PSA Testing "Yes" or "No"
 

Current "draft" recommendation by the US Preventive Services Task Force for PSA testing is to do away with it for men under 75.

"The common perception that PSA-based early detection of prostate cancer saves lives is simply not supported by the scientific evidence," task force co-vice chair Michael L. LeFevre, MD, MSPH, professor of family and community medicine at the University of Missouri, tells WebMD.

Read the draft recommendations here.

Your thoughts?

I would rather have a false positive than miss the opportunity for early detection. I am going to continue having them. My prostate has been good to me over the years. :)

I have a friend that found to have an elevated PSA at age 45. He did have prostate cancer, had surgery and has done well. Without that routine test he might have gone undiagnosed and had a different outcome.

I'd have to go with the scientific evidence on this one (as I always do). Although I'd have to investigate more and read about more independent analyses to reach a rock-solid conclusion.

I too would rather have 100 false yeses than not know. You bet I will have them every year.

I think that the PSA testing should continue. The real kicker is in their report "Two out of every five men whose prostate cancer is detected through a PSA test, one study found, have a slow-growing cancer that would never have posed any threat to their lives" That means that 3/5 men do have cancer that can be a threat to their lives. I have been there and done that. My PSA jumped from 1.3 to 4 in one year. I had a second PSA test after a bout of antibiotics followed by a biopsy. Talk a bout a kick below the belt when the doctor says you have cancer. I went home and did a ton of research, found the best surgeon in my medical plan and then I had surgery and I am now a member of the "Zero Club" (PSA of less then 0.04) for the past two years. While I am sure that I would still be alive today without the PSA test I would probably not be paying taxes any longer after about 8 more years (based on the post op exam of my prostrate). Based on the average life expectancy of about 84 for a US male I can see in not recommending the PSA test in men over 75. Those biopsies hurt and having blood coming out there is not a pleasant sight. Those are my thoughts and experiences.

Denver , I read that story this morning, and we,(wife is ER room nurse,) and we both agreed that the test should continue to be done...their conclusion is BS...
Bud

One wonders if the researchers are not going to get a PSA test?? It would be interesting to know. This sounds like - it is good enough for the "general population" - but . . .

Their conclusion isn't bs. It makes a lot of sense when you look at an entire population and the risks and benefits. The risk isn't just the false positive, it is what you do with the positive results. Wait and see is stressful. Biopsies have risks. And when tumors are found there can be incredible anxiety, even when those tumors may be slow growing and never life threatening. People don't like having cancer growing in them. But men have to decide for themselves and recommendations are for the test to be an individualized decision based on things like age and risk factors rather than an across the board decision.

My PCP and I agreed to pass on the PSA last year at my 60-year checkup.

Glad to see the report that validates our decision.
Tests that lead to treatment that too often causes more trouble than the disease should not be the standard.

Continue! A buddy of mine just underwent cryogenic prostate surgery. He had his PSA checked and it indicated the need for a biopsy. It was cancer. Without the test it could have gone undetected for years and led to a far more serious outcome. Better to be safe than sorry!

I am taking a different approach, as I do with many diseases. We admittedly cannot reduce the risk to zero, but there is compelling evidence that one can significantly reduce the risk of getting prostate cancer through a well-known dietary regimen, which I have been following for many years. (It is heart-healthy, as well.)

One of the main points of the study is to show that treatments have risk and are not always "safe". In fact, the results show that it is safer overall not to have the tests and possibly harmful treatments. Anecdotes are one thing, but scientific analysis of the data is another. Most old men have prostate cancer but die of something else.

That's far too reasoned an approach to be palatable to most. :)

But I agree. I'll almost always go with evidence over anecdote.

I've always had the test and am disposed to continue it. But I'm going to ask my doc what he thinks. I always get the finger test too.

Just had the yearly and got the finger, think I prefer a PSA test.

Only had one Bendover test -followed by a PSA test followed by a Radical prostatectomy. Since then- a 6 monthly PSA with the result being a big fat "0"

Glad my doc was on the ball.

Edit--- I had no sign of prostate problems and called into the Doc on a different matter. He just said you are of that certain age so bendover. The PSA count came back at 16 and Biopsy showed cancer in all 6 samples.

So I was lucky in that a PSA test showed I had a problem-The Biopsy showed I had a big problem.

The theory used to be that you needed both to be certain. I guess that is out now??

I totally agree Ken , i think you are spot on!:thumb:

Around here, the finger is covered by Government Health Insurance, the PSA isn't so guess which direction I go....

BF would be minus one member if it wasn't for early screening and testing. In 05, my PSA was a 2.4 and I was told that we would do a wait and see approach because the digital exam felt more like an enlarged prostate then cancer. A year later, my PSA was at 4.7 and the prostate was the same size as it was the previous year. Three months later, my hematologist took it again and it was 6.1. The biopsy showed a Gleason Score of +8 (out of 10). I hope that all of you guys that feel that these tests are a waste of time have your house in order. Has it ever occurred to anyone that the insurance industry may have been the backers of this project and the findings were biased in their favor? I think too many of us are willing to agree with these medical findings before we know all of the information because we don't want to think of the possibility that it can happen to us. I'm here to tell you, it does. One study does not make it gospel.

John_V, your case is almost exactly like mine: a Gleason 8 and velocity on the PSA. During surgery, it was found that my cancer had spread away from the prostate and pathology confirmed a fast growing cancer on a speed roll.

Six years later, my cancer returned, also found with PSA velocity, and I've since undergone 8 weeks of radiation and hormone treatments.

All this started at 51 years of age and a PSA test with zero noticable prior symptoms.

I am on the fence on this one but as I recall the issues of the debate (been going on for years now) the problem is primarily with the reaction to elevated PSA. Lots of men get treatment they don't need with lots of negative effects. There are no good ways to avoid unneeded treatments other than ignoring the elevated PSA (in which case why take the test). The question is not do you want to skip the test and risk missing a cancer. The question is more along the lines of do you want to skip the test and slightly increase your risk of a bad cancer outcome or take the test and more significantly increase your likelihood of different negative outcomes? The scientific stats appear to be saying the overall benefits lean toward sacrificing a few cancer victims to save a lot of other angst. Tough tradeoff if you lose on the cancer side but still...

Dennis,

Are you taking Casodex and getting the Zoladex injections? That was my treatment because of my chronic leukemia (CML). My oncologist/hematologist did not want to take me off of my leukemia meds for any type of surgery so my only choice at the time was the radiation/hormone treatment. I wish they would have had the Cyberknife treatment when I was diagnosed. It would have been another option for me that I didn't have at the time.

I think the problem here is more with the patient than with the doctor. I was in the medical profession for 25 years and I can tell you that many patients are too quick to listen to what the doctor tells them and do no research or bother to get a second (or more) opinion. There are too many urologist that are quick to start cancer treatments "just in case" and too many patients that are not informed enough to stop them until they know all the facts. I must agree that there are urologist that recommend brachytherapy with a very low Gleason score just to be on the safe side and avoid litigation if they don't suggest it and something happens, but the patient has his responsibility to be informed and make the final decision. Many men have an "out of mind" approach to prostate cancer. If they don't think about it or if they don't know what their PSA and/or PSA Velocity is, they won't get prostate cancer. I think that many of us who have been there and done that have a much different opinion to this pre-screening findings which more often than none leans toward those that do the financing.