Forbes article: Guys: You Don't Want That PSA Test For Prostate Cancer

I find this very puzzling. Health experts describe prostate cancer as tremendously over-treated. And they say that only a very small number of deaths are prevented by mass screening, while many men suffer from the SEs of surgery and radiation. That conclusion does not seem to square with the fact that deaths from prostate cancer have dropped significantly since the advent of PSA testing. Look at this site, which shows the decline in prostate cancer mortalities:

https://seer.cancer.gov/statfacts/html/prost.html

What caused that decline if not PSA screening?

fiddlecanoe said...
I find this very puzzling. Health experts describe prostate cancer as tremendously over-treated. And they say that only a very small number of deaths are prevented by mass screening, while many men suffer from the SEs of surgery and radiation. That conclusion does not seem to square with the fact that deaths from prostate cancer have dropped significantly since the advent of PSA testing. Look at this site, which shows the decline in prostate cancer mortalities:

https://seer.cancer.gov/statfacts/html/prost.html

What caused that decline if not PSA screening?

Not to ,ention these stats are in the face of more boomers coming of prime age for this disease

This kind of promotion really annoys me.

The article says "There is convincing evidence that PSA-based screening leads to substantial over-diagnosis of prostate tumors. Many tumors will not harm patients, while the risks of treatment are significant."

The problem (IF there is a problem) is not over diagnosis, but over treatment of men without sufficient exploration of all options.

That problem, I believe is the fault of over zealous medicos who promote their own brand of treatment.

I know that was the case for me. Diagnosed by a Urologist, the only option offered was immediate surgery. Knowing no better and not being exposed to the kind of information available through this forum, I accepted his "advice". I now have significant permanent SE's which may have been avoided with a more considered treatment plan.

But compared with the outcome if I hadn't been diagnosed - just doesn't bear thinking about.

Pratoman said...


I know this is a controversial issue, but if I didn't have PSA screening starting age 50, I would be metastatic by now, if not almost dead.

Who told you this Prato? Your surgery was 2 years ago at 3+4. We both had the same paths. The surgeon I spoke with at JH told me this surgery would not begin to payoff for 10 years.


I know it's controversial as well. And the numbers of men who die of it has decreased. The author, though, is a statistician. That's who you want "running the numbers". Not surgeons. (It's a numbers game). What I don't like about the article is that the guy is telling other people what's in their best interest to do or not do with his findings. That's not his job. But he's making it such.

Personally, I'm unsure about the whole thing. What I'm sensing is...it all boils down to the 'ol "What's one life worth?" debate.

And don't kid yourself. We all place our own values on a human life. And that's at the root of this debate.


edit: fwiw....I'm one of the one's whose unsure that by having mine treated....it didn't do me more harm than good. And I'm talking about moving the finish line here.

Once the test is run, it skews the decision making process. If the phrase "You've got cancer" doesn't enter bias into the decision making process...is there anything that possibly could?

The counsel needs to be about what having a PSA test actually gets you. Statistically speaking.

We need better tests than the traditional PSA test. The standard PSA test and subsequent tissue samples from the prostate has major shortcomings. Four of five men who take tissue samples because of the PSA test is not a treatment demanding prostate cancer and of the men who take biopsies, about 3 percent gets blood poisoning. New and better tests are coming, such as the STHLM3 test. Sweden is very close now to start general screening with STHLM3 of all men between 50 - 70 years. Estimates show that mortality from prostate cancer will be reduced by a 20-30 percent.

Round and round the debate goes. And it will never end. All the studies forget the one thing you can't measure (maybe that's why they ignore it): That between the test and the biopsy and the diagnosis and then the treatment there are at least three opportunities to pause for understanding. IMO, it is the treating physician's responsibility to insure that the patient has ALL the information they need and ALL the interpretation of that information they need to make a truly informed decision.

And, because insurance won't pay for those extended consulting sessions, and the doctors live on a 15 minute office visit schedule, they don't happen. None of this is the patient's fault. We want to make it their fault, to say "take charge of your care", rather than putting the blame where it belongs: Doctors who are more interested in buying the next yacht and insurance companies that are more interested in their corporate bottom line (and the size of the bonuses for the CEO and his minions) than they are in the actual well-being of their patients.

End Rant.

My short answer to the article: B.S.

Article said...
Steven Salzberg is the Bloomberg Distinguished Professor of Biomedical Engineering, Computer Science, and Biostatistics at Johns Hopkins University.

Biomed aka clinical engineering are the folks that fix medical equipment at the hospital the repair guys. Yes they are qualified techs that fix OR tables and sterilizers and monitors and such but what the heck does he know about PSA testing??? really. Big time agree with Purgatory total BS

Grump on Redwing!

More information should be a good thing. The problems are ill-informed and/or panicked patients, and irrational and/or uncaring doctors, who take the information and misuse it to overtreat. I wouldn't put it on the patients to be well informed (they're not the experts here), but it sure helps a lot if they are. I also understand the panic that a lot of people feel with the word "cancer" -- it conjurers up a lot of bad images in our society, and for many people personally.

Doctors generally aren't uncaring for selfish or mercenary reasons (at least not consciously), but keep in mind that a lot of doctors out there are basing their recommendations on years and years of experience when prostate cancers weren't generally discovered at such early stages. When a test comes along that changes when prostate cancers are diagnosed, it's going to require a change in doctors in how they approach treatment, and such changes take time (even a long time) to implement.

Doctors are also generally disposed to fix problems if they can, and there's a natural tendency to see one's interventions as beneficial, even if significant side effects result. This is especially true when the downside of failing to act could be fatal to the patient.

Yes, more information should be a good thing. It's on the medical profession to make sure that patients and doctors are sufficiently educated and controlled so that the information isn't misused to overtreat. That's a far better way to go than not getting the information in the first place.

Redwing, I don't mean to make you more grumpy, but everything you said was pretty much spot on. How depressing . It hints at a bigger problem that I sometimes think exists. Sometimes I feel like the entire medical establishment one big scam.

Or maybe it's just that we hold them to a higher standard, and the fact is, they are businessmen, like everyone else.
I guess that's probably a whole nother thread