PCRI on PSA screening

sounds fair to me.

I know I did whatever I could to weasel my way out of a biopsy including multiple PSA tests in hopes it would go down. Initially my urologist, the same one who performed the biopsy, told agreed to multiple PSAs because he thought a biopsy wouldn't be needed in my case given the perfect DRE and the fact that PSA was higher than acceptable but not too high.

On the other hand, the biopsy wasn't a big deal at all until it revealed I had cancer.

that's when the wheels really started turning.

It's also, however, pretty obvious that various competing factions working in the PCa world (all of them) will exploit this recommendation to their own benefit. Anyone can spin it however they please so that it fits their own agenda.

142,
This is Scholz's position:
1 and 1/2 million men are biopsied every year. 80% are negative and of the 20% that are positive the majority will have low risk disease. Only 10% of these will be put on AS. Only a few men understand what they are getting into as urologists schedule a biopsy at the first sign of an elevated psa.
Biopsies are not benign; men need through education and reassurrance prior to being biopsied. I always explain two things to my patients before a biopsy. First, that low risk pc is common, so common that the likelihood of a man harboring some degree of micorscopic cancer can be estimated by putting a % after his age. Second, low risk cancer is safe enough to be monitored without immediate treatment. Men need this information IN ADVANCE, BEFORE A BIOPSY, to defuse the inevitable fear that will come with a Dx carriying the monkier of cancer.
1-2% will have bleeding severe enough to require blood transfusions, 1-2% infections that require hospitalization. 41% have ED for 30 days after a biopsy and 15% ED for 6 months.
He uses PSA density, psa velocity, and PCA3 and antibiotics to eliminate infection, BPH and low risk diesease prior to a biopsy. Also recommends a MRIS or color Doppler before a biopsy. If all these are favorable then frequent psa monitoring and repeat imaging along with Adovart to increase the probability of of one having PC before biopsying.
Also if a biopsy is negative most patients get a second or third biopsy.
I sent a friend to Scholz after his psa was rising after a negative biopsy. His doctor wanted to do a 2nd biopsy; PSA was around 10. He has been monitored for about three years now with CDU and the above tests with no futher biopsies.
I think the above is a very reasonable approach rather than just pulling the biopsy trigger at the first sign of an elevated psa. Scholz also doesn't place much faith in free psa and uses PCA3 instead.

I wonder where these "over treatments" are happening. Uros needing to make extra cash? My primary care doc and Uro weren't ready to recommend a biopsy until there was clear evidence of a rising PSA number and no signs of of other problems. They monitored my PSA for almost two years before shoving things up my backside.

Also I've got a brother that has a 7.8 on his first ever PSA test. The Uro's response after the DRE: "Let's try that again in three months and see if we get the same number - could be normal for him." There was no rush to treatment or biopsy just a clear, calm evidence based set of decisions.

With all the press you'd think that all doctors are either dangerously stupid or corrupt money grubbers. I must live under a rock not to understand the real problem...