The recommendations make excellent sense to me. It seems many have only read the headline or a news brief.

I had an injection, don't remember which one, and 6 months of Casodex. I'm no longer on it.

What recommendations, the ones in the study or those you read here?

The problem is that way too many patients don't get involved and is what I meant by "the problem is more the patient than the doctor." With the information available to us today, there is no reason for someone being diagnosed with any type of disease to not understand it and not have a say as to what is going to happen to them.

When I was told that I may have leukemia by my primary care physician, I read about the different types of leukemia for almost a week-and-a-half, learning everything I could possibly find out about the disorder. When I met my hematologist for the first time, I was prepared and able to understand everything he was going to throw at me. I didn't just sit there and say, "OK! What do we do now?", and leave it to him to decide what was going to happen to me. The choices I made came from being well informed and fully understanding of what I possibly had. I didn't get a second opinion for the leukemia since a bone marrow biopsy was the only way to know for sure if I had this particular type of leukemia and any other hematologist would have ordered it as well. I did, however, seek more than one urologist opinion when the possibility of prostate cancer was brought up, even though my PSA Velocity pointed in that direction.

You can read all you want about PSA testing and Prostrate cancer.......Then, depending on your results, you might as well use a weegie board to decide your next step. Excellent PSA scores does not necessarily mean you don't have prostate Cancer and bad PSA score does not necessarily mean you do.......a

Exactly.

I think you misread the study. By your reasoning, no medical studies or analyses could be worthwhile.

He read the study properly. The study shows that the testing isn't worth the dollars, using whatever scale they use. But, economics aside, is the savings worth it? What does the test cost when it's part of a panel the doc is doing anyhow? As far as I'm concerned, my specific dollars will be used to pay for my specific test - if an economist says I can do more with that money elsewhere, well, it's none of his business. I will continue to spend my money on the test, thank you.

Not at all. From a herd viewpoint it is very useful to be able to identify risk and assess its' probability and cost. It is also useful to know just how accurate the measuring stick is for that risk. Also, resource allocation decisions by insurance companies, health authorities and governments are aided by population wide studies.

On the other hand unless a specific test is 100% accurate the best it can do for an individual is give probability. Where the likely individual falls on the probability line is a matter of judgement in light of other known factors.

It is just a matter of knowing the purpose of the study and the associated metrics. This study and associated test were for herd resource allocation, not individual benefit.

Agree. And, we are getting just a bit closer to "Death by Committee" IMHO.

After all this back and forth about what the "study" said I read the linked article (It isn't a study, it is a recommendation based on a lot of studies). What it says (or at least what I think it says) can be distilled to this. Most men who get a positive PSA test will go on to get a biopsy. But about 80% of those results are false positives so those guys get the negatives of a biopsy for naught. Of those whose biopsies show a cancer almost all of them will have treatment even though though most of the cancers would progress slowly and never have resulted in clinical symptoms before death from other causes. The aggressive or otherwise dangerous cancers will be detected later by clinical symptoms and would then be treated anyway. So the net result of screen is a lot of angst and earlier treatment of some cancers. It is those few guys who will get the earlier treatment of dangerous tumors that we are concerned with and why some of us have supported getting the screen. BUT, the statistics show that the benefits are minimal or none. The studies found NO advantages from screening for men over 70. And the studies showed marginal if any benefits for men 59-70. From the recommendation: "The evidence is convincing that for men aged 70 years and older, screening has no mortality benefit. For men aged 50 to 69 years, the evidence is convincing that the reduction in prostate cancer mortality 10 years after screening is small to none." If all of this is accurate then most (maybe not all) of the guys who got early treatment due to the test/biopsy would have gotten treatment later due to clinical syptoms and would end up with a similar result. The recommendation is to rely on clinical symptoms, not PSA screening to counsel a biopsy and subsequent treatment if a cancer is found. They are saying YOU are better off waiting for symptoms before getting a biopsy. This is not a cost tradeoff it is a straight benefit to you recommendation. Here is another quote:From a money perspective it seems like the test simply pumps money into the medical system with no evidence that the money makes a difference. Since the advent of testing a million men have had surgeries/radiation who would not have had them otherwise: "From 1986 through 2005, PSA-based screening likely resulted in approximately 1 million additional U.S. men being treated with surgery, radiation therapy, or both compared with before the test was introduced."

I plan to talk to my primary care physician about this at my next physical. My inclination would be to skip the PSA screen and rely on clinical symptoms. But I would be open to a rational discussion about why I might be wrong.

You're overlooking that it's not just about money or allocation of healthcare resources. Quality of life factors into this issue: Some of the men who receive aggressive treatment become impotent or incontinent as a result of that treatment. Very severe side effects resulting from treatment of a problem that may not be life-threatening or that may not cause significant health problems in an individual.

donheff:


Not going to disagree with you at all. You have looked at all the information available to you, analyzed your own personality and health and made a decision. To me, that is exactly what should be done.

I want the results of the test so that I - repeat - I - can make an informed decision as to risks, benefits and a course of action. If they take the test results away from me, then I no longer have a full base of information for my decision.

I see, following from this recommendation - Medicare and HMO's and insurance companies refusing to pay for the PSA, although I doubt, in a blood screen, that it adds much to the cost. Now, I would pay extra for the test results, but not all can.

So, I see a committee making a health decision for me as regards my getting all the info I need to make more valid decisions. I don't know whether or not I would have a biopsy, but I want that choice. I want to make it myself, not some committee.

Historically, I have made several very significant medical decisions AGAINST the "common wisdom" and "medical advice" for my son and for myself, and now for my wife. These were made after extensive research, consultation and thought - and in each case, I was right, and the medical world was wrong.

Nobody is taking anything away from you. It sounds to me like you are working a political agenda, not a medical/scientific one.

I don't know where you get that. Yes, I do see the results of this task force's recommendations eventually removing the PSA test from those paid for by various health providers. Medical or political? I guess they are sort of hard to separate in today's rather complex medical/political environment. I seriously doubt there is a pure medical/scinetific agenda. Do you think that there are any medical/scientific decisons/advice separated in some way from politics?

Let's play that tune. Let’s say your PSA test comes back elevated out of the normal range and the digital exam shows your prostate enlarged. You now have the info from the tests you wanted. Tests you can get regardless of the recommendations in the study you referenced. OK. What is it you think you now know? What is your next move?

Not trying to be a butt. My own GP, My Urologist and even my own daughter (Ya, she is also an MD) informed me of the PSA controversy early in the process. The controversy regarding routine PSA screening, and the results, have been around for a long time.

Bottom line; the majority of men on this forum, if they are lucky enough to live long enough, will die with prostate cancer, not of prostate Cancer.

Should men be tested routinely? Hell, I don’t know. I just know it is not the silver bullet like the current crop of movie stars and sports figures pimping the tests on TV would have you believe.

There are a lot of variables that you haven't included in my decision-making process. The PSA is only one of the factors in the decision to be made. Other factors? My age. The rate of increase in the PSA from year-to-year. Results of digital examination. Family history. Any changes or possibilities of various types of biopsies. Ultrasound? results. My general health at the time. Family responsibilities and current marital status. Alternative holistic medical options. Current research and trial procedures, Etc., etc.

Since my digital exam and my PSA test are indicative of absolutely no problem at this time, I have not pursued any of the above. But, the above, at a minimum is what I would consider.

I think that a doctor's have become too reliant on certain tests, rather then doing some actual doctoring to resolve a problem. Say you go to your doctor and they do the finger test, hmm, feels a little off, then run a PSA test to see if it needs further investigation, if it does, then do an Ultrasound and take some measurements to see how enlarged the Prostate is. If it seems cancerous, then they can look into doing a biopsy and see if it is cancerous, if it is, then they can treat it.

Whenever though, I see a paper like this, I want to know who funded it, the PSA test is expensive, so an Insurer might not want to cover it, they would be willing to fund studies that prove against the test, to justify it. Here in Ontario, Canada, the Liberals promised to cover it for all men over 50 if reelected and they were, this will cost about $30 million dollars a year, but this may be one of the things that goes away if provincial budgets get tight.

Sure, pure scientific research . . . no politics here. :eek:

That is what the entire controversy is about. Your current test results do not mean you don't currently have prostate cancer and are not in need of treatment.

Anyway, we really aren’t going to get to far with this. That is why it is called a controversy.:D

Always a possibility, but IMHO, a very low probability. There is a lot of evidence re: PSA, digital exams, etc., providing good info. I think the argument is not whether or not one has cancer, but, rather, is the "cure" necessary and worth the cost and risks.

Yup, that is also true.

Heck, it's not easy be'n a guy:lol:

They also recommended pushing back mammograms to some ridiculous age, then reversed that position. Wife is an oncologist and says stick with 50s.

The issue with things like the PSA test is that a lot of it has become political, because a lot of guys don't like the goop up the rectum, but that is the only other way to check the prostate, in a screening process. That has less to do with science then it does with trying to buy the votes of men over 50, and the women in their lives who need to listen to them complaining about the goop. It wasn't entirely successful, in that they went from a majority to a minority and that in itself may kill this, because they need to convince the PC's (right wing) or the NDP (left wing) to back them on it, in order to have it pass.

Interesting conversation. My concern is that like other things this study will be used by the people who actually matter to the medical community, the insurance companies, to deny coverage for the PSA.

I have had the annual PSA since about 1989. At that time it was relatively new and they were trying to test a wide spectrum of people so to get better data. During the years since then I've had more than one spike of very high PSA. The spikes have been in the double digits and served as a yellow flag that something apparently abnormal was going on. In each case, after appropriate further testing and, most important, intelligent analysis, we decided what the most likely cause was and proceeded. In each case we were correct and PSA levels returned to normal. But, the PSA served its' purpose. It was the alarm bell that focused attention on a problem. In each case the problem wasn't cancer but without attention could have been very serious.

I don't want the herd level political and economic decisions to remove my option for this test.

I was going to try and come up with my own well written point of view on this topic, however, Donheff did it quite nicely in his post ("41). I get a PSA yearly but only because my MD orders it when I go for my annual physical.
As an aside, the PSA test is not meant to replace the "finger" which also should be done as part of a complete prostate exam.

I still don't understand why some of you think you are going to be denied something, or have something taken away from you. In the worst case, if your insurer stops covering the test, you can still pay the $100 or so to have the test if you feel it's necessary. That's the cost of a new saddle or a headlight, or something similar most of us are already spending too much on ;-)

And what's this"herd level" thing? A study or data analysis whose conclusions you disagree with is "herd level"? Would you have described it as "herd level" if the conclusion was that PSA tests should be continued or expanded?

PSA screening is hardly more than habit and tradition. Contrast it to ultrasound screening of carotid artery. Screening companies are pushing it all the time. It is cheap and safe. But I bet most of you don't do it. You and your doctor never got into the habit and evidence based medicine stepped in first to not get you in the habit. Without symptoms there isn't a good reason for the screening. The bottom line is that the test for asymptomatic people does not do more good than harm. Same with PSA.

+1

This is not the first study I've heard about making a similar recommendation. The cost in the cost/benefit analysis as I understand it is not so much about money as about pain, worry and reduced quality of life resulting from unnecessary treatment and invasive testing following elevated PSA readings. I plan to tell my doctor that I don't want the PSA test, but I will take his opinion into consideration.