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Addendum to recent Forbes article on PSA testing

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Posted 4/9/2017 4:41 PM (GMT 0)
In the April issue of the AARP bulletin there is is an article titled "The great prostate cancer screening debate". This article includes some high risk definitions and guidelines for who should get the test and how often. Dr Eric Klein of the Cleveland Clinic recommends a baseline for men 50 and higher risk men at 45, followed by periodic tests depending on baseline results and symptoms. For men age 50 with PSA <.7 one test every 5 years; those 60 and older with 2.0 or lower might never need another test.

One particular statistic I found disturbing in a 2013 New England Journal of medicine article reported that 15 years after diagnosis, 87% men who underwent surgery and 94% of men who had radiotherapy were unable to achieve an erection.

I have to wonder if the average age at diagnosis is say 65, then ED at 80 years old may not be attributable to treatment.
Posted 4/9/2017 5:57 PM (GMT 0)
hr, ya, age adjusted ED is something that never gets looked at. Neither does any level of correction based on advances in technique or experience of the surgeon or radiation group. Dr. Klein has a great reputation, and his voice is important...and maybe he's heading in the right direction. And what about the low PSA but nasty cancers that are out there? (rare but real)
Posted 4/9/2017 6:05 PM (GMT 0)
My PSA at age 50 was .60 and at age 60 was 1.47. If these guidelines had been in effect I might never have had another PSA test after age 60. My dad had PC so maybe that would have put me in the higher risk group and more frequent testing.
Posted 4/10/2017 3:51 PM (GMT 0)
Complete erectile dysfunction ("unable to achieve an erection," as you have described it) affects about 15% of 70 year olds. Mild ED affects a higher number.

I agree with you that the post-PC treatment numbers are "disturbing."

What about urinary incontinence? What about rectal incontinence? Rectal bleeding? What about the rest of the long list of prostate cancer treatment side effects? It's disturbing...but to me it's most disturbing for the greater than one million men alive today in the US how have been over-diagnosed and over-treated. It's one thing if you in the smaller group of men that need the treatment and have some limited number of options; it's a completely different thing if the treatment is unnecessary and you haven't been given the opportunity for a well-informed shared decision-making process with their physicians.

Thankfully, the most recent rendition of the AAFP Guidelines (shown below, ref. the Forbes article) will continue to help improve the overall quality of care men receive in this country while also reducing the "disturbing" trend of over-treatment:

    (1)There is convincing evidence that PSA-based screening leads to substantial over-diagnosis of prostate tumors. (2)Many tumors will not harm patients, while the risks of treatment are significant. (3)Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by patients.


Post Edited (JackH) : 4/10/2017 1:15:20 PM (GMT-6)

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