Avoiding PSA tests for prostate screening

Just saw the NBC Today show this morning, and their doc on there was agreeing with the mantra that PSA tests for routine screening are not advised.

I know we've been through this topic before, I just consider it a bit of an insult - I wouldn't be here today (and I am sure many others on this forum) if I hadn't had a "routine" PSA test that would have been against the new guidelines. To say that my life isn't worth a $100 blood test just seems ridiculous.

What I think we really need is better versed docs and general public about when PCa is not likely to be life-threatening. In other words, I think that the problem is that too many with the indications of "active surveillance" are either recommended surgery, or the tendency of most in that category want to "get rid of it". That is where the effort needs to go - not recommending to the public that PSA tests should not be conducted.

Jeff

If I had not gotten PSA done and had a baseline, I would not have know that I had PC.  I did the active surveillance for awhile until my PSA took another big jump and then dropped to the lowest it had been in 2 years.  Got to be nerve racking.  I went ahead and had RT.

I heard the whole thing on NBC and read it in the paper.  I am not really sure what this group really is trying to do.  They were the same ones that wanted to stop mammograms.

Mediare came out and said they were not going to follow the reccommendation, so I guess most insurances will follow Medicare and not the panel.

I do agree that there needs to be something better than a PSA that will actually detect PC and know what kind it is besides having to do a biopsy.

"No biopsy, no surgery, no catheter, no incontinence, no ED. Talk about feeling screwed, I sure wish I had known then what they're telling me now." <Phenom>

Why? Dying of prostate cancer is NOT something to look forward to...In my opinion, the side effects you are enduring are a small price to pay for that PSA - Undetectable result....

Abandoning routine PSA testing will certainly double the men who die every year from prostate cancer, from 32,000 to 64,000. The number of men who are diagnosed every year will plummet from 232,000 today to probably half that number. Billions of dollars will be removed from the treatment gravy train....HT will become the predominant form of treatment...

The group did not recommend against all breast cancer screening, only against women age 40 - 49.

Screening for PCA with PSA is controversial. Unfortunately, we men got stuck in an era with a suboptimal test for PCA screening and the inability to determine whether or not low risk cancers will progress. 50 years from now, they will look back at this era and say"What a mess!". But we are dealt a hand we must play.
Donate to PCA research!

Sadly, I think you guys miss the point of the recommendations. The studies basically show psa screening does not improve survival from prostate cancer so why do the test? Lots of us (like me!) are getting surgeries and radiation resulting in ED and incontinence for absolutely no benefit in terms of survival rates. The 30,000 men who die in this country each year from prostate cancer would have died anyway regardless of finding out from the psa test is the point.  Ending up with bone mets which can be painful from advanced prostate cancer doesn't matter if you're still alive. QOL is not important.That doesn't affect the stats on mortality. You're still probably gonna die from something else. You can argue about the methodology all you want but I think we've been sold a bill of goods by the urological community, perhaps not on purpose but due to a faulty test.  As somebody else already said we are in an age of medicine where an indicated test appears to tell us that we might have a problem but nobody really knows for sure. So do what you think is best: stick your head in the sand and don't be tested, active surveillance, surgery, radiation, cryo, HT. You be the judge, because nobody else has a clue as to what you should do........

If this advisory group is looking at statistics, why not look at the statistics from 1980 let´s say. How many men died of PC then, and how many men in 2011 in the era of PSA testing. Adjusted for population growth, it should tell us something about saving lives.

The whole story seems a bit hypocritical to me. The people are basically bean counters. The same type of statisticians that are employed by insurance companies. I'm not saying there's no value to bean counting, but they can't have it both ways. We have experience on this site of guys in their 30's, 40's, and 50's who were turned down for life insurance based on an elevated PSA. Moreover, these guys might not have ever been found to have PCa if not for the insurance company's own protocol.

If the PSA is an important enough indicator for the bean counters to deny life insurance coverage, then obviously they have SOME info that there's a longevity danger for guys who have an elevated test result. To me, this says even more as to the importance of the test because they deny guys outright for an elevated result. So for these same types of bean counters to say that the PSA is not necessary as a part of general physical examinations is ludicrous... especially as it pertains to guys under, say, 55, who if they make it 20 years with whatever level of PCa they have, just barely make it to their life expectancy if everything else goes well.

If they're arguing against the PSA test being a regular part of physical exams or normal health screenings for guys over 55, personally, I still disagree with them. Since there is no way to determine the aggressiveness of the cancer, having information which is factored into every treatment course, is essential. Does the PSA test lead to overtreatment? Who knows. Probably now, it does in some ways. But you'll not find me getting into an argument with a guy who has had informed medical conversations with his doctor about treatment.

I will concede that a PSA test for an 80 year old guy seems a bit much. But again, from my perspective, this is a doctor / patient decision. The bean counters can't have it both ways. When they stop testing for PSA in life insurance, I'll start to wonder how important the test is. Until then, if they aren't willing to bet on a guy less than 55 with an elevated PSA with their money, I'm not going to change my opinion as to the importance of the PSA with guys under 55.

Does Canada do PSA screening?

What changed in 1993?  According to the NCI SEER dada base, prostate cancer deaths peaked in 1993 at 39.3 deaths/100,000 pop.  By 2009 the rate has dropped to 21.99 deaths/100,000 pop.  This is about a 44% decrease.  Interestingly, PCa incidence/100,000 in 2009 was about the same as the mid 80s.  The USPSTF claims the decrease in deaths was too large to be attributed to PSA testing but was due to improved treatment.  Here is a link to the NCI data: http://seer.cancer.gov/csr/1975_2009_pops09/browse_csr.php?section=23&page=sect_23_table.06.html.  A lot of interesting data if you like facts.

Carlos

It was interesting to read mtsarpilot's post in this thread and then mspt98's comment right after it. Clearly, mtsarpilot, with all cores positive, Gleason 7 (3+4) and a positive margin at a relatively young age was headed for a serious problem with PCa that was likely averted by the PSA test followed by treatment. I don't see how someone can read mtsarpilot's post, and many others like it, and conclude that we've been "sold a bill of goods" by the urological community.

Others are more like me, 65 years old at diagnosis. My caring physician had included a PSA test in every physical after I turned 50. The numbers began to rise, going from the low 2's to the 3's, then the 4's, then the 5's, and finally above 6. Only then did I accept his advice and see a urologist who felt a palpable tumor and scheduled the biopsy. Like so many men, I thought I was bulletproof, and only the PSA numbers finally convinced me that I needed to see a uro.....well, that and the fact that I worked at two funerals for men who died of advanced prostate cancer. Remove the PSA test, and how do we convince our hardheaded brothers that prostate cancer may be growing in their bodies? Don't we care?

I would also add that the funeral director where I work has often commented that the listed official cause of death (on the death certificate) often doesn't adequatelly describe what killed a man. It may just read "cardiac arrest" or something similar, when the actual cause was failing health caused by prostate cancer or some other more specific cause. So, I take a lot of these numbers with a grain of salt. 30,000 may be a really lowball number.

I spent part of my life as an educator, and I simply refuse to accept that ignorance is better than knowledge, especially when our health and our lives depend on the knowledge. Data can be manipulated, but common sense should always prevail.

It's only a recommendation,probably politicaly motivated to save money!We who all who have had PCA definately have a bias opinion with justification.I feel it comes down to you and your own health,if someone in your family has had PCA,then it's a no-brainer to have screening.It's all about risk,if your in the low risk you may not need the test,but everything is a gamble.The statements about the cure as bad as the disease can only be judged by those who have had it,all else are number crunchers who live by metrics   Metrics don't always give you the best information to make a decision,they are only one part that should be considered with persons general health,age,past family history.Unless you have any kind of cancer or you have had medical expirence by being a doctor who has seen hundreds of cases,your recommendation is unfounded.Most Uro's do not agree with this anyway!Things change as do time,hopefully,the results will be a better test and better treatments ,less evasive surgerys!I have friends who died in only eight months after 1st test,KAISER DR decided to treat him with vitamins ,psa went from 5 to 10 in 4 months,so you don't always have time like they say! your health is your health!It's your decision!

GAMMS

Vibes, you are one of the 139,000 men diagnosed with PC every year that does not need to be treated if you buy into Brawleys and the ACS line that over-treatment of indolent cancer is a big problem..

After your follow-up chat with your Urologist, please let us know what your future plans are...

To get up to speed with your condition, "A guide to surviving prostate cancer" by Patrick Walsh is a good read....

Hey, welcome to the club nobody wants to join....

What part of "NO POLITICS" do people not understand?

GOP - Thanks, you did it.

Locked.