The use of PSA as a determinant for PC?

Last week I received a phone call from my GP's nurse who informed me that my PSA levels were high and the GP wanted me to take CIPRO for 21 Days. At the time I was clueless on what PSA is.
I started searching online to learn about PSA, and was surprised by the division in the medical community on the use of PSA screening as determinant for PC. As of May 2013, Three major organizations, American Academy of Family Physician (AAFP),American Urology Association(AUA), and the USPSTF have basically recommended against the use of PSA for screening PC, and the AUA recommended a limited screening for age group 55-69. The organizations claim that the use of PSA screening is not worth the risk in comparison to the complications that result from PSA screening. So now I am extremely confused.
I finally met with my GP to go over the lab results, and I presented my findings to him. He disagreed with the limited use of PSA screening based on the fact that a few of his patients had PC and benefited from the PSA screening by catching PC in its early stages. He was very convincing and adamant about using PSA for early detection of PC. He also felt that there may be politics in some of the reasons for limiting PSA screening.
So after the visit, I started researching the studies that were used as a basis for limiting PSA screening. I found two major studies one in the US & one in Europe. The Europe study actually showed tremendous benefits of using PSA screening as a determinant for PC, where as the US study showed the opposite. That raised a question about the validity of one of the studies. Come to find out the US Study had pre-screened using PSA for about 50% of its patients prior to entering the study, where as the Europe study had 15% of it patients prescreened. So I feel that the US study may have contaminated its results by prescreening half its patients in the study.

I am not experiencing any pain or outward indication of a problem and my blood relatives do not have history of PC. I am 52 years old (outside the AUA recommended range). So I was surprised that my GP put me on CIPRO for 21 days. I have decided to continue the PSA screening with mixed feeling about its efficacy.
I would like to hear feedback from the forum on this topic, and anyone who has benefitted from early detection of PC using PSA screening.

Hey g,

Ok, you didn't say what your PSA reading was, so "high" doesn't give us much to help you with.

That being said, the PSA test is a test of prostate activity or irritation, not a cancer test, per se. Giving you cipro is based on the assumption that you have prostatitis, and he's treating it. You may not have any other physical symptoms. In fact, PC in it's early stages does not generally give any symptoms. By the time you're symptomatic, it's way to late to do much with it.

It sounds like your doc is being conservative and treating you appropriately. If, after the Cipro, things are still not 'right', he'll probably send you to a urologist for more specialized checks, and possibly a biopsy.

Hang in there, it can get real scary, real fast. The guys here are great, and have seen it all.

Wade. It's a controversy that will likely never die, never be settled.

I had a cancerous prostate removed 8 weeks ago. It was confined to the Prostate. If not for regular PSA tests, that cancerous prostate would still be inside me.
Draw your own conclusions.

glpWade-

What your Uro is doing is very prudent - eliminate other sources of PSA, such as prostatitis, BPH, sex before the PSA test, etc. before rushing to biopsy. There's a new test called PHI that's better than PSA (it incorporates PSA) - you can try that if the Cipro doesn't take care of it.

It's your decision about whether you want to screen for PSA, as long as you understand the risk of doing so. That's really what the AUA recommendation was about - shared conscious decision making rather than mindless automatic testing. There's no question that across the population we've had an epidemic of crippling overtreatment, there's also no question that some lives have been saved. Each man has to decide for himself if the benefits outweigh the risks.

- Allen

glpWade,
Not really sure what is meant by "complications from PSA screening." It is a simple blood test. My understanding is that a PSA test is not definitive of Pca, but only provides an indication that further testing is warranted. Perhaps the complications stem from subsequent testing such as DRE, Biopsy, CT scan, Bone Scan. These are all expensive test that help to identify the probability of prostate cancer. Like so many tests, they are all subject to skill and interpretation of the designated professional. For me, I am a strong advocate of PSA testing but more importantly, I am a stronger advocate of greater accountability on behalf of the medical professionals that treat us. Further, I am suspicious and any U.S. study that seems attempt to distract the general public on the importance of such tests. I often wonder if it's the insurance companies that are driving these studies to reduce their costs and drive profits up. So from my perspective, PSA can be a lifesaver. Would you agree that a test was unnecessary if it could save your life?

"If not for the PSA nobody would've guessed I had cancer."

Me as well. In fact my PCP tried to talk me out of getting a PSA. I had a friendly chat with her after the diagnosis.

I'll never get it. If you have a physical, you will have blood drawn for a variety of tess...I hope. So have the PSA measured. You can be as circumspect about the results and/or treatment as you want,but you have a number..it's not exactly an invasive proceedure. If it's under 10 and you are 50 it might be a problem,might not. But if it is 100..it is. Even so , if you want to roll the dice you are free to do so.

I agree with Q. Look how many are dx with PCa with a PSA under 5! How can a Dr see a rise if men aren't tested with regularity at a reasonably young age to establish a baseline.

What was the rant about? Are you a G-9 now after doing the AS? I'm sorry about10 but I can't get your point without your signatnure. My MO always refers to the PSA as a marker not a diagnosis . . . Q

PS: found your signature but I am still confused about why you thought you were ranting. Sorry,I'm mentally challenged today.

Wade do notveven get me started on a subject that should never have the such a stupid controversy to it. My husband Dave is the reason you make sure you follow your prostate health with screening. Dave was diagnosed with with stagev4 mets to bones and lymph nodes. Psa at diagnosis was 80 Look up Saddened Sue and you will how devestating this cancer is for us .I ONLY WISH A MILLION TIMES that Dave and I had never trusted the nurse practitioner when she told Dave at 57 he was to young to be worried about PC , she said it wasn't a good idealnto have psa testing because of false reads they follow guidlines that do not reccomend it BUT they never took into account that Dave has that aggressive type that is going to kill him...if you don't test for it you absolutely run the risk of having it as bad as Dave. For get the sex asspect of your life that is nothing if you have to lose it. Today he can barely get out of a chair he has horrendous shortness of breath. He can't do a thing not wash a car run a lawnmower or snowblower. The cancer has taken over almost every bone in his body I will post his psa this weekend, his last one was 2,582. I don't know you but this is the advise I give .Why would you run the risk they are not perfect tests but it is the ONLY way of finding it early so you never live the death sentence we live with. I have a massive pile of correspondence with complaints launched . We know its never going to cure Dave but I hope we can finally get rid of the stupidity of not screening.
Dx May 6 2013 stage 4 psa 80
Dvt result of PC prior to biopsey resuts gleason 9/10 6 out 6 cores cancerous
90% prostate cancerous , perienial invassion
Chemo, doxetaxel, spot radiation on spine 2 × prostvac drug trial
highest psa Jan 2015;- 3,005
the list actually makes me feel ill !! So Wade what would you want ?
laser turp surgery, xtandi, xofigio.

What's even worse about it is there really isn't a controversy in the published literature. The ACS guidelines (I just looked them up) are as follows:

All men should have PSA and DRE annually starting at age 50 UNLESS there is one first degree relative with PC diagnosed before age 65, at which point screening starts at 45. If there is more than one first degree relative, then screening starts at 40.

Is there overdiagnosis? yes. Was there a period where PSA was used as a primary diagnostic tool? yes. Are we mostly past that? I think so.

The most important concept is that PSA is not a cancer test, per se. It is a "something is going on" test. And the good practitioners know this. The popular press, however, does not. They'd rather print headlines that say things like, "AMA says PSA is worthless".

I started getting PSA and DRE at 40, a few years after my father was dx'd. My PCP didn't think it was needed, but he didn't say no. I was talking to a co-worker today, who is 57 and has never had a PSA, because his PCP doesn't believe in them. Sigh.

The whole conterversy starts and ends with the American and Canadian task force guidlines. They are the committee of Drs and I don't even think they are urologist who have come up with the idea of screening being harmful? .There is no formal type of education being given so men know what happens when you end up with PC. .Already shiny top they are doing you 50% injustice at your medical. The Dre while not often can catch abnormalities of the prostate that psa testing may miss. There has been men who have cancer but no huge psa spike.,! The bloodwork however should be done before the Dre as manipulation of the prostate can make psa rise. In the states you have those vans that offer screening by a urologist and I wish they did that in Canada. The only way to ever see a urologist is by a referral .So in essence the Dr doing your medical is holding your life in what they think. In Daves case we were told he LOOKED HEALTHY! So if that is the case what care or hope is there for mankind? When I took our income taxes in to be done the accountant who does them is aged around 45ish., He knows Dave has PC but asks me this when you turn 50 do you not automatically get a colonoscomy? He thought when you got that done they found out if you had PC. So where would he ever get his education on prostate.? Well he was educated by the time I left there....BUT WHY? Is this being handled the way that is. When I made the appointment for screening for Dave they should have said they do not screen for prostate cancer and then if they don't instead of confusing Dave the way they did they should offer to send you to someone who will. See for me I heard that men should be screened when I booked his appointment I requested that Dave get those tests. So now when we appeal the decision by the college of nurses Dave and I are are going after them with Daves human rights to PC screening was violated that day, The saddest part though is that nothing we are doing by pursing this is ever going to make our lives any better but I want there to never be this problem about screening by the time my grandson is old enough to need it. Yes his health record at 8 already is flagged with Poppa' s history of aggressive PC. .So in what happens in our lives with prostate cancer has made each of us the educaters with our own knowledge either as the person who is given the P C ticket or like me the wife and care giver of Dave.

Halbert feel free to share how not screening has impacted Dave .There were very few symtoms to his cancer in 2010 ED problems started. He felt like he had arthritis every bone in his body hurt after just cutting the grass not every time but off and on. At ejaculations it's not that it hurt but felt strange , again to not all the time .If we went for a walk some days he would need to stop and use construction mens loos. But you put it down to well maybe you drank to much before we went out..They are however things that when we look back things that started.Dave was in the nurse practitioner office in Jan and told her about ED problems but she told Dave those are just natural problems to men. In a letter we have back she told the college of phycicians that she could tell that time that he didn't have testosterone problems and prostate cancer would not be the cause of his problems. OMG she is so smart compared to us her patients. Yesterday I had a severe melt down I do not know if I can be strong enough to keep seeing Dave spiral down . To listen to how hard he has to breathe when he gets up from a chair scares me . He can't even to stairs and has only been to the basement 1 time since xmas. This summer I hope he can get in our summer car and go for a ride , last year he only was out in it 3 times and one of the times was to get the oil changed.

Some one once said psa is like your own check engine light!!!