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.

I'm wondering when the little brown ribbons are coming out for prostate cancer awareness...

It depends, the PSA test, costs around $50 or so, screening companies love it, because they make money off it, insurers hate it, because it doesn't take many patients to end up a serious amount of money, and then premiums go up and those paying the premiums complain, because of the cost. Think of a company that has 10,000 employees of which half are male, that's 5,000 tests at a cost of $250,000 someone has to pay that....

The real question is, how many cases of prostate issues are found via the PSA that are not found through the physical exam.

It's too bad that we have not had an oncologist chime in...possibly I can get mine to register. I had no symptoms of prostate cancer but took the PSA test as part of physical. Tested PSA was 6.7 and was sent to a urologist who did a biopsy. Biopsy indicated cancer. Three doctors said that I had to do something about it. I did radiation treatments then radioactive seeds and was ready to ride a bike within a month. PSA fell no lower than 1.2 and after three years my PSA has started to climb. It means that when they killed the cancer in my prostate there was cancer s already out of the prostate. I believe that the PSA test and treatment also has given me another three years on top of the ten years my oncologist tells me I should have left.

I listened to a Doctor on NPR radio talk about the PSA testing controversy and he had some interesting statistics. I think he said that 7 of 1000 men who have the protate removed die from complications of the surgery. He said that even more patients die within 30-60 days from strokes and heart attacks that are somehow a result of the procedure. Statistics tell us that 40percent of men that have the procedure become impotent. Another 40-50 percent end up incontenent to some level. There is also a general tendency to rush to a judgement that something needs to be done to treat the cancer as soon as it is diagnosed. There are many other complications from prostate cancer treatment that aren't mentioned here. Although I can't write my name in the snow like I could when I was 20 years old I was fortunate enough to escape all these complications except for the big one...I still have cancer.

This new PSA testing controversy is a good thing because it is a reevaluation of what the medical community has been doing for us(and to us) for the last 10 years. No body has said that treatment hasn't saved lives. They are just questioning how many people they have made miserable in the process.

This is a question that everyone needs to answer with help from their doctor. Everyone needs to MAN UP here. This ain't about insurance companies , politics and money. Live your bucketlist everyday, treat people right and cherish the time you have left because soon we'll all be dead anyway.

As I understand it, the problem is not that detecting prostate cancer is difficult. The problem is distinguishing aggressive life-threatening prostate cancer from other prostate cancers. The statistic is that something like 50% of men have prostate cancer at the time of their death, but did not die because of prostate cancer.

There is an evaluation called the Gleason Scale that attempts to evaluate growth rate of the cancer cells, but there is a lot of science and medicine left to learn.

Sorry to use the jargon "herd level". That is common nomenclature when something affect the whole population. It isn't a matter of the outcome. It is a matter of the focus. Herd level vs. Individual.

The fact is that depending on one's personal financial status and health plan, or lack thereof, if a study convinces the policy makers to remove something from the approved list it becomes unavailable. Also, if a certain drug or test does not meet the manufacturer's profiit goals it becomes unavailable. Reduced use can bring that result.

To me the bottom line is that by and large tests are not to mechanically determine a course of action. They produce information for an intelligent analysis. It is that intelligent analysis and discussion between provider and patient that brings an acceptable course of action.
Too many, including some who have posted in this thread, appear to be unwilling to accept the ambiguity and the necessary patient participation that is today's reality.

I think the authors of this recent PSA data analysis and recommendation were guided by the medical ethic of "First, do no harm". Wise words.

There has been an excellent series of articles on this subject in the NY Times starting last week. I particularly liked this one:

http://www.nytimes.com/2011/10/09/ma...tml?ref=policy

Wise words but not what guided the authors. They were guided by the desire to determine on a population wide basis whether the test was economically and procedurally worthwhile. Such studies are actually pretty common. The uproar about mammography was the result of such a study. Whether we like it or not much of our medical care is determined by political and economic factors at corporate and governmental levels. Bottom line we are talking about money.

From what I know this study could just as well have recommended better analysis and interpretation of PSA data resulting in better post test actions. It certainly appears the damage comes not from the PSA test results but from ill considered actions from physicians and patients. Of course the providers make more money from those actions than from patient counseling so maybe that might be an area deserving more focus.

Added after intervening post while I was typing:

Since the NYTimes article is in line with my thoughts it is the absolutely best thing :) .

Excellent article. Confirmed my intent to just say no to the PSA test.

Isn't that the new recommendation? That only certain women with risk factors start early on the mammograms? And the rest start later than they do now if at all? At least with women, there's some radiation in the mammogram, so there's a potential harm due to the test. Not 50+, but thought I'd chime in as I've started getting my PSA at the checkup (I'm not good about going in yearly, but when I have gone in I've had to ask specifically for it a couple of times). With some relatives recently getting theirs out (and some great grands dying of what we think is prostate cancer in their 40's), my mom's been pushing me to get it measured regularly since I hit 30. Since, they're drawing blood for my cholesterol and triglycerides and everything anyway, what's the harm in one extra tube drawn? Now, yes I'm getting the finger pushed off as long as I can, but I've already been scoped down there once and it ain't the end of the world.

I'm hoping the research into prostate cancer will give us the equivalent of BRCA1 and BRCA2 alleles that are indicators of increased breast cancer risk so that only those with heightened risk for prostate cancer (like my family history of it) will have to get tested more frequently and younger. I think it was my human physiology professor (or maybe it was anatomy) that said it was something like 80-90% of men over the age of 75 have at the very least an englarged prostate, but at that point in their lives the treatment was more likely to kill them than the cancer.

I know there will always be two opinions on a subject like this but as person that has had ProstateCancer- Can any of you "Doubters"- tell me of any other simple test that will indicate that there is a possibility that you "May" have P Ca.

I can't.

I know a high PSA count is not definitive of P Ca and I have work mate that has a PSA count of 27 and has been at that level for at least 15 years and Biopsy's show nothing. The DRE on me at the doctors indicated a problem- PSA count of 16 showed something amiss- Biopsy showed Cancer. I was lucky.

There is no other simple test. From the articles it sounds like other than PSA you go with a biopsy based on clinical symptoms. If I was in himespau's situation I would probably elect to have the test. Prostate cancer runs in the family, hits early, and kills so his cancer is much more likely to be disastrous than the average Joe's. For the average Joe the calculation is more difficult. Even a positive biopsy may not call for treatment. Once we get into our 70s the treatment is likely more dangerous than the disease.

My last post on this subject. I have to agree that after a certain age, screening on a regular basis is not necessary as you will most likely die from causes other than prostate cancer. The thing that I am seeing a lot of people miss here is that PSA, in itself, is not an indicator of prostate cancer, but you need to have some base line results to start with. Elevated PSA can be present with several conditions. It's the PSA Velocity that is a red flag for considering prostate biopsy and not just an elevated PSA. However, in order to know what the PSA Velocity is, you must have more than one PSA test at least one year apart.

If you wait until you have symptoms, you already have the cancer and the amount and type of treatment will be determined by the Gleason Score which is determined by the biopsy. I have been through this and I wished that they had found the cancer when my Gleason Score was low and I could have gotten away with just having the brachytherapy. Had I waited or not had another PSA test done to see what my PSA Velocity was, the cancer would have broken through the prostate wall and gone into the surrounding tissue, bone marrow and/or lymph nodes. If this is about cost effectiveness, see what it costs if the cancer gets into the bone or lymph nodes and see how much your life span changes.

I'm sorry if you guys that think that screening is not necessary until you get symptoms because it's a pain in the ass to go get screened. But if you are in your 50's or 60's, I think you would be singing a different tune if you get prostate cancer that has a high Gleason Score and then you have to go through all sorts of crap when you could have nipped it in the bud had you found out earlier. As someone previously mentioned, the bottom line is money and I pay my money to the insurance company to cover preventive tests.