Why I Won't Get a PSA Test for Prostate Cancer.

[Cattledog]

I recently had an awkward conversation with my doctor. I was getting a routine physical, and he recommended that I get a PSA test for prostate cancer. I’m 63.

I told him the PSA test harms more men than it helps. He acknowledged that PSA tests produce false positives, but he insisted that follow-up tests and biopsies will determine whether you really have a life-threatening cancer. He knew someone whose life had just been saved by the test.

When I still declined to get tested, he looked as though he felt sorry for me. He should feel sorry for the millions of men who have gotten unnecessary biopsies, surgery and radiation as a result of taking the PSA test.

PSA stands for prostate-specific antigen, an enzyme produced by the prostate gland, which is located below the male bladder. The test, which was developed in the 1980s, looks for elevated PSA levels, which can indicate cancerous cells in the prostate gland.
The problem is that inflammation and other problems unrelated to cancer can also elevate PSA levels. And when the PSA test correctly detects cancer, it is often so slow-growing that it would never have caused death or even impairment of health. Detection of these non-deadly cancers is called overdiagnosis.

In 2012, the U.S. Preventive Services Task Force, a federally funded panel of experts, recommended against the PSA test, saying the cons outweighed the pros. The decision was based primarily on data from two large studies, one done in the U.S., which found that screening did not reduce mortality, and the other in Europe, which showed a modest reduction.

https://blogs.scientificamerican.com/cross-check/why-i-wont-get-a-psa-test-for-prostate-cancer/?WT.mc_id=SA_TW_HLTH_BLOG&sf89684891=1

[Hoyt]

1. I get your choice, in fact I made the same choice when docs first started discussing the pros and

cons several years ago. The last time I went to the doc, I went ahead and had the test figuring that if it came back positive, I could then decide about retesting, biopsies, treatment, buying a motorcycle and running full speed off the Grand Canyon, etc. They say in most cases, prostate cancer is slow growing and many men opt for no treatment. And I heard talks that if you live long enough, you are likely to find evidence of prostate cancer.

Who knows what I'll choose when it's time to do it again. That's one thing for sure, testing or not is not a life-time decision.

Good luck.

[Binkie The Clown]

2. I'm 71 and my doctor agrees with you and me. At my age, why bother? n/t

[ollie10]

14. Fallacious

At 71, if you have decent enough health otherwise, you would be crazy not to treat prostate cancer if you found out you had it. Although it can be a slow disease, it can also spread quickly.

My doc told me about a guy who refused to get a biopsy several times. Finally, the guy went to the doc with pain in his pelvis/hip. Turned out, by this time the guy had bone cancer that had spread from the prostate to the bones.

Hindsight is 20/20 but it is tragic what happened to this guy. He refused to find out he had prostate cancer. At one point, it could have been simply treated (before it had spread). But by the time he found out, it was too late. This saddens me to even repeat the story. Think of what his family must have gone through.

[Binkie The Clown]

15. Yup. There's always one or two exceptions to every general principle.

But cherry picking one of those exceptions does not make the general rule invalid.

My grandfather smoked two packs of unfiltered Camels cigarettes every day, never got lung cancer or COPD, and lived to be 96. Clearly that general principle about smoking and lung cancer is wrong. NOT!

An uncle never smoked a day in his life and died of lung cancer when he was in his 40s. Clearly that general rule about not smoking to avoid lung cancer is wrong. NOT!

Worldwide, MOST men over 60 die with prostate cancer. Note I said "die WITH", not "die OF". The vast majority of men who die WITH prostate cancer die of other causes not related to that cancer.

The more important number is the NNS and the NNT (Number Needed to Screen, and Number Needed to Treat). 1410 "high-risk" individuals need to be screened to save one life. And 48 have to undergo expensive treatment with serious side effects to save one life. (Journal of Clinical Oncology) In other words, 1409 are screened who don't need to be screened, and 47 get expensive and painful treatment that they don't need. And that does not even take into consideration the fact that medical treatment is the 3rd leading cause of death nationwide.

To say something like "not getting screened doubles you chances of dying" is not very much different than saying "buying two lottery tickets doubles your chances of winning the grand prize in the lottery." Technically, both are true, but when the raw odds are low enough doubling those odds is, for practical purposes, meaningless.

For me, at 71, if prostate cancer got started tomorrow, I'd be well into my nineties before it became serious. I imagine I'll die of something else before I get within spitting distance of 100.

[ollie10]

16. It's your life!

I am aware that many people who have prostate cancer die from other causes first. It is an interesting point. But you are talking about groups of people not individuals. There is no way you can assume that if you got prostate cancer today it would be twenty years before you had problems and/or death.

Not all cancers are slow growing. If you are an individual who has a fast growing cancer, the chances of you having a fast growing cancer is 100%, you either have it or not, not some smaller number applying to groups of people in a screening. A biopsy can help you learn the nature of how aggressive your cancer is. Without that, you are shooting in the dark.

I am talking about the individual person here. Your decision to have a biopsy should be based on your personal information, not some statistics in a study. Likewise, your decision about treatment should be based on your individual cancer, not whether a lot of other people have slow growing tumors.

When my urologist was discussing my treatment, he said I am only 65 and in excellent health. I had a potentially aggressive tumor and my treatment was centered on these facts. 70 is just five years older. An aggressive prostate tumor could spread and kill you long before you would otherwise die.

[Binkie The Clown]

17. Your concern is noted. Now let's talk about the real threat to my life and yours...

Catastrophic ecosystem failure due to climate change.

[ollie10]

19. So let's fight climate change

Can you get more done to fight climate change if you live to be 85 or if you die at 78?

[RKP5637]

3. K&R!!! n/t

[TexasProgresive]

4. !st the PSA needs to be done earlier than 63 to get a baseline for the individual

2nd they need to be done on a yearly or 2 year schedule to check for upward trends.

That is what happen with me. I went from normal to abnormal with a 100% increase. I had a biopsy (12 core) that showed abnormal (re precancer) cells in about 6 cores. One had a one mm cancer. My doctor said it is possible that the core took out the whole cancer. I told him, "I want it out." When they checked the whole gland in the lab they found a quite large tumor but it was missed by 11 samples and the 12 only nicked it. I was very lucky as the gland was smooth with no nodules indicating a low chance of metastasizing to the bones. I still get PSAs and they run 0.0. If there is a rise they will do a scan to find where cancer cell have migrated to bone and can do localized radiation. It has been 5 years since surgery.

This is my story. Since you don't indicate having a history of PSA tests to show trends I don't know what to advise. I will tell you the biopsy was uncomfortable but not particularly painful. I went to work afterwards working off rolling ladders in the central office. I will tell you that I moved slow and carefully that afternoon because I was certainly aware that someone had violated me. Anyway it was not bad and the next day I was normal.

What I know about prostate cancer is that if a man lives long enough he will contract it. Some are slow growing and others are acute. It's your life do what you want- but I warn you prostate cancer that has metastasized to the pelvic bones is a painful agonizing way to go.

[redstateblues]

5. I've heard that at some point you can die with it, not because of it

I'm closing in on 69. I got a PSA test a few years back and it looked ok.

[ollie10]

13. It depends on your age and general health

You have a point, however I don't think 63 or 69 is old enough that you throw in the towel. If you are in your 80s and in poor general health, you will probably die from something else. However if you have 10-20+ years of life expectancy, you don't want it cut short by prostate cancer (it is often slow, but it can be aggressive, it can spread rapidly, and it can and does kill people in a very painful way

[stopbush]

6. I had a PSA come back with a reading of 262.

Normal is around 2.5.

My doctors freaked out. Scheduled an emergency consult with a urologist. A calmer head - mine - prevailed: I assumed the lab botched the test and asked to retest.

Retest came back at 2.6. Had another retest done a week later: 2.6.

Why would any doctor think an off-the-charts result of 262 would be valid?

[Jim Lane]

11. Occasionally an off-the-chart reading is accurate.

I sometimes represent children with lead poisoning. The CDC defines the "reference level" for lead poisoning as a blood lead level above 5 micrograms per deciliter (µg/dL). Some studies have concluded that children can be damaged even at levels of 3 or 4. There is no safe level. As a practical matter, though, the use of lead in modern industrial society makes it difficult or impossible for anyone to have a level of zero.

Back to off-the-charts: One of my clients was tested at 120 ?g/dl. That's not quite as far off the charts as your result but it's pretty shocking. Yes, the little girl was retested, and yes, the first test was accurate.

In your case, my reaction would have been to do a retest AND an emergency consult, the latter on a "what-if" basis. If 50 patients get such consults and 49 of them turn out to be pointless because the test was botched, it's probably still a net saving of medical resources if that 50th case is detected as soon as possible.

Anyway, I'm glad you were one of the 49.

[doc03]

7. I mentioned that panel of experts that recommended against a

PSA test to my doctor. He said the government doesn't want Medicare to pay for it. He is all for the test.

[phylny]

8. Okay.

It saved my husband's life. He had no prostate cancer symptoms - not one - and if he hadn't had his PSA checked during his routine exam, he would have been dead within two years.

His cancer, at age 55, was so large and advanced that there was no choice but to have an open procedure that has left him impotent with impaired urinary control. As it was, the cancer was precariously close to his bladder and he ended up having radiation several years later as his PSA continued to rise. He continues to have other, related, problems to this day, but is cancer free.

Everyone has a choice. I'm glad he chose to have his done, because he's here now, not dead.

[unc70]

9. Those of you ignoring PSA are deluding yourselves

I have written about this before. The "research" that led to the questioning of the PSA was terribly flawed. Their "control" groups were not abstaining from treatment. They were getting normal treatment similar to that of the aggressive treatment group. Get the PSA and a biopsy if indicated. That way you can have an informed decision.

Prostate cancer is nasty stuff. If it gets out of the prostate, it is a very painful and agonizing way to go. Very unpleasant. There are really different types that progress at far different rates. Please do not stick your head in the sand; do not ignore; we do not want to lose any progressive Democrats to this disease, or anyone else.

[mopinko]

10. i never could figure out how a false positive was harmful.

i admit i am behind schedule on mammogram, but jeez. getting a second test, a biopsy, or imaging studies, is a big thing? come on.

[ollie10]

12. Best wishes from a prostate cancer surviver

As a prostate cancer victim, I would like to respond to your post.

I had elevated PSA levels for a few years, and quite frankly I was scared to death. I read a lot of stuff on the internet and came to a similar conclusion as you appear to have done. In effect, I went through what could be called "watchful waiting". But it was really fear.

Then my PSA spiked higher (to around 9) and even then I was at first hard headed enough to put off doing anything about it. Got it retested in 6 months. Then I finally and reluctantly agreed with my urologist to have a biopsy.

Here is the truth: you can argue until the cows come home that PSA is over-used and biopsies are over-used, but there is only one way to find out if you have prostate cancer and that is by having a biopsy.

I got bad news. I indeed had cancer, and it was of a grade that would indicate a likelihood of spreading outside of the prostate gland .

I am not going to advocate for any type of therapy here, because different strokes for different folks, no two cancers are identical and no two people are identical.

I did have a robotic surgery by one of the leading surgeons in the world. Long story short, it appears they got it all and my side effects are a lot better than I had feared or expected.

What I am leading up to is they did a pathology report on the prostate gland after the surgery. Good news was there was no positive margins, so it appears it had not spread outside the prostate gland and my followup PSA tests are 0. Anyhow, my cancer was very close to the edge of the gland, within about 1 millimeter from the edge. I am so lucky. If I had waited much longer to have my biopsy and surgery, I have little doubt that it could have spread outside the prostate gland.....and my prognosis would have been very bad at that point. My stubbornness and hard headedness could very well have led to an early and very painful death.

My advice to you is go ahead and have the biopsy. It is not as bad a procedure as you may be fearing. For me it was almost painless, certainly less of an inconvenience than a dentist visit.

If you find out you don’t have cancer, happy day, and you will know that. Right now, you don’t.

If you find out you do, then you can go to work figuring out the best therapy to pursue, and there are several choices out there (and you and your doc need to figure out which is best for you....one size does not fit all). Best to know what you are dealing with, where it is in the gland, how big, whether the cells are aggressive, your general health other than this, etc.

You are just 63. If you are in decent health, you probably figure on 20 or more additional years. What a pity to cut it short by crazy thinking that you are so old, it doesn't make any difference!

Another bit of advice: : A large percentage of prostate cancer victims lead to family breakups and divorce. My advice here is don’t try to be the hero and fight this battle alone. Get your wife/partner involved from the start. He/She will be your best asset in this. This affects your partner almost as much as you, although in different ways. I almost went down the wrong path here, and I found myself with a wife who was feeling alienated by the entire thing. I could have lost the best thing that has ever happened to me, and it would have been my fault.

So, my advice is there is nothing at all in the prostate thing that cannot be overcome if you and your partner are communicating (from the start). Make it a team effort, and it will be better.

I hope this helps. If you would like to contact me, I would be happy to talk.

[RKP5637]

18. Excellent advice! n/t