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

JackH

I'm not "ignoring data". Regardless of whether "data" says PSA testing saves lives or not, our experience (and the experience that matters most to our family) is that PSA testing gave my DH a chance that he wouldn't otherwise have had. READ the experiences of so many men on this forum. My husband is still playing with our grandchildren. That's what matters most to me, and I suspect to most of the folks on this board.

Would you prefer that all the folks on this forum who had no risk factor, but who were diagnosed due to a routine PSA test, perish so that G6 folks and their doctors don't have to be responsible for their own medical decisions?

Again, used wisely, PSA is a useful TOOL. The proof may be anecdotal, but it's here, on this forum, if you only care to look. If and when there is something better, then by all means, let's use it. Until then, it takes a lot of......something....... to suggest that even one life should be lost for a lack of a $40.00 screening test.

Tony Crispino said...
Not much has changed here through the years I've been here. We've had some pretty poignant debates when the screening guidelines get changed. Some feel testing every man annually is a must, and some feel the guidelines out there are reasonable. That's great for us to say when it should be done because we are the positives.

I think it's up to the individual when and how often to test. I had advanced PCa, my dad has what might be advanced PCa, and my 4 years older than I brother has no idea where his PSA is today. Mostly because he doesn't care.

Then there's the question about the doctors that would suggest and deliver the testing ~ do they understand it? I still have friends coming up to me with high PSA's that have been pretty much ignored. A friend came up to me the other day to let me know that he had his physical at age 41 and his PSA was 3.8 and the doc told him as long as it's lower than 4 its fine.

Still I stand for screening. How frequently? It's hard to say. AUA says start at 55 for a normal healthy man with no known risk factors. 40 if risk factors are present. AUA also suggests a baseline PSA at age 40 to determine the need for follow up if needed.

Examples of some guidelines out there:

ACS Guidelines: (Same as when I was detected with an exception to include 40-45)
www.cancer.org/cancer/prostatecancer/moreinformation/prostatecancerearlydetection/prostate-cancer-early-detection-acs-recommendations

AUA Guidelines: (Weak Evidence)
/www.auanet.org/education/guidelines/prostate-cancer-detection.cfm

MSKCC Guidelines: (Aggressive Screening)
/www.mskcc.org/cancer-care/types/prostate/screening/screening-guidelines-prostate

Note: The United States Preventive Services Task Force currently has the well known Grade D recommendation to NEVER screen for prostate cancer. But I think that is melting away right now. When they were working on that paper (T. Wilt et al) the scene was different. At that time there was a tendency to try to treat every detection. But that has declined a bit and in addition we have new tools that are in development. I also note that there is a current discussions at the USPSTF to reconsider the Grade D. But the problem remains that we need better data on when and how often to screen.

Tony, thanks for adding handy links for others to use and see what the medical professions are recommending. You forgot to include the ASCO recommendations, found here:
http://www.asco.org/practice-guidelines/quality-guidelines/guidelines/genitourinary-cancer#/9501

It's worth noting that NONE of them recommend "routine" PSA screening, and ALL of them recommend what I have been advocating here. I'll just use the ASCO recommendation as an example:

• In men with a life expectancy <10 years,
• it is recommended that general screening for prostate cancer with total PSA be discouraged, because harms seem to outweigh potential benefits.
  
• In men with a life expectancy >10 years,
• it is recommended that physicians discuss with their patients whether PSA testing for prostate cancer screening is appropriate for them. PSA testing may save lives but is associated with harms, including complications, from unnecessary biopsy, surgery, or radiation treatment.
  
• It is recommended that information written in lay language be available to clinicians and their patients to facilitate the discussion of the benefits and harms associated with PSA testing before the routine ordering of a PSA test.