HealingWell
Search Close Search
☰

Should we stop or continue with psa testing for the male population

Support Forums
>
Prostate Cancer
✚ New Topic locked
1 23
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 7/12/2016 2:19 PM (GMT 0)
Gemlin, I agree (of course…who wouldn’t?) that we should—and we will—continuously improve our detection capabilities.

Liquid biopsy mentioned at length by Tony is interesting but off-topic from PSA testing which in untreated men is used pre-detection. Liquid biopsy can help guide treatment decisions post-detection…this is it’s purpose, at least initially, as described above.

I’ve written about this before, but we must continually remind ourselves not to wait for the panacea to "solve everything." It will not come. There will be “continuous improvement,” but there will not be the “absolutes” that people seem to often be hopeful for. There will continue to be “gray areas” just like there are now. Today, PSA scores in the 4.0-10.0 range are generally considered a “gray area,” for example.

The result of a new test—any new test—will not be a 1 or a 0, it will not be a “yes” or a “no,” it will not be a “treat” or “do not treat.” No, instead, it will continue to be a number on a sliding scale. Maybe the scale is 0-100…just as an illustrative example. Low scores mean most likely indolent; higher number mean aggressive. So you get a risk score of 56.8 on the new test (just as an illustrative example; completely made-up number). You are, once again, in a “gray area.” Treat, or don’t treat? Your call. Don’t expect a “1” or a “0” output.

And by the way, liquid biopsy may be useful in the future for prostate cancer diagnostics for aggressiveness (even though this purpose is beyond what is described in the article above), but it, too, will yield a number on a sliding scale. Same with STHLM3 mentioned by Gemlin. It’s simply not a panacea. It does represent a step towards continuous improvement.

Don’t mistake my skepticism for negativity. Being a man of science myself, the step-by-step improvements are wonderful, and appreciated…and expected. But it’s useful to point out that today 10+ year old Active Surveillance program success rates already meet the success rates of the litany of aggressive treatments…doctors have known for the last decade how to successfully weed-out men who don’t need immediate treatment. Yet in the last 10-years, nearly a million more men have been unnecessarily overtreated (myself included)…many “butchered” as island time referenced…
Posted 7/12/2016 2:30 PM (GMT 0)
Okay, I'm sorry to the group for being argumentative, but the statement below is BS.

<rant

Maybe, when these G6s have a more advanced cancer they will understand the G7-G10 perspective that the "ROUTINE" screening saved our lives.

"yours was not a situation of "routine" screening...which is, as I said, considered unethical "

It is this bassackward idea of ethics is what would/has be/been killing some of us. It's a freaking simple arse BLOOD test, that's all. If the asinine doctors won't grow a set that enables them to properly treat G6s then they should be lined up and have their licenses revoked.

Who suffers because of this "ethic", US the >G6 crowd. Yeah, you know the one's who may well die.

Don't punish the patient, it is the expectation of the public as it should be, that patient education is a DUTY of the medical community. It is a very new idea that medical condition education be laid at the feet of the patient. Until relatively recently this was never an expectation before.

I'd say it's more the drive by the physician class to absolve itself of responsibility.

rant/>
Posted 7/12/2016 2:34 PM (GMT 0)
" Being a man of science myself, "

Jack, what is it you do for a living that makes you a man of science?
Posted 7/12/2016 2:37 PM (GMT 0)
"Routine" PSA mass screening of untreated men is, today, considered unethical in the medical professions.

Which part of this are you confused about?
Posted 7/12/2016 2:41 PM (GMT 0)
I am far from confused, I call out the medical communities lack of ethics.

Routine screening has saved many lives, including mine and many on this board. How is that unethical? It's a SIMPLE blood test.
Posted 7/12/2016 3:48 PM (GMT 0)
Ahhh...I get it.

You are one who believes that because you were diagnosed 2-years ago that "PSA testing saved your life..."




That's a very emotionally-laden perspective which many men initially have and is difficult to overcome even with facts & data...and is also a slightly different topic which has been the subject of other threads in the past.

In fact, in a 2015 thread titled "How many of you are living because of PSA screening?" your one-sentence response, alephanull, was focused on diagnoses: "As my DRE was normal, the only thing that caught my PCa is the PSA test." Typical.

https://www.healingwell.com/community/default.aspx?f=35&m=3513301&p=2
Posted 7/12/2016 3:58 PM (GMT 0)
DH would be in REAL trouble right now if not for PSA. No family history, no risk factors, no symptoms, etc. GP ignored 7.9 PSA two years prior to diagnosis (psa 26). I don't know what the answer is regarding routine testing. All I know is that I will be forever grateful for it. How many men would we lose to this nasty stuff is we waited for symptoms to appear?
Posted 7/12/2016 4:10 PM (GMT 0)
Jack H-

Ahhh...I get it.
You are one who believes that because you were diagnosed 2-years ago that "PSA testing saved your life..."
That's a very emotionally-laden perspective which many men initially have and is difficult to overcome even with facts & data...and is also a slightly different topic which has been the subject of other threads in the past.

This statement leaves me a little confused. My DH is a Gleason 9, horse is out of the barn guy. I can't speak to studies, but anecdotally, with no symptoms, no family history, no risk factors, how might he have been diagnosed, if not for routine screening? We most likely would have rocked along until symptoms appeared, and his disease surely would have been way more advanced by that time. He has the kind of PCa that will kill you. What "facts and data" do you have that show the PSA test didn't save his life?
Posted 7/12/2016 4:26 PM (GMT 0)
RandyJoe, are you really unfamiliar with the major studies on this? I find that hard to believe.

PSA screening saves very few lives (not zero; but very few)—you saw earlier island time made reference to the 50:1. The common phrase is that “The test is about 50 times more likely to ruin your life than it is to save your life.”

If you really are unfamiliar, I suggest starting with a article before progressing to the study reports. The articles help add context. Here's a decent one from the NYTimes, and the article has a link to the published study: http://well.blogs.nytimes.com/2012/01/06/embargoed-no-benefit-from-prostate-cancer-screening/?_r=0
Posted 7/12/2016 5:11 PM (GMT 0)
I remember when the discussion for screening was based upon the 40% reduction in mortality rate since the introduction of PSA testing. The USPSTF papers that led to the Grade D recommendation cited that 43 detections needed to take place before a single life would be saved. That shifted over time as the primary paper cited, the ERSPC out of Europe, had continued follow up that may indicate the number is more like 1 in 24 detected would be saved. Still a small number.

On Liquid Biopsy:
The goals of this research are to hopefully one day replace invasive surgical biopsies. With hope that both pre-diagnosis use and post-diagnosis use would be usable tool in the future. Biopsy is one of the core problems in PCa as it tends to cause infection in up to 20% of men biopsied and can lead to hospitalization in as many as 3-5% of men biopsied. In very rare cases biopsy can cause death. Thus this kind of research can reduce morbidity should it become available. This may one day make the detection process safer.

More research underway in the genetics is hopefully not only going to detect prostate cancer but better define who needs treatment and who does not. Genes are being used today to try to "translationally" define tumors so that we can target the tumors that need to be treated.

Until we get there, screening is about education and decision making based largely upon poor research and opinion. For myself, diagnosed when at age 44 with what turned out to be Stage 3B cancer, I do not know if my life was saved or not. I'm still here ten years later and that's a good thing. Technically I was not screened. I had a condition that warranted a PSA test that came back near 20. If I had been screened at 40 there is no clear evidence that my tumor would have been detected or found to be any less advanced. But I remain for some level of screening because I can't shake that 40% decrease in mortality rate in the PSA era.

Post Edited (Tony Crispino) : 7/12/2016 11:14:30 AM (GMT-6)

Posted 7/12/2016 5:13 PM (GMT 0)
Yeah, jacka

What RandyJoe said is spot on.

As for “The test is about 50 times more likely to ruin your life than it is to save your life.”

This actual statement is BS. The testing does absolutely NOTHING except provide data for doctors to educate and evaluate with.

It's the TREATMENT that may or may not ruin your life.

The ROUTINE testing that my doctor did is the only thing that had him recommend a biopsy. What part of that don't you understand.
What part of NO history, NO risk group association do you not understand??

"Ah, I see ............"
Your condescension towards practically anyone who disagrees with you is impossible to miss.
"Typical"...

I am really starting to wonder is if you ever actually had/have PCa, and am instead are a some medial professional plant who thinks they are god. Or maybe a staffer with USPSTF

So, give us your stats (besides G6 that is).
Give us your credentials as a man of science.

My sig tells about my PCa
My "man of science" credentials. Bachelors in Mathematics, 30 years experience in Information Technology.
Posted 7/12/2016 5:21 PM (GMT 0)
your emotions are understandable, alphanull...and common


When one's arguments have failed, many weak people resort to ad hominem attacks on the person rather than the position they have taken.

Little kids resort to stomping their feet.

Post Edited (JackH) : 7/12/2016 11:32:14 AM (GMT-6)

Posted 7/12/2016 5:26 PM (GMT 0)
Tony, I, too, remain agreeable to "some level of testing" (your phrase)...I use the term many physicians use, "smart" PSA testing.

But most medical professionals agree that the drop in mortality was not significantly driven by PSA screening (haven't you seen the discussion about the etymolology of PC and the timing of the mortality declines...your buddy Ruth E says it couldn't have been the primary cause). The primary causes of the drop in PC mortality has been advancement in the life prolonging treatments for advanced cases, and reduction in smoking(!).
Posted 7/12/2016 5:38 PM (GMT 0)
So, your referencing me differently that my username isn't being petty?

All, I asked for was proof of your man of science claim. I also posted doubts about your status as such.

And asked for clarification of your credentials.

No stomping of the feet. My mention of your condescension is a shared belief among some on this board. Maybe not all, but some.
Posted 7/12/2016 5:44 PM (GMT 0)
[can you not tell, yet, that I am ignoring your request for personal information about me?...besides, you didn't say 'please']
Posted 7/12/2016 5:49 PM (GMT 0)
JackH

I have read the studies, and I still say testing in necessary. It most certainly was in our case. The burden then falls on doctors not to treat what doesn't need to be treated. PSA is a screening tool which tells us which men need to be tested further - not a test for cancer.

If G6 men should not be treated, that needs to be addressed. No one should be subjected to unnecessary treatment. However, all the high risk guys on here who will attest that without PSA, they would have been oblivious to the fact that they had cancer until a point where they could not be helped, should not be sentenced to death because some doc somewhere wants to make an extra buck.

I think it might be very easy for a G6 who feels he was over-treated to advocate for no PSA testing. My heart truly goes out to anyone whose life was "ruined" due to unnecessary treatment. (At least they still have a life.) But that falls under the category of undereducated doctors and patients. Let's educate them, rather than sentence thousands of men like my husband to an early death.

I remain thankful for the PSA test that alerted us to PCa BEFORE DH was symptomatic and beyond help.
Posted 7/12/2016 5:56 PM (GMT 0)
Most of the researchers I work with feel there is a lot of things that have contributed to the reduction in prostate cancer specific mortality rate. The largest idea that "Stage Migration" being the #1 reason. In other words early detection was finding tumors before they manifested to incurable status. It was far more evident before the new novel life extending treatments started coming around. And I suspect that these treatments are reducing PCSM incidences but its not clear as to how much or if it should weigh on the screening issue at all. I would think it shouldn't.

As far as life-style changes in America ~ there are still a lot of issues here. There might be reduction in smoking but we are at an all-time high in obesity and other vices. Sadly we can still do way better here.
Posted 7/12/2016 6:02 PM (GMT 0)

RandyJoe said...
I have read the studies, and I still say testing in necessary.


That's fine, RandyJoe...it's a little pointless to "argue" with someone who chooses to discount facts & data for your own "belief." You asked for data, but now you ignore them. The findings were quite simple: "...although annual P.S.A. screening did detect more cancers, it didn’t save more lives." Much of what you and others have written about here is about detection, not "saving lives."

I'll highlight, again, that I'm not aware of anyone advocating for the complete elimination of the PSA test. That, as I said in the beginning, is a silly question. But we can be "smart" (and ethical) about it's use.
Posted 7/12/2016 6:12 PM (GMT 0)
Jack,
Yes, I most certainly noticed that the very first time I asked. That's actually why I keep asking, that and your condescension.

Practically all men on here are willing to share their situation.

And it is your choice not to, as it is personal.

But when you give "advice" in the manner in which you give it (condescending attitude), you come across as a an ..................

I read this board and see how you treat other brothers and it infuriates me.

I am trying to remember if you have ever actually asked for help. I can't remember that being the case. But maybe you have, maybe you haven't. Most of us on this board have come for help, compassionate help that is.

In the end, I keep asking for credentials and your status as I want to know what gives you the right to be this way to your brothers.
Posted 7/12/2016 6:25 PM (GMT 0)
OK, that's it. Dial it back a bit please. Not liking the tone or opinion of other posters does not warrant Rule #3 violations. Thank you.

Jim
Posted 7/12/2016 6:25 PM (GMT 0)
I've posted about my PC case many times in the past. You can search for it. Beyond that, my comments and guidance to others stand solidly on their own...I use & share data, and help others see when they are not. I'm going to say that it's your problem, not mine, if you don't like the matter-of-fact way that I present myself (and obviously this does not concern me in the least); many people appreciate a straight-shooter.

In fact, this is my 12th post in this thread...why don't you just go ahead and highlight (copy/paste) the comments you are making such a big ****ing deal about...just to show how terrible of a person I am. Go ahead, please do.
Posted 7/12/2016 6:28 PM (GMT 0)
It's comments like this that are objectionable. No matter how you want to twist it, that is a condescending reply.

"That's fine, RandyJoe...it's a little pointless to "argue" with someone who chooses to discount facts & data for your own "belief." "
Posted 7/12/2016 6:29 PM (GMT 0)
I think not. There was little to argue with there, and I point this out.

Let's get back on topic.
Posted 7/12/2016 6:34 PM (GMT 0)
OMG

You can't even see how arrogant and condescending you are.

"argue" with someone who chooses to discount facts & data for your own "belief." "

In my 30+ years of professional life if I ever stated something like that, I'd be called on the carpet and told to straighten up.

I will drop it now as it is clear the trees are in the way of the forest.
Posted 7/12/2016 6:34 PM (GMT 0)
A well-written passage from a Boston University Today article on this topic:

    "Finally, there is the particularly misleading influence of survivor stories. I hate to say this, but the truth is that most screen-detected breast and prostate cancer “survivors” are, in fact, more likely to have been overdiagnosed than truly helped by early detection. Ironically, the more overdiagnosis a screening test causes, the more people who feel they “owe their life to the test,” the more likely the rest of us are to have heard their stories—and the more popular screening becomes."
✚ New Topic locked
123