PSA test does more harm than good? wt?

Medical group to say men don't need prostate cancer screenings, source says

Just to confuse us a little more, this study comes out...what to do?

http://www.cnn.com/2011/10/06/health/prostate-screening/index.html?hpt=hp_t 2

Dan

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34 replies. Join the discussion

What I am pointing out is that almost everything we read is that early detection is the key. Read the article and let's throw this around the discussion table.....seems very dangerous or potentially dangerous. I am not sure how a PSA test is in itself is harmful..maybe the results can be misleading. What you do with the information can be harmful but it can also be enlightening, i would think???

This should get alot of talk...throw in your thoughts!

Dan

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Dan, I believe it is not the test itself but the panic it can cause if a reading is higher than "normal". Since many men are older, and all they know is cancer without understanding the nature of prostate cancer, many think they have to get it cut out, which can cause problem as we all are aware of. Maybe more education to the older men, a mentor coming along side of these guys and making this disease more public and not "hidden" like the breast cancer movement.
At our state fair last August, we had a Prostate Screening going on. Do you realize it was women volunteering the screening, wives dragging their husbands to the screening and information table? Where were the men helping other men with this disease and not hidden on a message board? Florence Oregon has the right idea going. And if all the guys on this board would start a local Man to Man group, maybe we can do something to help.
Off my soapbox for now....LOL
Sharon

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I read several articles this morning about this. Really strange. How can a PSA test itself not be wise? My PSA had gone up from 3 to 5 in one year (age 62), so I had a DRE (negative) followed by a biopsy (positive).

If I hadn't had the PSA test, I wouldn't have had the biopsy, and the cancer would have grown without being treated.

Here's another:

http://www.latimes.com/health/la-he-psa-test-20111007,0,4483814.story

Weird.
Tom in CT

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I think that Sharon is correct in that many men panic when they hear that they have PCa and want it cut out immediately or do something without maybe weighing all of the options. I had somewhat minimal numbers and the doctor suggested surgery as do many but i chose WW/AS for three years and monitored. The urologist had said that most people hear they have cancer and want it removed immediately when the truth of the matter is and I do believe that the treatment itself CAN be more harmful than the cancer itself BUT I am sure there are people on this group who would argue this point and should do so.... this is a very important personal decision.

Dan

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Several years back Sharon and I were sitting in a booth in a restaurant. We heard a conversation of two guys in the next booth, one was commenting how many times he was getting up at night to urinate. Well, trying to be a good samaritan, I approached them and suggested that he get a PSA test to check for PC, etc, etc. This approach I still believe was proper, but the response of these two younger men was negative and mocking. I have always hoped that the one who was complaining had eventually pursued this with an urologist. Who knows, maybe I did make a difference.
I have always told other men to start getting a PSA at 45 and know it like they do their colesteral. At least to have a baseline so they will know when it begins to rise.
I don't understand this recently news about NOT getting a PA?????!!!!!!!

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Dan, I have learned in our battle with this disease is you do have a couple of different kinds that are under the term "Prostate Cancer". I know there are the young guys-under 65- that are diagnoised and seem to have a more aggressive prostate cancer than someone over 70 and they have the prostate cancer that can be watched and possibly have no treatment the rest of their lives. And what do you do, wait until symptoms rear their ugly heads in the younger men, the middle men or older men when a simple blood test can be watched? I sometime believe our gov't and medical society want euthansia now and this is one way of enacting the platform.

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typo....PSA?????!!!!!!

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A local Man To Man group!? How about a local Us TOO group so you can give out really good pamphlets and get great support? Our local group is having community talks about PSA with experts just so we can openly deal with the question of whether PSA testing is something we want to do, and push-back on the government, or whether it can cause more harm.

Isn't Man to Man a subset of the American Cancer Society? And isn't the American Cancer Society recommending that PSA testing not be done?

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Following up on my earlier comment - if the panel's recommendation NOT to have a PSA test is based on problems resulting *from rushing into a decision for treatment* ... well, that's a pretty shaky reason.

It would be like recommending that people not buy cars, because you can get killed if you race them.

But not everyone races cars - or races into a prostate cancer treatment decision.

Weird x2.

Tom in CT

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You are right, jeanj, about Man to Man being part of the American Cancer Society. That's how the group in Florence, Oregon got its start (thanks for mentioning us, kalchic). On our website, www.ustooflorence.org, we give the reasons why we are no longer a Man to Man group...strictly an Us TOO group. It is the message! When the American Urological Association changed its guidelines in 2009 to recommend a baseline PSA/DRE at age 40, we were thrilled. Then along came ACS in 2010 and recommended men have a talk with their doctors at age 50 about the "known and proven" risks and the "possible" benefits of screening (instead of being "offered" screening at age 50). That did it! In September, 2010, we sent a letter to ACS severing our relationship. We knew there was no possibility of ACS changing its guidelines because Dr. Brawley, Chief Medical Officer says he has never had a PSA and will never have one because he doesn't believe it saves lives. He is also in a higher risk category, being African-American. I've seen his YouTube interview about prostate cancer screening in which he opposes those who promote prostate cancer screening, claiming that early detection saves lives. His next statement is, "That's a lie! We don't know for sure." If interested, you can see his interview at http://www.youtube.com/watch?v=odul8iY5xf4.

This morning I, along with all the other Us TOO facilitators, received an email from Tom Kirk, President and CEO of Us TOO International. Naturally, it was about the latest USPSTF recommendation that men should not be screened for prostate cancer. Anyone who wants to help us by writing letters, emails, etc., during the public comment period (Oct. 11 - Nov. 8), I suggest keeping in contact with www.ustoo.org. I have pasted his email below because it has some links to important sites.

Dear Bob,

We are on this. In a story in today's New York Times, I was able to provide a quote in response to the news, and have been speaking with other media all day today. Read the full New York Times story here: http://www.nytimes.com/2011/10/07/health/07prostate.html?hp

Due to pressure from the media, the USPSTF has posted their draft report on their website here:
http://www.uspreventiveservicestaskforce.org/uspstf12/prostate/draftrecpros tate.htm

The Task Force will be accepting comments on this draft recommendation statement beginning on Tuesday, October 11, 2011, and running through November 8, 2011.

I encourage you all to post your comments beginning Tuesday, October 11th at this website:
http://www.uspreventiveservicestaskforce.org/tfcomment.htm

We are working with our friends from the other prostate cancer nonprofit organizations on the Prostate Cancer Roundtable to coordinate a response from the prostate cancer community. You will be seeing statements and calls to action from all of us in the coming days. Keep watch on the Us TOO website for more information.

We want you to take action. Be ready to engage your network of fellow survivor warriors, friends, family, coworkers and neighbors. Thank you for your participation and support!



Sincerely,


Thomas Kirk
President & CEO
Us TOO International
tom@ustoo.org

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I found this section of the draft report especially interesting:

"While the USPSTF discourages the use of screening tests for which the benefits do not outweigh the harms in the target population, it recognizes the common use of PSA screening in practice today and understands that some men will continue to request and some physicians will continue to offer screening. An individual man may choose to be screened because he places a higher value on the possibility of benefit, however small, than the known harms that accompany screening and treatment of screen-detected cancer, particularly the harms of overdiagnosis and overtreatment. This decision should be an informed decision, preferably made in consultation with a regular care provider. No man should be screened without his understanding and consent; community-based and employer-based screening that does not allow an informed choice should be discontinued."

While I question the draft's general finding that "there is no statistically significant benefit to PSA screening", I certainly agree with the "each man should make his own informed decision" on screening (as well as whether to treat or not to treat).

The report also confirms that "The American Urological Association recommends that PSA screening should be offered to men aged 40 years or older (43). The American Cancer Society emphasizes informed decisionmaking for prostate cancer: men at average risk should receive information beginning at age 50 years, while African American men or men with a family history of prostate cancer should receive information at age 45 years (44). The American College of Physicians (45) and the American College of Preventive Medicine (46) recommend that clinicians discuss the potential benefits and harms of PSA screening with men aged 50 years and older, consider their patients’ preferences, and individualize screening decisions."

Tom in CT

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I'd really recommend that USTOO - or even just someone beginning a new discussion here - remind all of us that we can comment on the draft report beginning on October 11 at the link given in this discussion. As that's several days away, the comments aren't open yet, and when we get busy ... we tend to forget.

Tom in CT

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I believe the term "Man to Man" I used was in reference to a one on one mentoring NOT a group sponsored by a organization. More men involved with other men in guiding men through this battle. Coming along another man with the information available to help make a informed decision concerning one man's fight. In the breast cancer fight, you always have women coming along side women, every step of the way. Shouldn't prostate cancer be the same? Then is doesn't matter what some study says...the guys know the truth as do their significant other.

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The New York Times article seems to suggest there are only two grades of PCa, slow growing and aggressive, and that a person with the slow growing type will die of something else and by the time its detected its too late if it is the aggressive type. The continuum of the Gleason Score, which in some way rates the agressiveness of the cancer, seems to suggest otherwise. If the Gleason Score is 6 maybe watchfull waiting make sense and if it 10 maybe it is to late to treat successfully. But what if it is 7 or 8 and the affected person is under 65? I think it makes sense to treat the PCa and you do not know the Gleason Score until a biopsy is performed, which is indicated by a PSA test.

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I think the problem being addressed is that the decision for prostatectomy in particular or other radical treatment in general is being made at the wrong point or on the wrong data. At one extreme, if an 85-year-old man has prostate cancer with Gleason 1+1=2 on biopsy, he is probably best advised to watch. At the other extreme if a 60-year-old has Gleason 4+5=9 or 5+5=10, he should probably opt for one of the radical treatments. I inserted "probably" because I don't really know the odds on survival or statistics on duration of survival for a man in that situation. It is conceivable that radical treatment would not prolong survival. Some combinations of treatment probably would, however, significantly decrease the probability of local recurrence, which is said to be quite unpleasant.

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on the point earlier from calchick re. the panic which ensues.

Two years ago (age 55) - a routine PSA resulted in an increase from 1 to 3. "Velocity" right? I was sent for a DRE (nothing), and biopsy 'to be sure'. A 'little something' (less than 1% of 1 of 12 samples) was found. A re-read concurred. The urologist-surgeon recommended prostectomy. I was set to go.

A PCa researcher in california advised me to at least double check PSA. Result 1.67. I cancelled the surgery and switched urologists. The new uro called the biopsy "clinically insignificant". The researcher believes the 3PSA was the result of a 'little flair up', that may have since subsided. Since then, constant monitoring has ranged from no higher than 1.83 to a low of 1.22. I've gone to a plant based diet and continued AS.

The point of all this? on the one hand I'm glad for early diagnosis - should not be afraid of information. on the other, constant stress for 2 years which might have been avoided. A radiologist once said to me: 'in some ways, we've done you a disservice, to put you in this position - having to make this decision now". One day, I will likely have to take action, there is a family history. But I have lived two years in fear and stress. a second opinion from an oncologist/hemeotholgist told me he thought mine was - or would have been a case of over-treatment.

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wow this is all so relevant and personal... 62 had RP 6 months ago.. Cancer confined to prostate gleason 3+4... I was told glowing stories of quick recoveries and full erectile and uro function... I have gone thru hell (recovery ) and my erectile function sucks ( pardin the pun ) . I can ejaculate with a somewhat flcid penis...but instead of sperm I now ejaculate urine.. With diet I had brought my PSA down from 7.5 to 4 , but the doc was convinced I needed the surgery.. Its done , I am grateful to be cancer free, but I am not sure I made the right decision.... Like many others the fear of god was put into me and playing the waiting game was a bit of a strain..Also a good friend of mine died of a very aggressive prostrate cancer and that had a huge influence... A very tough decision for all of us out here. !

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kalchic - You hit the importance of support groups on the head. Men who have been newly diagnosed (and scared to death) walk into my group and see 30 or so men who have been down the road - talk with them - hear their journeys - listen to a urologist - walk out with a new sense of confidence. Its all a case of the newly diagnosed reaching out and the veterans remaining behind to help them along.

Bob

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I am astonished to find that some of my friends opted for surgery even though PSA was around 3 and gleason score of 6. I wonder, at PSA of 3 why did urologist do a biopsy. None of them had any symptoms. They told me that once they heard "cancer" they wanted it OUT. Probably urologists are to be blamed for this. Is there a test to check to see how aggressive is PC?

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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.

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.

on the other hand, am well aware of the profit motive for many drs and corps for the surgery, radiation, adt, etc

and aware also of the desire of ins cos to save costs/payments, which would happen if no treatments done or done a lot
less.

==> this 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 did I do the right thing, the wrong thing in getting treatment or in getting psa at all, and seeing all the side effects of the adt and imrt 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

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