I for one an not opposed to the test because it is a PITA. I'm sorry you had to experience this but, if the recommendation is accurate, you are simply wrong. Having the test will not make it more likley that you will get better results. It will make it more likely that you will get treatment you don't need. I will talk to my doctor about Gleason scores but from what I have been reading it is not possible to identify which tumors are aggressive at an early stage. If testing and diagnosis can (with reasonable accuracy) make such identifications (i.e. if patients can rationally decide when to treat and when to ignore) then the recommendations would be criminal.

Edit: when I talked about this to my doctor a year ago he recommended sticking with the test and I did. I will go over these issues again this year. If he starts recommending ignoring the absolute value of the test and only biopsying upon a showing of rapid increase and if he can document that that finding is fairly accurate for showing tumors I might consider continuing with the test. This would be on the theory that I would treat any tumor discovered. Based on current medical capabilities I would be more likely to back off in a few years (after 70) since I would be less and less inclined to treat.

One of the problems with prostate cancer is that is generally asymptomatic. By the time symptoms develop, it can be too late for treatment.

What kind of symptoms do non-testers think they will get before the cancer has progressed beyond normal treatment?

I had a very aggressive cancer with a lot of peripheral damage, yet no symptoms at all. In fact, my cancer returned aggressively 6 years later, again with no symptoms.

Who wants to risk no testing until they ejaculate blood or have no ejaculate at all? Or, even worse, starts having back or hip pain through metastases? If that happens, your treatment has gone way beyond normal prostate cancer treatment.

I've been told this is one of the side effects of Flomax. Which if we believe the ads significant numbers of men are using.


I guess whether to have a lab test and then have to make analysis and decisions following the test; or just do nothing and take what comes when symptoms arise depends a lot on an individual's personality. Some have a greater degree of self-discipline than others and so can make a decision and live with it. Others don't. Some providers are more willing to spend the time explaining and counseling their patients and other's aren't. Right now the system puts a premium on after test decision making; which evidence shows has not been up to par in all cases. But, if the test is not available neither patient nor doctor gets to make any decisions; until the disease manifests itself in other ways.

Do you realize that you are saying that you would be willing to go through 100 unnecessary prostate biopsies?
You would be willing to have that done 100 times, risking the complications of infection, etc?

Just doing a little reading, there is a new test in the study stage that detects Engrailed-2 a protein found in the urine if men with prostate cancer, if they can work this into a commercial product, you go to the pharmacy, buy the kit, take it to your doctors office, open it up and pee on the stick, and then your doctor looks at it, and tells you your prostate in cancerous, then do the biopsy. One of the issues with PSA is that if there are false positives, there is also the possibility of a false negative, which could have much more dire consequences.

I hope they come up with new tests but I don't like the concept of buying a kit and taking it to the doctors office. I would rather pee on the stick myself and see what color it turns. Then I can can go see the doctor if it turns red.

He'd probably make you pee on the stick again (or pee in a cup that's taken to the lab) to confirm the results, but I like this idea. Though it seems to me engrailed is one of those genes first discovered in a fruit fly that I had to read about way back when about and that gives me bad memories of trying to study fruit flies.

@donheff

You're talking a great deal of sense in this thread. Screening is only useful if the benefits outweigh the risks and if it leads to interventions that actually save lives.

Those who are in favour of routine PSA should ask themselves what their view would be if it had not yet been introduced to the general population but had been the subject of an extended clinical trial, with the outcome reported in the study. That outcome would have been something like this:

"PSA testing does detect prostate cancers. However, those whose cancers were detected by the test had outcomes that were very little different from those in the control group, who were not given the tests. In other words, having the test made no difference to their chances of getting cancer and virtually no difference to their chance of dying of it. In addition, the PSA test gave rise to many false positives which led many patients to receive invasive, risky and sometimes very damaging treatment they did not need."

In the light of such a trial, I suggest that very few people would want to introduce routine PSA testing or subject themselves to it. And an extended clinical trial, with pretty much exactly those results, is what you have been conducting in the States for years.

Well that would be another option, one blue line your fine, two blue lines, call you doctor, the doctor may just give you a referral to a Urologist and not even bother seeing you....

A few comments based on my experience;

Know your family history, PC does run in families.
Consider your age and general health with respect to any actions taken as a result of a high PSA score.
Pay attention to anything that could be symptomatic.
PSA is best looked at as a datapoint needing further investigation.

In November of last year I had routine bloodwork done. My GP suggested a PSA since I hadn't done it in years.
It came back a bit high (5.7) so he suggested we wait a few weeks, that I stay off the bike, and we'd repeat with a look at both total and free PSA. I of course had no symptoms.
The test came back with the same total count but the ratio of free to bound PSA was in a range only encountered when cancer is present. That convinced him to send me to a Urologist for further consultation.
The Urologist did a DRE and simply told me I needed a biopsy and explained why. The biopsy returned with positive results, 8 out of 12 cores cancerous, Gleason 7+.
The day after the biopsy I was in the hospital with septicemia from the biopsy, a nice fever racked 4 day visit. So no, you don't a casual meeting with a biopsy needle.
A few weeks later, back to the Urologist for a "what now" chat. He explained the situation, the possible treatments and the possible outcomes.
I told him I'd take 3 months to visit and consult with a radiation Oncologist, a DaVinci surgeon, witch doctors, the whole bit. I'd read up on treatments (or lack thereof) and be back in three months for yet another PSA. If it had gone up, I'd pick a course of treatment and go.
The 3 months lapsed, we did a third PSA with the obvious result, higher of course with velocity increasing. I elected DaVinci robotic surgery after even the Radiation Oncologist told me to consider nothing else. The reasoning being, at my age (59) and general condition (rail thin, 1000 mi./month cyclist) I'd recover from the surgery quickly, and the likelyhood of getting all the cancer was very high.
I had the surgery with the pathology report showing no evidence the cancer had spread beyond the prostate. My surgeon was smiling when he told me that, it really made my day.
I recovered quickly (walking the next morning, back on the bike in 5 weeks) and now have a 0 PSA score and here's hoping it stays there.

Here's the bit about family history, a week after the surgery my uncle (mom's bro) called having just heard from my mother about my little adventure.
He said, he'd had the same operation a few years earlier, and that his brother (another uncle) has PC and my grandfather had it when he died.
So moral of the story? PSA testing in my case raised a flag and paying attention to that flag did add years to my life, Gleason 7 is aggressive. I'm glad I paid attention to it, I'm glad my GP suggested it.

I'm tending to agree with Goldfinch, at least partially. Patients should be counseled on the risks of false positives. Today, any stay in a hospital or rehab center carries some risk of MRSA, among other things. Watchful waiting may be a pain in the neck and unsatisfying, but as someone who saw my dad die both of the complications of a less-than-necessary surgery (successful otherwise) combined with MRSA, I think even great hospitals are not reliable enough to trust with excessive treatments.

But I wouldn't want to eliminate PSA screens for younger folks, like me. If it's like with colonoscopies, docs would like to be able to compare risk assessment procedures (such as at my 58 yo) with "good" test results taken on the same patient when at a younger age. That means at least one young-age PSA test per male when in his 30's or so.

I don't want some faceless committee or agency cube dweller making a decision that my physician and I should make. Stay out of my business. I've already had skin cancer, so my risk profile is a little higher. This crap needs to stop. Next thing you know, some cube dweller will want to regulate how much lube I put on my bike chains.

Is that what is being proposed? I didn't think anyone was suggesting that you should be prevented from choosing to have a PSA test where that is appropriate, merely that routine PSA screening of everybody wasn't effective. And on the evidence, that seems to be right.

No one will stop you from doing whatever you want but health insurance should only cover useful medicine. I don't want my health insurance jacked up because you want homeopathy covered despite zero evidence of effectiveness. If you want homeopathy, pay for it. I suspect the same may happen with routine PSA tests. You can still pay for it. Based on what I am hearing here I suspect that PSA tests will probably remained covered in higher risk situations where reasons exist to suspect cancer and doctors want to monitor PSA velocity among other symptoms. Regardless, you could still elect to pursue it at your own cost.

The only thing that any committee or agency can decide is who gets to pay for the test, you or your insurer. If it's your insurer, then it means increased premiums for you or your employer, if your employer is government, then everyone gets to pay for it, with increased taxes or your great-grandchildren get to pay for it, in the future. If your employer isn't government then people who buy it's products or services get to pay for it. If you get to pay for it. then it's money that's out of your pocket, money that could have been used for something else.

The whole issue is that the test costs around $45, or at least it does here in Canada, is the benefit worth spending $45 or isn't it. For some people it is, for some it isn't. Interesting that in the US a positive PSA means a biopsy right away, you would think an Ultrasound scan would be done first, to see what the prostate looks like, maybe take some measurements, rather then scheduling an invasive procedure right away.

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.

https://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

https://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.