12/psa-tests-prostate-biopsies-and-the-power-of-circular-thinking/

Sounds like a lot of trick questions going on here in this thread, this is what happens when people start playing with words, especially if words are being taken out of context (not saying any one person in particular, just a general statement).

The PSA test itself, as a test, is accurate - that is the readings. Pre-diagnosis, readings of x.x are more than sufficient as a tool. After primary and secondary treatments, then readings of x.xx or even x.xxx are equally important, to see if there is any trend towards recurrance or treatment failure in general.

Is the PSA test as a tool accurate alone for PC dx? Of course not, as we know there are men with high PSA scores that are related to non-cancer related prostate issues, i.e., infections and enlargement. And we know we have men with PSA readings below the old standard line-in-the-sand of 4.x, that have severe PC.

So by itself, the PSA test doesn't tell the whole story for sure. That is why other testing tools are used, and why biopsies are ordered.

Still a good starting point for all things prostate in my opinion. I still don't agree with any of the fuss and nit-picking going on with this subject in the press, and even here. The PSA test is still a good tool, and the fear of overtreatment and the fear of potential side effects from treatments, should not be an excuse not to test men. I think that whole notion is penny wise and dollar foolish (think I have that in the right order, lol).

Sometimes, based on the media's presentation on PSA testing and screening, it's like they are trying to say, oh, don't test, because it might indicate that there are men with PC that do need treatment. Not buying that its the other way around, and they are wanting to eliminiate or discouraging testing because someone might be overtreated and/or have side effects and quality of life issues.

Gee, what's worse than having the chance of long term incontinence and/or ED? It's called being dead in a casket at an early age because of an aggressive cancer that wasn't diagnosed and/or treated. Sometimes you can't have your cake and eat it too, in that, to stop a bad cancer, you may have to choose on some of the risk of side effects and quality of life issues.

david in sc

Phenom, thanks, wish others could see it that simple, instead of making it an endless point of debate, point and counter-point. I see things on the individual basis - one patient at the time, and I view every life as being equal and worthy of saving. I am not a statistic, I am a living, breathing, human being, and I am simply trying to live my allotted time the best I can under the circumstances.

david