PSA testing, worth it?

[WillBrink]

Doctors group questions prostate cancer screening

NEW YORK (Reuters Health) - The American College of Physicians (ACP) became the latest group to ask doctors to be clear about the limited benefits and "substantial harms" of prostate cancer screening before offering their male patients a prostate-specific antigen (PSA) test.

The ACP's guidance statement, published Monday in the Annals of Internal Medicine, also explicitly recommends against screening men younger than 50, older than 69 or with less than 10 to 15 years to live.

Men in their 50s and 60s may weigh the potential benefits and harms of PSA testing differently, which is why the idea of shared decision-making between patients and their doctors is so critical, said the ACP's Dr. Amir Qaseem.

"It's important to sit down and explain everything to the patient and then if someone wants to be screened, that's okay," Qaseem told Reuters Health.

The concern with screening is that PSA tests catch some cancers that never would have affected a man's life because they are so small and slow-growing - yet treatment can cause side effects such as incontinence and impotence.

And there's still disagreement about whether regular screening saves a significant number of lives.

http://www.nbcnews.com/health/doctor...ning-1C9268595

[montanadave]

The data with respect to PSA screening and digital rectal exams is certainly a mixed bag, to be sure.

I'm in my mid-fifties and my dad was diagnosed with prostate cancer at age 64. He underwent a radical prostatectomy following his initial diagnosis, had a recurrence about ten years later, had radiation treatment, and just turned 87. I'm guessing something else will probably kill him first (like the batteries going dead in his TV remote).

With my family history, I get a yearly PSA screening and generally have my doc give me the rectal exam every other year. I've only had one scare with the PSA. Followed up with a urologist, did a second PSA, and it had fallen back into the "normal" range.

My opinion is I'd rather know if something's up and have the option of making my own informed decisions about how I wish to proceed. YMMV.

[Army Chief]

Have seen this in the news more frequently of late, as well as discussion on the over-reaction to cancer and cancer-like diseases in general. Obviously, my own perspective has been re-shaped by the events of the past year, but I get the sense that many men have over-responded to this particular threat in recent years. That is likely the result of benign ignorance on the part of the patient, as well as a desire to treat/prevent on the part of the physican, but we seem to have arrived at a point where some long overdue questions are finally being aired. Perhaps this is the male equivalent to the Caesarian Section, where the procedure reached the point where it was (and is) being done out of convenience, or just to prevent a complication, as much as out of necessity.

I've known a handful of men who went through treatment for this, dealt with the recovery and post-op issues and ended up right back where they started a few years later, like Dave's own father. I don't know anyone who waved-off and denied care who ultimately succumbed to the condition. Granted, my sample size is useless, and my illustration largely anecdotal, but I don't get the impression that this is as big of a killer -- or lifestyle modifier -- as we've generally been led to believe, given the unusually slow rates of growth which seem to be typical.

Tough call, to be sure. Would I want to be tested? Sure. Would I want to rush into an aggressive treatment protocol if the numbers were way off? Not necessarily. I've learned far too much about cancer over the last 12 months, and have come away with an appreciation of the differences between the ones that kill you in three months and the ones that just sort of aggravate you for 30 years.

Sometimes, just sometimes, the cure really is worse than the disease. Somewhat less likely is the chance that there may actually be a good point in this wandering missive.

AC

[WillBrink]

Have seen this in the news more frequently of late, as well as discussion on the over-reaction to cancer and cancer-like diseases in general. Obviously, my own perspective has been re-shaped by the events of the past year, but I get the sense that many men have over-responded to this particular threat in recent years. That is likely the result of benign ignorance on the part of the patient, as well as a desire to treat/prevent on the part of the physican, but we seem to have arrived at a point where some long overdue questions are finally being aired. Perhaps this is the male equivalent to the Caesarian Section, where the procedure reached the point where it was (and is) being done out of convenience, or just to prevent a complication, as much as out of necessity.

I've known a handful of men who went through treatment for this, dealt with the recovery and post-op issues and ended up right back where they started a few years later, like Dave's own father. I don't know anyone who waved-off and denied care who ultimately succumbed to the condition. Granted, my sample size is useless, and my illustration largely anecdotal, but I don't get the impression that this is as big of a killer -- or lifestyle modifier -- as we've generally been led to believe, given the unusually slow rates of growth which seem to be typical.

Tough call, to be sure. Would I want to rush into an aggressive treatment protocol if the numbers were way off? Not necessarily. tested? Sure. I've learned far too much about cancer over the last 12 months, and have come away with an appreciation of the differences between the ones that kill you in three months and the ones that just sort of aggravate you for 30 years.

Sometimes, just sometimes, the cure really is worse than the disease. Somewhat less likely is the chance that there may actually be a good point in this wandering missive.

AC

The above brings up the essential issue that one has to be part of their own treatment decisions and look at actual risk to benefit involved of treatment vs non. I do have personal experience on the score, so I'm not suggesting anything I have not had to face myself: the risk of the illness to the risk/benefit of the treatments.

I think the med community is starting to do a better job of really looking at risk/benefit of treatments vs non, but they walk a very tight line of course.

My fathers prostate cancer returned 10 years later, and now in his late 80s, docs told him 'watch and wait' vs aggressive treatment was recommended. I don't think he'd survive the treatment for the disease frankly and it does not seem to be growing quickly.

My mother was offered radical treatment for her cancer which would have left her not living life as she viewed it worth living, and passed on the treatment. She lived a few years past expected. She never changed her mind on that.

You of course also live it day to day and have been an example set for all to see, which we all appreciate probably more than you may realize Chief.

[Doc Safari]

I think the med community is starting to do a better job of really looking at risk/benefit of treatments vs non, but they walk a very tight line of course.

Although I don't want to disparage individual health care providers, I am convinced these decisions are being made for monetary reasons rather than legitimate health care reasons. Isn't it just a strange coincidence that all of a sudden things like breast cancer screenings and other "preventive" screenings are in question after the passage of Obamacare?

I'm not trying to turn this into a political thread by any means, but as a friend of mine always said about doctors: "Never trust anyone who has a financial interest in finding something wrong with you."

[Army Chief]

I'm not sure that this is an overly-cynical question to ask, and we have to remember that most of the best care facilities also have to remain viable as business entities. I'm sure that doctors act for the right reasons, but the system is what it is, and rates, fees and billing structures are the real enablers.

In my own experience, I didn't realize that, even within the cancer game, an oncologist is not necessarily an oncologist, and specialization within the field often leads to physicians trying to "sell" the services with which they have the most direct interest and expertise (i.e. surgery versus radiation versus chemotherapy ... or all of the above). All within the same basic field of medicine, mind-you, and all trying to solve the same basic problem for the patient. There is no doubt that the underlying intent is above reproach, but it can still feel like buying a used car sometimes. More to the point, I'm left to wonder if those decisions might increasingly be made without any patient input whatsoever under an Obamacare-style system.

AC

[jcwallace]

The problem here is that level of PSA in the non-cancer crowd vs the cancer crowd has a lot of overlap. So if you want 100% sensitivity then a LOT more people would be getting biopsies. Tissue biopsy is the only definitive way to diagnose the cancer, risk of infection <1%, so not too bad. Treating the cancer with TURP can cause ED. The problem initially was that people tried to do PSA alone to screen. But DRE is better, and DRE + PSA is also better.