More than 40 percent of men over 75 undergo PSA screening despite national recommendations

First, I'm a few years younger than 75, but it has been my observation (in no way scientific) that no generation in the history of the world has had a greater feeling that we just might live forever, nor a greater shock at realizing that, just like every generation before us, we will actually grow old and die.  We were part of an enormous youth movement.  Heck, many of us still listen to "oldies" on the radio station, music that is  more than half a century old, re-living those teenage years in our memories.  The idea of growing old just doesn't sit well with us.  And so, even at 75, many of us don't consider ourselves "old," and we hope to live for many more years.  And some of us will. 

My second observation is that testing a 75-year-old probably doesn't make sense to a guy in his 40's or 50's, but it might make sense to that same guy when he himself has become a healthy 75-year-old.  I'm 68 now, but despite having had cancer I'm still enjoying life and still feel active and involved.  Some guy who's 75 and has never been sick a day in his life (unlike me, who has been taught by a cancer diagnosis that our existence here on earth is definitely finite)  is going to have a hard time accepting the fact that he might have cancer, but that he shouldn't be tested to find out.  Maybe one has to actually BE 75 to understand that.

Does it make statistical or scientific sense NOT to test?  Sure.  But do we as individuals give up on life and resign ourselves to the ash heap just because we've reached a certain age?  Ask that question of those 90-year-old WWII vets who are willing to crash their way into their Memorial in Washington, D. C.

So, I fall back on my "freedom to choose" argument.  In other words, it's a mystery to me why so many people are adamant about a woman's "right to choose" regarding health care, but are unwilling to apply that same argument to other areas of healthcare.  (I'm not in any way directing criticism at you, Jeff, or trying to imply that you feel a particular way, just wondering in general).

Somebody said...
[I do, however, have a problem paying for their unnecessary treatments (raised taxes for Medicare) which may follow and all of the doctor visits and follow-up treatments for the various unnecessary side effects, after effects, and problems...]

Now, if that man has several other co-morbidities, I would expect that his physician would not order a PSA test, but again, I think he should talk to his patient about that.  I would be surprised if that's not what actually goes on most of the time. 

On the other hand it wouldn't surprise me if a good number of 75-year-olds have no serious co-morbidities and would want to know if they possibly have prostate cancer.  If so, THEN the decision can be made to treat or not treat, and this, again, should be discussed by the man and his physician.  If an elevated PSA leads eventually to a finding of Gleason 6, probably no treatment would be advisable.  But if an aggressive cancer is found, I would think an otherwise healthy 75-year-old deserves treatment which might permit him to die with, rather than from prostate cancer.

I hope some of our 75+ members will join in and give their perspective on the issue. 

ed

clocknut said...
It's my opinion that it's a man's right to be tested.  Doctors shouldn't simply stop testing men at a certain age without discussing the implications of that with their patients.

This is entirely consistent with what I wrote.  It seems like the doctor-patient dialogue I crafted—which addresses exactly the subset of men targetted in A Yooper's article—is also exactly what you (clocknut) are saying should happen.  Discuss the evidence, discuss the implications, help the patient see the big picture, and then say, "What do you want to do?"

I'm going to copy/paste it again here.  It seems like this has an opportunity to be a best-in-class model to the doctor-patient dialogue for men with less than 10 yrs LE.  Anyone want to offer any possible improvements to this:

"Bill, I've been watching your health for a long time.  We've been testing your PSA for years, and you have consistently been below any threshold which would warrant any further investigation.  We've talked in the past about how prostate cancer is ubiquituous among men, but the vast majority are slow growing.  For a man your age, after 75 years, to suddenly grow a rare, aggressive prostate cancer is virtually unheard of.  Based on studies, the reality is that you probably have some sort of low-risk variety in your prostate now, but based on the measurable patient characteristics in your file right here in front of us it is likely the kind that stays indolent and causes no harm.  Men 75 or older are at elevated probability of both direct and indirect complications and risks from treatment.  Every single medical group on the face of the earth says that the right thing to do is to put your excellent history of PSA away in your file and simply stop testing it and stop worrying about it, because I would never recommend you for any aggressive treatment whatsoever if we did find anything at this point.  What do you want to do?"