PSA Test Not Needed?? CNN posted today

SeattleJ
SeattleJ Member Posts: 32
(CNN) -- The U.S. Preventive Services Task Force, the group that told women in their 40s that they don't need mammograms, will soon recommend that men not get screened for prostate cancer, according to a source privy to the task force deliberations.

The task force is set to recommend a "D" rating for prostate specific antigen, or PSA, testing. Such a rating means "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits," according to the group's website. The task force is set to propose this recommendation Tuesday, and then allow for a comment period before issuing a final recommendation.

According to a draft copy of a report scheduled to be released Monday, a review of studies shows screening with the PSA blood test results in "small or no reduction" in prostate cancer deaths.

The report adds that PSA testing is "associated with harms related to subsequent evaluation and treatments."

The PSA test can help determine if a man has prostate cancer. It is sometimes accompanied by a digital rectal exam.
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Comments

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,013 Member
    Say what?
    Just heard this on NBC new. Here's a link to the CNN article and a video about it:

    http://www.cnn.com/2011/10/06/health/prostate-screening

    Not sure what to make of this recommendation but I imagine that most doctors will ignore it, just as they have the recommendation against supposedly "needless" mammograms.

    After reading the article and listening to the video, the problem doesn't seem to be getting the test -- that's pretty much harmless. The problem is acting on the test and the biopsy by getting treatment -- mostly surgery by inference -- when you don't know for sure whether you've got a high risk cancer that really requires treatment or not.

    As it stands now, we are treating all men if there's a positive biopsy and as a result many men suffer the negative consequences of surgery (mainly incontinence and ED) when it wasn't even necessary. On the other hand, the few men w/high risk cancer are saved making the negative effects of surgery less consequential.

    This really goes to my point -- which I've made repeatedly -- that surgery is NOT an appropriate treatment for early stage PCa. If men did not immediately opt for surgery but chose a less risky method of treatment -- like CyberKnife or Proton Beam Therapy -- at the outset, we'd substantially reduce the incidence of incontinence and ED suffered by men diagnosed with PCa and would still probably cure most of these men of the cancer w/o surgery.

    Those men who have a higher risk cancer and are not cured by the initial treatment can be treated again by means of surgery (if warranted) or follow-up radiation and/or hormone therapy.

    Of course, this means that a lot of urologist/surgeons will be out of a job. So, it's not likely to happen but IMHO this is an obvious way to solve the "problem.'
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member

    Say what?
    Just heard this on NBC new. Here's a link to the CNN article and a video about it:

    http://www.cnn.com/2011/10/06/health/prostate-screening

    Not sure what to make of this recommendation but I imagine that most doctors will ignore it, just as they have the recommendation against supposedly "needless" mammograms.

    After reading the article and listening to the video, the problem doesn't seem to be getting the test -- that's pretty much harmless. The problem is acting on the test and the biopsy by getting treatment -- mostly surgery by inference -- when you don't know for sure whether you've got a high risk cancer that really requires treatment or not.

    As it stands now, we are treating all men if there's a positive biopsy and as a result many men suffer the negative consequences of surgery (mainly incontinence and ED) when it wasn't even necessary. On the other hand, the few men w/high risk cancer are saved making the negative effects of surgery less consequential.

    This really goes to my point -- which I've made repeatedly -- that surgery is NOT an appropriate treatment for early stage PCa. If men did not immediately opt for surgery but chose a less risky method of treatment -- like CyberKnife or Proton Beam Therapy -- at the outset, we'd substantially reduce the incidence of incontinence and ED suffered by men diagnosed with PCa and would still probably cure most of these men of the cancer w/o surgery.

    Those men who have a higher risk cancer and are not cured by the initial treatment can be treated again by means of surgery (if warranted) or follow-up radiation and/or hormone therapy.

    Of course, this means that a lot of urologist/surgeons will be out of a job. So, it's not likely to happen but IMHO this is an obvious way to solve the "problem.'

    My opinion.
    I basically agree with Swing, that there is overtreatment by many who have a positive biopsy, when Active Surveillance with Delayed treatment is appropriate. I believe that most, are willing to have "Active Treatment" with potentially very negative side effects instead closely monitoring the disease within an Active Surveillance program in low risk patients where the likelihood of non progression is 70 percent(with no side effects), and the other 30 percent are still treatable with for the most part, the same Active Treatment option as would have first been chosen.

    I also believe as Swing, that some of the side effects of surgery can be horrible; additionally, I also believe, which Swing does not mention, that other active methods also are very invasive, i.e.all forms of radiation....I believe that while the skin may look fine on the outside, the tissue is still radiated and and is destroyed, maybe even more invasive than surgery. Major negative effect are seen down the road, not up front.

    There are other methods such as Cryo (freezing) basically a salvage therapy which causes ed in 100 percent of cases; hormones which have side effects that in a major way negatvely affect quality of life.

    In summary I believe that many who are diagnosed for low risk prostate cancer feel that they need to do something, which is invasive to get rid of the cancer, and do not consider an Active Surveilance protocol which I believe is more appropriate. I have seen this attitude time an time again on this board and in person.
  • nowrest
    nowrest Member Posts: 48
    psa test
    So we get rid of the PSA test. Then how do you detest cancer? I realize of course that the test is unreliable but what else is there?
  • dakotarunner
    dakotarunner Member Posts: 102 Member
    nowrest said:

    psa test
    So we get rid of the PSA test. Then how do you detest cancer? I realize of course that the test is unreliable but what else is there?

    I agree with no PSA test,
    I agree with no PSA test, how do we detect cancer? Do we wait until other problems show up? Maybe the test is not the greatest option available, but when it is the only option other than a DRE, it sounds like a winner to me. Many men do not mind giving a little blood for a test, but when the Doctor slips the glove and says bend over, they are gone.

    I guess what you don't know can't hurt you, until it is too late. At least in won't bother the panel who came up with this. Hang in there fellas, and use your best judgement.
  • SeattleJ
    SeattleJ Member Posts: 32
    The problem isn't the test
    To my mind, the problem isn't the test. It is clear that the PSA test gives both false positives & negatives and isn't terribly reliable. That's why so much research is being done to find a replacement. It's really only accurate for post-treatment PSA. However, the problems of over-treatment aren't caused by the screening test. They are often caused by men finding out they have a low grade,low volume cancer and demanding treatment. It's hard for many men to accept the idea that "no treatment now" is the best course of action. They want the cancer out or killed. There are also medical professionals that want to aggressively treat every cancer they find. However, you don't solve this by not screening men or by giving out the message that screening tests have no value. If we stop screening, we will miss those cancers (like mine) that are aggressive and dangerous.

    I'm sensitive to this subject because this same group recommended cutting back on mammograms. As my wife is a breast cancer survivor (early stage found by mammogram) and I'm a prostate cancer survivor, this "guidance" hits too close to home.

    John
  • Kongo
    Kongo Member Posts: 1,166 Member
    PSA Test Is Not The Problem
    John,

    I completely agree with comments you made in another post that the problem isn't the PSA test in and of itself. I don't think the problem lies with the patients either...as most lay patients have no real idea at the time they're first informed about their scores what the implications actually mean. In my mind, the big problem with the PSA test is what the diagnosing physician does with the information and how it's presented to the anxious man sitting in his office.

    I think my case if fairly typical. A routine physical indicated that my PSA was 4.3 and my GP told me I needed to have it checked out by a urologist. Anxiety starts to build at this point. A few week later after a brief DRE with no abnormalities, the urologist strongly recommended a biopsy "to rule out cancer." Well shoot, who isn't going to go along with that recommendation? So back again in a few weeks and have the biopsy. A few weeks afterward I get the news..."unfortunately, we found cancer...but the good news is that we got it early and we can take it out and fix this problem for good." Now the anxiety is really building. I liked the urologist, I liked his staff, his office was convenient, he was recommeneded by my GP who I admire and respect. He had great credentials. Why not just do what he says? But wait, there's more: Run over to X-ray and get a bone scan to make sure the cancer hasn't spread. Of course at this point you're not thinking too clearly and of course you want a bone scan and how quick can I get there? Nowhere in this process did anyone tell me that the bone scan with the pathology I had wasn't going to find anything. Nobody told me the pathology might well be an indication of indolent cancer. Instead, while in a very vulnerable mental state, I was pushed toward surgery and the sooner the better. "We can get it all."

    I think a lot (if not most men) in this situation get sucked into the system and end up getting over treated and may well indeed end up with complications much worse than their original cancer ever would have given.

    In my opinion, what should have happened is this. The GP tells me the PSA is "above normal" but, oh by the way, there really is a lot of conflicting opinion on what "normal is." Before we go to the urologist, lets rule out prostititus, a low grade urinary tract infection, or BPH. GPs ought to be able to do this easily. He should explain that things like sex before a blood draw, a lot of bicycle riding, taking Advil, and several other things can cause a temporary spike in PSA. Go home, be celibate, quit taking Advil, avoid the bike for a few days, and come back in a week and let's do another PSA test. In the meantime, let's test your urine for UTI. And, oh by the way, let's calculate your PSA Doubling Time, PSA velocity, and PSA density.

    If, after doing these simple additional checks which every GP ought to be well informed about and capable of performing, the PSA is still elevated and PSA density is above 0.1 and the doubling time is troublesome, and he has ruled out a UTI then maybe it might be a good idea to consult with a urologist.

    The urologist should rule out prostititus through a 6-8 week anti-biotic regimen before he suggests a biopsy to further determine what is going on.

    Patients should understand the pros and cons of biopsies, the risk of infection, and the fact that a negative biopsy doesn't necessarily mean you are free of cancer...but only that the less than 1% of the prostate tissue sample didn't have any abnormal cells.

    If cancer is then detected, patients should be counseled by independent oncologists, radiologists, and surgeons who are not financially connected with the diagnosing doctors. Second opinions on the biopsy should be obtained.

    Prostate cancer patients need an ombusdman to oversee this process and ensure that the men and their spouses or significant others get an informed and balanced perspective of the pros and cons of each treatment method, what the side effects might be, and what short and long term risks are involved.

    If we had a process similar to this we would probably save billions of dollars in over treatment costs to our health care system and improve the quality of life for men suffering from PCa.

    Many posters recognize that the PSA test may have saved their life just as many women were treated for breast cancer after a timely mammogram enabled them to get treatment before it was too late.

    The other thing about PSA testing that tends to be overshadowed in these reports is that after treatment, whether by radiation or surgery or some other means, the ONLY way to monitor the success of the treatment is to regularly monitor the PSA for the rest of your life.

    I say keep the PSA test. Change the way we handle the information it provides.

    K
  • lewvino
    lewvino Member Posts: 1,010
    Kongo said:

    PSA Test Is Not The Problem
    John,

    I completely agree with comments you made in another post that the problem isn't the PSA test in and of itself. I don't think the problem lies with the patients either...as most lay patients have no real idea at the time they're first informed about their scores what the implications actually mean. In my mind, the big problem with the PSA test is what the diagnosing physician does with the information and how it's presented to the anxious man sitting in his office.

    I think my case if fairly typical. A routine physical indicated that my PSA was 4.3 and my GP told me I needed to have it checked out by a urologist. Anxiety starts to build at this point. A few week later after a brief DRE with no abnormalities, the urologist strongly recommended a biopsy "to rule out cancer." Well shoot, who isn't going to go along with that recommendation? So back again in a few weeks and have the biopsy. A few weeks afterward I get the news..."unfortunately, we found cancer...but the good news is that we got it early and we can take it out and fix this problem for good." Now the anxiety is really building. I liked the urologist, I liked his staff, his office was convenient, he was recommeneded by my GP who I admire and respect. He had great credentials. Why not just do what he says? But wait, there's more: Run over to X-ray and get a bone scan to make sure the cancer hasn't spread. Of course at this point you're not thinking too clearly and of course you want a bone scan and how quick can I get there? Nowhere in this process did anyone tell me that the bone scan with the pathology I had wasn't going to find anything. Nobody told me the pathology might well be an indication of indolent cancer. Instead, while in a very vulnerable mental state, I was pushed toward surgery and the sooner the better. "We can get it all."

    I think a lot (if not most men) in this situation get sucked into the system and end up getting over treated and may well indeed end up with complications much worse than their original cancer ever would have given.

    In my opinion, what should have happened is this. The GP tells me the PSA is "above normal" but, oh by the way, there really is a lot of conflicting opinion on what "normal is." Before we go to the urologist, lets rule out prostititus, a low grade urinary tract infection, or BPH. GPs ought to be able to do this easily. He should explain that things like sex before a blood draw, a lot of bicycle riding, taking Advil, and several other things can cause a temporary spike in PSA. Go home, be celibate, quit taking Advil, avoid the bike for a few days, and come back in a week and let's do another PSA test. In the meantime, let's test your urine for UTI. And, oh by the way, let's calculate your PSA Doubling Time, PSA velocity, and PSA density.

    If, after doing these simple additional checks which every GP ought to be well informed about and capable of performing, the PSA is still elevated and PSA density is above 0.1 and the doubling time is troublesome, and he has ruled out a UTI then maybe it might be a good idea to consult with a urologist.

    The urologist should rule out prostititus through a 6-8 week anti-biotic regimen before he suggests a biopsy to further determine what is going on.

    Patients should understand the pros and cons of biopsies, the risk of infection, and the fact that a negative biopsy doesn't necessarily mean you are free of cancer...but only that the less than 1% of the prostate tissue sample didn't have any abnormal cells.

    If cancer is then detected, patients should be counseled by independent oncologists, radiologists, and surgeons who are not financially connected with the diagnosing doctors. Second opinions on the biopsy should be obtained.

    Prostate cancer patients need an ombusdman to oversee this process and ensure that the men and their spouses or significant others get an informed and balanced perspective of the pros and cons of each treatment method, what the side effects might be, and what short and long term risks are involved.

    If we had a process similar to this we would probably save billions of dollars in over treatment costs to our health care system and improve the quality of life for men suffering from PCa.

    Many posters recognize that the PSA test may have saved their life just as many women were treated for breast cancer after a timely mammogram enabled them to get treatment before it was too late.

    The other thing about PSA testing that tends to be overshadowed in these reports is that after treatment, whether by radiation or surgery or some other means, the ONLY way to monitor the success of the treatment is to regularly monitor the PSA for the rest of your life.

    I say keep the PSA test. Change the way we handle the information it provides.

    K

    Excellent post as always
    Excellent post as always Kongo.
    My diagnosis followed closely to what you described with a few exceptions.
    I did take the anti-biotic regimen between my psa tests. PSA still climbed. Then I was sent from family doc to the urologist who did the needle biopsy. After the phone call telling me I have cancer and to bring my wife in...He spent close to 1.5 hours discussing ALL treatment options in detail with us as a couple. He is a surgeon but did not push me one way or the other. He did tell me to perform my research and he would support me in what ever path I picked. He did caution that with my Gleason 7 I needed to do something in his opinion within one year. About one month before my Davinci surgery I Stayed away from the bike, sex, etc...had another PSA test on my own at a 'health fair' and the PSA had climbed again.

    I have a family history of prostate cancer. I was only 54. Post biopsy confirmed that I indeed needed something done since I did have a positive margin.

    So many though just take what the doctor states and do not take the time for their own research.

    This urologist still performs my PSA testing for me for my followups.

    I agree keep the PSA Test...better education though is needed on handling the information.

    lewvino
  • mrspjd
    mrspjd Member Posts: 694 Member
    SeattleJ said:

    The problem isn't the test
    To my mind, the problem isn't the test. It is clear that the PSA test gives both false positives & negatives and isn't terribly reliable. That's why so much research is being done to find a replacement. It's really only accurate for post-treatment PSA. However, the problems of over-treatment aren't caused by the screening test. They are often caused by men finding out they have a low grade,low volume cancer and demanding treatment. It's hard for many men to accept the idea that "no treatment now" is the best course of action. They want the cancer out or killed. There are also medical professionals that want to aggressively treat every cancer they find. However, you don't solve this by not screening men or by giving out the message that screening tests have no value. If we stop screening, we will miss those cancers (like mine) that are aggressive and dangerous.

    I'm sensitive to this subject because this same group recommended cutting back on mammograms. As my wife is a breast cancer survivor (early stage found by mammogram) and I'm a prostate cancer survivor, this "guidance" hits too close to home.

    John

    Well said
    Well said, John. Excellent post and I agree 110%.

    Re the statement in a previous post by another member that “…this means that a lot of urologist/surgeons will be out of a job,” with regard to PCa treatments alone, I might add that it won’t just be the uro surgeons with a lighter case load---radiation oncologists, especially those working in the field of SBRT aka CyberKnife, will be at risk of losing much of their PCa business, since the majority of their PCa biz currently focuses on marketing to and treating men dx’d with low-risk PCa.

    In regard to the report that the USPSTF may be recommending the elimination of PSA tests for men, here’s a novel idea (tongue in cheek, of course): I propose a new clinical study. The study group would consist of the men and women on the USPSTF advisory committee. (Yes, I know, I have a sick mind and that the study is flawed.) The men will not be allowed to have PSA testing (ever), and the females will not receive any diagnostic or yearly preventative mammograms. Each member of this study group will be followed until an end point. Upon the death of each study participant, an autopsy would be performed to determine cause of death. It will be interesting to determine the rates of occurrence and death from PCa and BCa in these men and women, respectively.

    If even a few could have been saved by early detection, cancer education and treatment, then I’d be willing to bet their families would be very vocal supporters of early detection practices/testing along with a mandatory proactive education program on the potential impacts (pros and cons) of add'l diagnostic tests as well as all viable treatments, including active surveillance, for those who fit the low risk profile.
  • jerrylh
    jerrylh Member Posts: 5
    lewvino said:

    Excellent post as always
    Excellent post as always Kongo.
    My diagnosis followed closely to what you described with a few exceptions.
    I did take the anti-biotic regimen between my psa tests. PSA still climbed. Then I was sent from family doc to the urologist who did the needle biopsy. After the phone call telling me I have cancer and to bring my wife in...He spent close to 1.5 hours discussing ALL treatment options in detail with us as a couple. He is a surgeon but did not push me one way or the other. He did tell me to perform my research and he would support me in what ever path I picked. He did caution that with my Gleason 7 I needed to do something in his opinion within one year. About one month before my Davinci surgery I Stayed away from the bike, sex, etc...had another PSA test on my own at a 'health fair' and the PSA had climbed again.

    I have a family history of prostate cancer. I was only 54. Post biopsy confirmed that I indeed needed something done since I did have a positive margin.

    So many though just take what the doctor states and do not take the time for their own research.

    This urologist still performs my PSA testing for me for my followups.

    I agree keep the PSA Test...better education though is needed on handling the information.

    lewvino

    US preventive services task force
    This organization is reliable and accurate. It has been continuously misreported that it recommended against breast cancer screening in women under 50. It was misreported again in the New York Times again today. Please do what no one seems to want to do. Go to the website and look at the recommendations http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

    Their recommendation against the use of screening PSA's is absolutely correct.
  • KathyLQ
    KathyLQ Member Posts: 100
    I don't get it... do nothing, and then just DIE from Cancer?
    Hi everyone, I am a woman, age 59
    I got breast cancer last year, chose a mastectomy with doctor's recommendation and have gone through 6 surgeries for reconstruction (so don't talk to me about "associated harms", I've lived them!), LOL!

    I assume you all are familiar with the Mortality rates for Prostate Cancer? They're here if you want them : http://ratecalc.cancer.gov/ratecalc//new.html

    My point... do nothing.. and men will die! If I had done nothing with my breast cancer, my life expectancy would have been shortened quite a bit. I consider myself lucky because the pathology of my breast found no additional cancer cells, and none were in the lymph nodes.

    So where is the recommendation on WHEN to take out the prostate to prevent likely death from the cancer progressing???

    My boyfriend is 71, he has had a prostate biopsy, and yes there is cancer. He is planning surgery. He's very healthy, could live another 20 years. So what would he do under the new recommendation?... wait until he is 85, then realize he really needed the surgery and suffer major "associated harms" from surgery then? Or take a chance that he'll sail through surgery better at this age?

    Anyone want to comment?
  • jerrylh
    jerrylh Member Posts: 5
    KathyLQ said:

    I don't get it... do nothing, and then just DIE from Cancer?
    Hi everyone, I am a woman, age 59
    I got breast cancer last year, chose a mastectomy with doctor's recommendation and have gone through 6 surgeries for reconstruction (so don't talk to me about "associated harms", I've lived them!), LOL!

    I assume you all are familiar with the Mortality rates for Prostate Cancer? They're here if you want them : http://ratecalc.cancer.gov/ratecalc//new.html

    My point... do nothing.. and men will die! If I had done nothing with my breast cancer, my life expectancy would have been shortened quite a bit. I consider myself lucky because the pathology of my breast found no additional cancer cells, and none were in the lymph nodes.

    So where is the recommendation on WHEN to take out the prostate to prevent likely death from the cancer progressing???

    My boyfriend is 71, he has had a prostate biopsy, and yes there is cancer. He is planning surgery. He's very healthy, could live another 20 years. So what would he do under the new recommendation?... wait until he is 85, then realize he really needed the surgery and suffer major "associated harms" from surgery then? Or take a chance that he'll sail through surgery better at this age?

    Anyone want to comment?

    your comments
    Hi Kathy

    First of all regards your boyfriend, no he would wait until he is 85 and never need anything done for his prostate cancer. Be aware that at age 85 95% of ALL men have prostate cancer and that 100% of all males age 90 have prostate cancer. Remember that only 2.5 to 3.0% of men with prostate cancer will die from their disease. And that death rate is the same even in countries where there is no screening. Remember, Kathy, these are recommendations for healthy males, not for males with blood in their urine for example.

    The reaction of most of the readers here is not surprising. in the 1950s and 1960s everyone was getting screening chest x-rays to detect early lung cancer. The studies revealed that we were not saving lives, but the screening continued for another 10 years until it finally died out.

    Jerry
  • Beau2
    Beau2 Member Posts: 261
    PSA
    Hey Seattle,

    Good point, "The report adds that PSA testing is "associated with harms related to subsequent evaluation and treatments."

    It really seems that the Task Force is trying to kill off a cheap and easy test because it is related to other evaluations (biopsies) and treatments (radiation, surgery) that may be harmful and are costly.

    Why not go after the big ticket item (treatments) and say guys with a low risk PCa get no treatment .... I'm guessing its because currently there is no way of being even 90% sure a guy has low risk PCa (short of removing the prostate and doing a complete biopsy). This is why low risk PCa patients on AS continue to get their PSAs done ... they are not sure if they have a low risk PCa.

    Its easier to recommend no PSA; therefore no biopsy; therefore no treatment. Its just a bunch of old guys anyhow.
  • Swingshiftworker
    Swingshiftworker Member Posts: 1,013 Member
    mrspjd said:

    Well said
    Well said, John. Excellent post and I agree 110%.

    Re the statement in a previous post by another member that “…this means that a lot of urologist/surgeons will be out of a job,” with regard to PCa treatments alone, I might add that it won’t just be the uro surgeons with a lighter case load---radiation oncologists, especially those working in the field of SBRT aka CyberKnife, will be at risk of losing much of their PCa business, since the majority of their PCa biz currently focuses on marketing to and treating men dx’d with low-risk PCa.

    In regard to the report that the USPSTF may be recommending the elimination of PSA tests for men, here’s a novel idea (tongue in cheek, of course): I propose a new clinical study. The study group would consist of the men and women on the USPSTF advisory committee. (Yes, I know, I have a sick mind and that the study is flawed.) The men will not be allowed to have PSA testing (ever), and the females will not receive any diagnostic or yearly preventative mammograms. Each member of this study group will be followed until an end point. Upon the death of each study participant, an autopsy would be performed to determine cause of death. It will be interesting to determine the rates of occurrence and death from PCa and BCa in these men and women, respectively.

    If even a few could have been saved by early detection, cancer education and treatment, then I’d be willing to bet their families would be very vocal supporters of early detection practices/testing along with a mandatory proactive education program on the potential impacts (pros and cons) of add'l diagnostic tests as well as all viable treatments, including active surveillance, for those who fit the low risk profile.

    FWIW
    If the reason for the recommendation is to reduce the number of needless surgeries occasioned by indiscriminate PSA testing resulting in large numbers of men suffering incontinence and ED as a result, I do not think that radiation services like CK or PBT (and other alternative treatment methods like HIFU) would necessarily decline in the treatment of early stage PCa, because they can be marketed as a viable alternative to surgery which will NOT have as great a likelihood of causing incontinence and/or ED but still kill the cancer even if they're not sure whether the cancer requires treatment or not.
  • Beau2
    Beau2 Member Posts: 261

    FWIW
    If the reason for the recommendation is to reduce the number of needless surgeries occasioned by indiscriminate PSA testing resulting in large numbers of men suffering incontinence and ED as a result, I do not think that radiation services like CK or PBT (and other alternative treatment methods like HIFU) would necessarily decline in the treatment of early stage PCa, because they can be marketed as a viable alternative to surgery which will NOT have as great a likelihood of causing incontinence and/or ED but still kill the cancer even if they're not sure whether the cancer requires treatment or not.

    FWIW2
    Hey Swing,

    I agree that the recommendation is to cut back on treatment (primarily surgery, brachy, radiation, etc.). Since CK and PBT are used primarily on low risk patients, I would have to agree with mrsjpd that CK and PBT would feel a hit. Or are you proposeing the CK and PBT docs will morph into high risk PCa specialists?
  • KathyLQ
    KathyLQ Member Posts: 100
    jerrylh said:

    your comments
    Hi Kathy

    First of all regards your boyfriend, no he would wait until he is 85 and never need anything done for his prostate cancer. Be aware that at age 85 95% of ALL men have prostate cancer and that 100% of all males age 90 have prostate cancer. Remember that only 2.5 to 3.0% of men with prostate cancer will die from their disease. And that death rate is the same even in countries where there is no screening. Remember, Kathy, these are recommendations for healthy males, not for males with blood in their urine for example.

    The reaction of most of the readers here is not surprising. in the 1950s and 1960s everyone was getting screening chest x-rays to detect early lung cancer. The studies revealed that we were not saving lives, but the screening continued for another 10 years until it finally died out.

    Jerry

    What about the Gleason Score? And DNA ploidy?
    I asked my boyfriend for more specifics. He is 71, he has a Gleason Score of 7, and one biopsy core was 15%, and and 2nd biopsy core was 5%. At this current time, he is leaning towards the robotic surgery. BF is very active, not overweight, walks 5 miles regularly, rides a bike 5-10 miles regularly. Has relatives that have lived into their 90's.

    I found this article at the Prostate Cancer Research Institute interesting: http://www.prostate-cancer.org/pcricms/node/165. Titled: "The Gleason Score: A Significant Biologic Manifestation of Prostate Cancer Aggressiveness On Biopsy"

    It mentions a DNA analysis, called "DNA ploidy". Is this being done?

    Comments?
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    Beau2 said:

    FWIW2
    Hey Swing,

    I agree that the recommendation is to cut back on treatment (primarily surgery, brachy, radiation, etc.). Since CK and PBT are used primarily on low risk patients, I would have to agree with mrsjpd that CK and PBT would feel a hit. Or are you proposeing the CK and PBT docs will morph into high risk PCa specialists?

    As a man who is doing Active Surveillance with Delayed treatment
    if neessary, I feel that I am fortunate to be a position where I can can be monitored, and active treatment can be done if it progresses.

    If I was not diagnosed, as many men will not be now, the disease can progress without being monitored, causing very negative consequences.

    I do believe that the PSA gives some inication that a biopsy may be needed.

    I also believe that there is a lot of overtreatment when a positve biopsy is found resulting from patient fears, ignorance and a need to do something. Additionally many docs are self serving. If this were not so there would be no discussion about the PSA test.
  • hopeful111
    hopeful111 Member Posts: 13
    Kongo said:

    PSA Test Is Not The Problem
    John,

    I completely agree with comments you made in another post that the problem isn't the PSA test in and of itself. I don't think the problem lies with the patients either...as most lay patients have no real idea at the time they're first informed about their scores what the implications actually mean. In my mind, the big problem with the PSA test is what the diagnosing physician does with the information and how it's presented to the anxious man sitting in his office.

    I think my case if fairly typical. A routine physical indicated that my PSA was 4.3 and my GP told me I needed to have it checked out by a urologist. Anxiety starts to build at this point. A few week later after a brief DRE with no abnormalities, the urologist strongly recommended a biopsy "to rule out cancer." Well shoot, who isn't going to go along with that recommendation? So back again in a few weeks and have the biopsy. A few weeks afterward I get the news..."unfortunately, we found cancer...but the good news is that we got it early and we can take it out and fix this problem for good." Now the anxiety is really building. I liked the urologist, I liked his staff, his office was convenient, he was recommeneded by my GP who I admire and respect. He had great credentials. Why not just do what he says? But wait, there's more: Run over to X-ray and get a bone scan to make sure the cancer hasn't spread. Of course at this point you're not thinking too clearly and of course you want a bone scan and how quick can I get there? Nowhere in this process did anyone tell me that the bone scan with the pathology I had wasn't going to find anything. Nobody told me the pathology might well be an indication of indolent cancer. Instead, while in a very vulnerable mental state, I was pushed toward surgery and the sooner the better. "We can get it all."

    I think a lot (if not most men) in this situation get sucked into the system and end up getting over treated and may well indeed end up with complications much worse than their original cancer ever would have given.

    In my opinion, what should have happened is this. The GP tells me the PSA is "above normal" but, oh by the way, there really is a lot of conflicting opinion on what "normal is." Before we go to the urologist, lets rule out prostititus, a low grade urinary tract infection, or BPH. GPs ought to be able to do this easily. He should explain that things like sex before a blood draw, a lot of bicycle riding, taking Advil, and several other things can cause a temporary spike in PSA. Go home, be celibate, quit taking Advil, avoid the bike for a few days, and come back in a week and let's do another PSA test. In the meantime, let's test your urine for UTI. And, oh by the way, let's calculate your PSA Doubling Time, PSA velocity, and PSA density.

    If, after doing these simple additional checks which every GP ought to be well informed about and capable of performing, the PSA is still elevated and PSA density is above 0.1 and the doubling time is troublesome, and he has ruled out a UTI then maybe it might be a good idea to consult with a urologist.

    The urologist should rule out prostititus through a 6-8 week anti-biotic regimen before he suggests a biopsy to further determine what is going on.

    Patients should understand the pros and cons of biopsies, the risk of infection, and the fact that a negative biopsy doesn't necessarily mean you are free of cancer...but only that the less than 1% of the prostate tissue sample didn't have any abnormal cells.

    If cancer is then detected, patients should be counseled by independent oncologists, radiologists, and surgeons who are not financially connected with the diagnosing doctors. Second opinions on the biopsy should be obtained.

    Prostate cancer patients need an ombusdman to oversee this process and ensure that the men and their spouses or significant others get an informed and balanced perspective of the pros and cons of each treatment method, what the side effects might be, and what short and long term risks are involved.

    If we had a process similar to this we would probably save billions of dollars in over treatment costs to our health care system and improve the quality of life for men suffering from PCa.

    Many posters recognize that the PSA test may have saved their life just as many women were treated for breast cancer after a timely mammogram enabled them to get treatment before it was too late.

    The other thing about PSA testing that tends to be overshadowed in these reports is that after treatment, whether by radiation or surgery or some other means, the ONLY way to monitor the success of the treatment is to regularly monitor the PSA for the rest of your life.

    I say keep the PSA test. Change the way we handle the information it provides.

    K

    panel's recommendation that psa test is not needed for most men
    In the context of above reply and "Change the way we handle the information it provides.", some comments:

    am so confused and discouraged by this recommendation; I realize its not meant to be a textbook on pca
    but leaves out the finer points about should anyone get any treatment at all and what evidence (ie gleason, etc)
    might relate to actually getting treatment, as opposed to not doing anything at all even if they have taken a psa
    and its high or high velocity, etc.

    I realize some books and articles explain about this, but its not always easy reading and I don't know how many Drs do explain it at
    any level, ie if you have such and such a gleason score, and/or
    such and such results from bone scans, etc -- that certain treatments
    should be done, otherwise surveillance. I guess this is just another
    example that until things change with the info provided us, that its up to us to discover it as best we can.

    But right now, am sort of doubting/wondering if all that info about
    gleason, bone scans, etc are valid also as to decision making -- just
    as its mentioned that often recommendations for the treatment
    itself is given with profit in mind and not really needed in dr. opinion.

    Rather depressing to be thinking in these terms but while disagree
    with panel recommendation itself, seems like have read many times
    before about treatments that were not needed or for which side
    effects not explained in enough depth.



    also confused about mention of "healthy men" not getting psa - most folks I think who did/do have pca had no other
    evidence of it before psa led to biopsy/treatment/etc - as is mentioned
    in several posts in this thread.


    am well aware of the profit motive for many drs and their practice orgs for the surgery, radiation to be done, as well as for the adt to be done and promoted by drug cos even if not needed.

    but aware also of the desire of ins cos to save costs/payments, which would happen if no treatments done or done a lot
    less - and from some comments elsewhere have stated that this was partly
    or all behind the panel's recommendation, and that panel recommendations
    effect coverage/benefits of ins cos or medicare and can thus lead to reducting those benefits even if a person wanted those treatments
    and their dr agreed.


    ==> thus having gone thru treatment recently (adt, imrt) and now waiting for the first 3 mo psa result and dr visit,
    and having read what I thought was a lot in books, msg boards, etc -- am just totally confused by all of this
    now and asking myself did I do the right thing or the wrong thing in getting treatment or in getting psa at all, and seeing all my side effects of the adt and imrt, which i know is not unique to just me, does not help (i was gleason 7(4+3) in 4 cores of 12 - 90% in each of those, gleason 3+3 in a bit of some others.

    sorry if writing a bit incoherently here but this recommendation really has me confused (though aware that this recommendation
    and referred to studies are not new nor is this controversy but so much more visible and in my face now)

    hopeful111
  • VascodaGama
    VascodaGama Member Posts: 3,513 Member
    Beau2 said:

    PSA
    Hey Seattle,

    Good point, "The report adds that PSA testing is "associated with harms related to subsequent evaluation and treatments."

    It really seems that the Task Force is trying to kill off a cheap and easy test because it is related to other evaluations (biopsies) and treatments (radiation, surgery) that may be harmful and are costly.

    Why not go after the big ticket item (treatments) and say guys with a low risk PCa get no treatment .... I'm guessing its because currently there is no way of being even 90% sure a guy has low risk PCa (short of removing the prostate and doing a complete biopsy). This is why low risk PCa patients on AS continue to get their PSAs done ... they are not sure if they have a low risk PCa.

    Its easier to recommend no PSA; therefore no biopsy; therefore no treatment. Its just a bunch of old guys anyhow.

    PSA is not problematic but it is not complete
    The problem is not in the PSA but the interpretation and judgements that follow its findings. Physicians are not prepared to interpret accurately the tests’ meaning. Treatments are still primitive and guessing and do not address the cancer itself igniting thoughts like the “get rid of it”.
    Reliable Institutions also fall in the trap and produce “Guidelines” which are antiquated to the occasion. Updates must be based on past experiences of many years and that turns the whole aspects of the prostate cancer ambiguous.

    Prevention programs for cancer should be obligatory as must as are the vaccines we all take at young age.

    Regards to all
    VGama
  • Kongo
    Kongo Member Posts: 1,166 Member

    PSA is not problematic but it is not complete
    The problem is not in the PSA but the interpretation and judgements that follow its findings. Physicians are not prepared to interpret accurately the tests’ meaning. Treatments are still primitive and guessing and do not address the cancer itself igniting thoughts like the “get rid of it”.
    Reliable Institutions also fall in the trap and produce “Guidelines” which are antiquated to the occasion. Updates must be based on past experiences of many years and that turns the whole aspects of the prostate cancer ambiguous.

    Prevention programs for cancer should be obligatory as must as are the vaccines we all take at young age.

    Regards to all
    VGama

    Obligatory
    Hey, Vasco

    What type of obligatory cancer prevention program would you suggest?
  • Kongo
    Kongo Member Posts: 1,166 Member

    PSA is not problematic but it is not complete
    The problem is not in the PSA but the interpretation and judgements that follow its findings. Physicians are not prepared to interpret accurately the tests’ meaning. Treatments are still primitive and guessing and do not address the cancer itself igniting thoughts like the “get rid of it”.
    Reliable Institutions also fall in the trap and produce “Guidelines” which are antiquated to the occasion. Updates must be based on past experiences of many years and that turns the whole aspects of the prostate cancer ambiguous.

    Prevention programs for cancer should be obligatory as must as are the vaccines we all take at young age.

    Regards to all
    VGama

    Obligatory
    Hey, Vasco

    What type of obligatory cancer prevention program would you suggest?