Originally Posted by
neurocop
What you need to know about studies like this one on the value of PSA testing is that they draw their statistical conclusions from populations rather than individuals.
A negative test doesn't absolutely exclude prostate Ca, but for all practical purposes it does exclude it. A high PSA (>5) level is suggestive of Ca, but could be due to relatively benign things like prostatic hypertrophy or a low level prostate infection. A really high level (say >20) is highly suggestive of Ca.
A high PSA may lead to invasive and potentially harmful procedures, like biopsy, and it's clear that subjecting everyone over 50 to PSA testing will lead to many arguably unecessary biopsies. It will also lead to lots of expensive testing and even risky diagnostic procedures, at least as far as the healthcare expense beancounters are concerned. But it is also true that such testing will, in a certain number of cases, allow for the detection of early stage asymptomatic and curable prostate Ca...For those "individuals" the routine PSA testing will be life-saving.
There's another angle to all this. Prostate Ca is fairly common in older men...the incidence increases with age, and the majority of men >75 years old will have cancerous cells in their prostates. Few will die from prostate Ca. ...This doesn't mean that prostate Ca is nothing to worry about. Prostate Ca is serious business. It is particularly serious when diagnosed in younger men, where it typically presents more aggressively than in older guys. And it is this younger population that will suffer from the conclusions of this study.
For the purposes of full disclosure, I am a physician. I was aware of this study's recommendations about routine PSA testing in "younger" men, but I chose to get tested when I turned 50. The result was negative. I plan to get tested every 5 years, rtegardless of symptoms, and if my PSA becomes elevated I'll procede accordingly.
Good post and covers all the bases that we have been discussing. But it doesn't help me with the underlying dilemma: as an individual how do I balance the risk/reward? Your approach appears to rest on the intention to catch any possible cancer and treat ALL cancers. Or, at least, to do so at younger ages. The studies seem to me to be saying that overall the risks outweigh the rewards, i.e. you are
individually better off risking a small chance of a bad cancer outcome to avoid a much higher chance of a bad unnecessary side effect of PSA testing/treatment. It is this choice of balance that is so difficult for many of us to sort out. Also, you don't address how (or if) the balance changes with age. For example, if I accept your premise for testing at younger ages what about when I am older. If I stayed low on the PSA scale into my mid 60s, 70s, 75... is there a point at which I should figure everybody starts getting CA at this point and treatment may not be worth pursuing (thus time to stop screening)? It seems to me that at bottom line this is not really a medical question that can be answered for us by a knowledgeable physician. It is more of a personal lifestyle question that includes evaluation of rapidly changing medical facts - I guess that often is the case with cancer. There are a lot of possible approaches to this risk/reward dilemma (test and treat at a relatively low PSA; test and treat only at a very high PSA; test and treat only with rapid acceleration; and possibly cut off testing at a given age). I would like to see more discussion about the impact of those alternatives and the risks/rewards involved.