One of the differences amongst the opinions stated here is that those of us who used the PSA test and found cancer will continue to use the test. Those who may not be inclined to use PSA testing for themselves seem to be without actual personal experience with cancer diagnosis. I agree that all of our reported experiences of cancer diagnosis after PSA testing is not as academic/controlled as the referenced study may have been, but I will continue to take PSA tests often. It is much the same when a bureaucrat who has no actual personal experience with the process makes the decision for us. Good luck, whatever choice you make.

I recall a few years ago when the local PBS TV station in Denver, Channel 6, ran a very good program on prostate cancer and detection. Some feminists thought it repulsive or something, and that was never aired again. Until prostate cancer gets as much attention as breast cancer and all those pink ribbons, lots of guys are going to ignore symptoms and testing.

Interesting video on the subject.

http://www.youtube.com/watch?v=8MHZp...&feature=share

There are a lot of problems with the committee's recommendation-I hope they temper it a bit so men who read it don't just look at the committee's conclusion and put that aspect of their health on 'ignore.

Here is the American Cancer Societies recommendation-which is much more reasonable

http://www.cancer.org/Cancer/Prostat...ecommendations

Not having PSA tests $ave$ the in$urance companies lots of $$$!
Who was behind the 'no PSA' test dictum?
Had the finger, had the PSA, had radioactive seed implants (great way to go!) and been cancer-free for 5 years.
Getting my yearly PSA test in couple weekis.
PSA test literally saved my a$$!

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. This allows the researchers to conclude that routine PSA screening for cancer in "younger" individuals doesn't show much "benefit" (again in terms of population outcomes) compared to the "cost" and/or "risk" of such screening. The study seemed to be well-designed and analyzed. What does that mean for you as a guy who wants to catch a prostate Ca early when it could be cured? Actually, it means very little, because the study deals with "population" risks/benefits.

The PSA is a simple blood test. It costs money (about $100 for the test plus some more for the doctor visit). 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. I recall our US Senator from California, Alan Cranston, who basically escaped prosecution for his being involved in the Keating Five scandal because of his prostate Ca diagnosis...he lived for many years and died of something else. There was also that Libyan Lockerbie bomber terrorist who was recently paroled from a British prison because of his prostate Ca diagnosis...So far as I know the bastard is still alive and will, like Senator Cranston, die of "old age." 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.

Individually, my belief is that the more information I have, the better decision I can make. Simply having a high PSA does NOT mean an automatic biopsy or other treatment. That is a choice for me to make. I can't make it if I don't have all the info I can get. The PSA is one more bit of info to go into the decision making pot, along with my age, general health, digital exam, ultrasound, family history, annual change in the PSA and whatever other factors are important at the time, including potential new tests.

I do not assume that high PSA ='s biopsy, which it seems to me is the assumption being made by some folks.

We should remember that there is no right or wrong answer here; we each have to make our own decisions. The report provides additional information to help us decide.

This endless discussion reminds me of the ongoing discussions in other forums about when to start taking Social Security benefits. The point there, as well as here, is that we can't know in advance the right answer for ourselves without knowing the future. So, take your personal situation into account and make your best guess.

Good points, especially about the relationship of patient age to the usefulness (benefit vs. risk ratio) of "routine" PSA testing. Prostate Ca is more prevalent in older men (>65), as I mentioned in my earlier post, but older men seem to present with less aggressive cancer and often die of other things, regardless of how the cancer is treated (radiation/surgery/drugs). It is the younger men who would most benefit from identifying prostate Ca early, while it is still "curable." Yet it is precisely these younger men (in their 40's, 50's, and early 60's) that are likely to suffer if the study's recommendations are followed.

DnvrFox makes an excellent point about the value of having "information" to make an informed decision about your individual healthcare. I believe in giving patients as much info as possible to make informed decisions, and that's how I treat my own patients and would want to be treated by my own physician. It's a matter of respect for the autonomy of individuals. One of the things I find troubling about this study is that it seems to imply that patients are somehow to ignorant or otherwise incapable of making decisions about their healthcare.

There seems to be two trains of thought going-3 if you count the Undecided. First is that it is a waste of time and money and should not be bothered with. The other is from those of us where Prostate Cancer was detected through a PSA test and are gratefull for it.

P Ca is not a killer. It can sit in the Prostate for years without causing a problem. It can cause a few urinary problems and that could be the first sign that something is going wrong. Those urinary problems may not be P Ca but "ONE" of the tests that can be done that is very simple and non intrusive is the PSA test to see if there could be a problem. The definitive test is a biopsy and I do not want another one of those. My biopsy showed Cancer on all 6 samples. My cancer did prove to be aggressive on the autopsy but I was lucky in that it had not spread. That is the problem with P Ca- it can spread to other organs and that is when it can become fatal.

Prostate Cancer is not a problem- A few minor inconveniences in the early stages but providing it does not spread may only cause you to be never far from a toilet or a bush. But if it breaks out it can cause cancer to the liver- kidneys- Bone or any organ of the body. That is serious and not easy to Cure- in fact that is when it can become fatal within a very short space of time.

So up to you. When you get to "A Certain Age"- then P Ca can hit. I was lucky in that my Doctor decided I was of that certain age and And the Rectal examination lead to a PSA test and then the Biopsy and finally the Removal of the Prostate. 10 years later and I am still alive- aged 64 and still enjoying life. That could have ended a good few years ago.

The recommendation don't specifically call for testing in your situation but reading between the lines I think they would encourage it. They recommend waiting for symptoms to "treat" P Ca. But symptoms like urinary issues would not necessarily lead directly to biopsy but might be investigated with DRE and a PSA test to see if additional signs were alarming first. What the recommendations say is that the tests should not be routine and universal for non-symptomatic men. IIRC the tests are not routine in your neck of the woods are they?

Another issue that may counsel against routine testing is false negatives. I found this at the Mayo Clinic: "Some prostate cancers, particularly those that grow quickly, may not produce much PSA. In this case, you might have what's known as a "false-negative" — a test result that incorrectly indicates you don't have prostate cancer when you do." So routine testing may be prone to miss the unusual but dangerous tumors and catch the less aggressive ones.

A question that really needs to be addressed is the efficacy of treatment. The recommendations seem to suggest that the treatment (keeping in mind we are talking about populations rather than individuals) doesn't seem to affect morbidity. In other words, treated or not the outcomes remain the same. If this is true, then the concept of early detection is of academic interest but not useful to the individual.

I just had my annual blood screening yesterday and chose not to have the PSA. I went to the site provided by one of the posters here, the American Cancer Society, and followed their advice, which said that with a 2.5 or lower PSA screening is not needed every years. since last year I had a 1.5, I elected not to have the test this year. It seems to met that the American Cancer society is as good as any organization on advice about cancer screening. I am almost 64 and do not want to get involved in medical procedures that lead to more and more unless I absolutely have to. So it looks like previous PSA values should also play a role in the decision of getting or not getting a PSA every year.

I think what begs the question, if we give 10,000 men the rectal exam, and follow that up with an ultrasound for those that feel enlarged to confirm the prostate is enlarged, and then do a biopsy if it is. And we take another group of 10,000 men and give them all a PSA test, and a biopsy for all of those that have an elevated PSA level. Now will the group that has the PSA test catch more cancers that are aggressive enough to require immediate treatment, or will the rectal exam?

I think the main studies used for the committee to make their decisions were 9 years long. This would be sufficient data for a fast growing cancer like pancreatic but slow-growing (in most cases) prostate cancer can take 10-15 or longer to go from clinically insignificant to deadly. We need longer studies before an accurate recommendation on testing is made. It is only in the 10+ years that the morbidity between tested/untested is likely to diverge in a significant way.

And the morbidity rates of tested/untested 65-75 year old men in the study is irrelevant for a 50 year old man who has a much longer life expectancy. A lot of the 65-75 year old men are going to die of something else before the prostate cancer will get them. Not so with a 50 year old.

The problem is in finding a control group. All things being equal, if you have 100 men between the ages of 50-65 with known ca of the prostate, how do you convince 50 of them to forego treatment in order that we see what happens?

You tell the entire group that surgery will probably make them impotent and incontinent and then count how many turn down treatment.

You are absolutely correct; and not just for prostate cancer. The outcome, unfortunately, remains the same regardless of what a person does. The only two differences are life quality and timing.

When I was seeing the consultant about Surgery- there were a group of us that always seemed to meet up. We were all confirmed by Biopsy to have P Ca. Out of the 5 of us- 3 are still alive after 10 years. One elected not to have surgery and he died 3 years later with Bone Cancer. The 4th- on the table and the Lymph nodes are taken for test before surgery is done. His showed that the Prostate Cancer had spread so pointless doing the surgery. He died within 6 months.

The PSA test does not confirm or refute Cancer but it is an indicator that Further tests should or should not be done. The Biopsy confirms Cancer and the degree. There is a scale that tells how serious your cancer is on the biopsy and if you are high- then the cancer is serious and treatment should be done A.S.A.P. A Low score and it may not progress further or may be slow growing.

Now it is up to you. The PSA test is a simple Basic test that is non invasive- It is only a blood sample but unless there is a more basic easier test that becomes available- then that is the first test to be done that could save your life.

This is political. The politicians are worried about the aging population. When Social Security began in 1936, people lived an average of 65 years, now, especially in Asia and Europe, they live much longer. Americans are living longer too, although not as much. At the same time, automation is doing away with many low skill jobs, making it hard for people to work into their old age.

Resveratrol both prevents and is active against prostate cancer to some extent.

http://www.ncbi.nlm.nih.gov/sites/en...atrol+prostate

It also helps with arthritis.. I posted some links on that earlier.

Its best if you just buy the 50% powder extract and just put it in your mouth, letting it soak in. Thats what I do. 25 grams of 50% powder costs around $12.

That lasts me several weeks.

Walgreens sells 500 mg capsules that are a pretty good deal as they are just filled with that powder. There are Walgreens stores everywhere. Its more effective if you let it absorb, instead of swallowing it. A little bit goes a long way that way. It improves microcirculation and so it helps with dozens of illnesses.

The idea that a mature man should decline to see a red flashing light, no matter how dim, lest we passively fall victim to too aggressive and potentially adverse treatment is condescending on the face of it.

My 50+ colleagues, a warning is just awarning, subject to personal analysis based on the clear light of logic we have honed to acuity at great personal cost.

Give me the facts…let me investigate the background…trust me to face the realities of my own health…and accept my decisionsin regard to my fate.

We are not children.

My father told me some odd to me information about prostrate cancer.
His last 40 years as a pharmacist in public, private, then VA hospitals, gave him a lot of experience in more than this.

What he saw was most prostrate cancer patients that die, do so not from the cancer itself, but from something they came down with during treatment. Pneumonia was very common, sad to say.

My eyes popped open, so you know I'm going to talk about this with my trusted MD on my next visit. It's worth looking into.

So, those who are wondering whether the PSA test is worth taking are sniveling babies while you are a big brave grownup? Another interpretation is that you are unsure of your choice and feel compelled to denigrate anyone who thinks differently. Remember, this is a test you will continue to be able to take. The insurance industry may (sensibly) say foot the bill yourself.

Thanks for your support on a valid contrarian point of view...always heartwarming. Thanks also on the personal representation of someone you don't know.

Dude, us grownups pays our money and takes our choice.

Sorry if I misinterpreted your post. I thought you were making a personal representation of those of us who didn't share your views. I have a hard time interpreting your post as anything other that implying that we are children, not mature enough to deal with information. Maybe you can explain how it was meant to be interpreted.

Let me see if I understand the position of the "No Test" people. You, personally, would not take the test because you fear that if it is positive you might be tempted to agree to potentially life changing treatment that might not, in fact, be necessary. You want to extend this to all men by removing the PSA test from the medical repetoire. Then no man could take the test because it would not be available.

On the other hand there are many who want the test available, even with all its' warts, as one in a group of tests to be considered in assessing personal health.

Seems to me the Have It Available folks are the most reasonable. It allows each man to exercise some measure of control over his own life. BUT, like all tests, having the PSA available brings with it a responsibility to be engaged in personal health decisions and not leave them up to anyone else, including the doctor.

I have followed this thread from the beginning and NEVER saw anyone suggest any such thing. If I am wrong, please cite the post(s) that led you to that conclusion.

What many of us testing skeptics have said is that the science appears to indicate that testing (and the biopsies and treatment that follow) do more harm than good. The choice to test and respond therefore seems to be a choice to risk fairly likely harm with a small hope that you will catch a dangerous cancer sooner than you would otherwise. Some of us are wondering if that is worthwhile. Very few of us skeptics have fully decided the issue, myself included.

Some other countries have determined that the test is not worth covering under national health schemes. Based on the panel recommendations it seems possible that some US health insurance plans may stop covering the tests in the future. If so, you could still have the test and pay for it. I have not seen any posts calling for "removing the PSA test from the medical repertoire" as you put it.

Edit: I have seen a number of posts that seemed to me to be hostile toward us skeptics. Examples are the one, above, that I read as describing us as immature and yours and others that wrongly accuse us of wanting to stop you from getting the test. I haven't noticed hostility from skeptics towards those who want to have tests. My suggestion is that you decide for yourself whether to get tested but slow down on assuming that people who choose otherwise are somehow the enemy of your choice.

Gee, you detect hostility and I detect usurping my decision making responsibility and ability. Guess we are both reading the tone of the posts and reflecting the reality of the panel's actions. The panel focused on consequences of the test when follow on protocols are automatically followed. Had they, instead, promoted the idea that good judgement needed to be used after the PSA, just like it is needed after any test my response would have been different. Biopsies and other invasive procedures don't need to be the automatic consequence of an abnormal PSA. In fact, I would suggest that the real problem is the lack of intelligent response to test results.

If they, and others who feel like them, are able to have the PSA test declared uneconomical and holding dangers for men it will no longer be an approved test under Federal or Insurance Company rules. The follow on consequence then will be that to meet profitability goals the price will go up and people who cannot independently pay for the test will be denied it. Based on my personal experience that was cited earlier this is not a desirable outcome.

I agree with donheff that no one is taking anything away from you, or usurping your responsibilities. The data show no change in morbidity. Other data show that wearing seat belts saves lives. Are you upset with the government mandating seat belts in cars? The seat belt is there, and you can choose to use it or not. The PSA is (and will be) there, and you can choose to use it or not. If you think you are entitled to have your insurance pay for any particular medical test you deem important to you, just because you think they should, then you should be prepared to have the increase in your insurance premium more than offset the cost of paying $100 for a PSA.