Urology group stops recommending routine PSA test

Haha.
Another can of worms coming right up.

The USPSTF recommendation on breast cancer has not been altered in any way and the ASCO is going to be refining breast cancer screening soon. You will see more ruffled feathers at an oncology event near you (well if your are in Chicago).

There is no action that can be taken. During the draft process the USTSPF had the comments section open for PCa and all of the major advocacies were protesting. It didn't prevent the preventive force from preventing...

Tony

1969 said: "Ultimately, individuals are the Captains of their ship. BUT information is knowledge. Anyone here who would council a friend, "Don't worry about a PSA until you're 50." should be ashamed of himself. Ashamed!"

Exactly. "Hi, a PSA test afforded my 45 year old husband an opportunity to investigate further, but, YOU, you don't really need one."

Please, can someone who is part of this 1 out of 1,000 tell me how they could ever look at another man and say, "you don't really need a PSA test". I can't fathom advocating for these new guidelines when I know the PSA test alerted us to a problem.

It has been our experience that men don't even want to talk about that part of the body. This is just another reason for them to forget about it completely.

I wonder how PC fundraising efforts will be moving forward such as:

Know Your Stats:  (well only under these situations should you know your stats)

Future campaigns will be very challenging to make sense to the average guy:

PC Awareness --- yes, we want you to know if you are at risk and go through this flowchart to see if you really shouldn't be made aware of any issue.  You might have something, but may be you don't.  There is a blood test that you can have to see if you might have cancer, but it's a little tricky whether you should get it done or not.  But, anyways, do you have any money for our fundraiser to make men aware of prostate cancer, because it can be lethal, but normally just slow growing and if you get checked, you might get treatment that you didn't need anyways.  Any questions and thanks for your contribution...it will surely make men aware of something...but we're not sure.

Walkbyfaith,
The problem is also that nobody knows if they are that 1 in 1000. If anybody in this thread is closer than I to that number then ok. But we don't actually know if I've been saved yet either.

I'm certainly not saying I would ever tell a man that he does not need to be screened. Instead I would tell him to make sure he knows what he is getting into and point him to the guidelines issued here and also other guidelines that would suggest a baseline test. I would tell him that the door is open for him to make his own decision regardless of the recommendations. I certainly would not be pushy in any way. I could share the experiences I've encountered over the years and how I've changed my view point at various times as I grew more knowledgable. I would tell him what I tell every patient that walks through the door at UsTOO Las Vegas. This is a big boy game. The stakes are high. And he is his own number one advocate. Make sure the decisions are educated decisions.

What would bother me is forcing my case on someone and I convince them to get screened and he gets that opposite overdiagnosis that leads him to over treatment and he now has to live with the side effects he never needed to have for the rest of his life.

Tony

Post Edited (TC-LasVegas) : 5/8/2013 3:41:12 PM (GMT-6)

I can see it now. My attempt at lighting up the courthouse with blue lights for "Prostate Cancer Awareness Month."

"Prostate Cancer Awareness Month!" Get Your PSA Tested! 2012

"Never mind... Just be aware that you HAVE a prostate, that's all!" 2013

(fade lights)

But I already own the lights and they are reusable! My cash is not! ;)

And, yes... I totally get it.

But, I still firmly believe that men need to be made aware of and educated about prostate cancer.

David, We had to do mega research... mega fast!

I'm sort of torn on this whole thing. I converse with several other people on another support group. It's pretty incredible at how much "buyer's remorse" I hear about. At least 15 of about 32 that say their husbands regret the decision as they now feel like maimed individuals. The other half of the group has already had funerals for their late diagnosed husbands. Funerals seem to be back to back for a 2-3 months period and I was questioning my sanity for remaining part of the group. But, I don't quit.

Then, my husband is in the 1%... Same doctor who ignored 2006 PSA, stated the the 2011 DRE was normal when the PSA came back at 57....And, about 20 other doctors/interns/janitors performed DRE's once we got to MDA, and ALL said "Abnormal," and were staging him at III or IV based on DRE alone! I do realize that this highly sought after doctor in our area (yes, he is) totally missed the boat on all accounts.

So, while I am rambling to cover all aspects...

There simply has to be a middle ground on these young men.

Tony,

I was trying to be funny in my last post, but seriously, society has failed at PC Awareness for decades. I organize teams for various fundraising events...they are for research....certainly, we try to make them aware, but how effective, really? and now I'm going to try to make them aware of what.....

Why don't we just tell everyone to throw in that towel with awareness?

I can see doing certain things in honor of someone, but this whole awareness angle is interesting.

davidg said...

compiler said...
I think we agree.
Of course, what does overtreatment mean?

I think perhaps the real problem is that patients are not given a good view of the various possibilities. If I have a G3+3 say in 3 cores at 20%, my options certainly include surgery, assorted seeds/radiation, and AS. If I am the mindset of "get it out," then if I CHOOSE surgery, am I still being overtreated? That is not a simplistic question, especially when the evidence suggests that the G6 will not metasticize.

I do think there are still too many urologists who pressure their patients into quick surgery (ka-ching!), without encouraging their patients to investigate more options. For some patients, I guess that's just fine. But the doctor ethics in such a situation is not stellar.

Mel

Fantastic point, Mel. That would not be overtreatment, that would be freedom to choose how to tackle this.

THIS is the crux for me... I can see an insurance co denying coverage for someone that chooses surgery or any treatment in this case because it is "outside of the standard treatment practices for such a small degree of disease." THAT is scary to me. I get the whole money grab by drs argument, but I'm choosing to argue from the "honest" perspective. A doctor SHOULF guide you in appropriate ways to recover your health. I have no doubt that it is the goal of an insurance co, however, to dictate when treatment should be pursued and I think their motivation is equally as sinister as a doctor who might direct a person to treatment to cash in. Problem is, the insurance company controlling that type of tdecision has far more grave potential consequences...imo.

David:

Oh, I agree. I know I only mentioned surgery, but my point was more general, about pushing patients into one treatment without encouraging the patients to explore all the possibilities.

You may recall that I mentione the local urologist I first visited (who I fired) when I had a rising PSA. He was extremely pushy in terms of doing an immediate biopsy. He had scheduled it before I even saw him. He then became irate when I said I would first get a second opinion at Umich. He became even more irate when I said they were going to do the biopsy. He told me that if they found something he would be reluctant to do the surgery. That was fine with me. I had already decided that this was not a good fit!

I will say almost every other medico I saw was very good about my consulting with others and gathering information.

The only exception was Dr. H at Umich who really seems to resent the fact that I consult with Drs. Lam/Scholz (she claimed she didn't even know them when I know darn well she spoke at a conference they organized!). Additionally, she got bent out of shape when I said I was going to do the Lupron shot with my local urologist. She then said she didn't want to see me during the tx. although I could continue as a patient. Go figure that one out. I can:  HUGE EGOS, and of course the old ka-ching.

Mel

Mel

Morality/Ethics,
I can't believe that doctors in their 40's and early 50's wouldn't have the psa test themselves for their own health; a few years ago 80 to 90% of URO's had regular tests..I can't believe that those doctors who had been tested wouldn't offer the test to their patients...Maybe I'm wrong but I'm "old school".
Bill