Screen or Not? What Those Prostate Studies Mean

[groovedaddy]

Last week, two major studies from the United States and Europe found that P.S.A. testing — the annual blood test used to screen men for prostate cancer — saves few if any lives, while exposing patients to aggressive and unnecessary treatments that can leave them impotent and incontinent.

The news was unsettling and confusing to many middle-age men, particularly those who already have diagnoses of prostate cancer as a result of P.S.A. testing. Doctors say some men are reconsidering surgery or radiation treatment they have planned. Others, convinced that their lives were saved by P.S.A. screening, wonder how anyone could question the value of early detection of prostate cancer.

In the face of all this confusion, what’s a man to think? Here are answers to some frequently asked questions.

WHAT DID THE STUDIES REALLY SHOW?

The bottom line of both studies is that P.S.A. screening does find more prostate cancers — but finding those cancers early doesn’t do much to reduce the risk of dying from the disease.

http://www.nytimes.com/2009/03/24/health/24well.html?th&emc=th

[Orrex]

1. When I heard that the prostate exam would be digital

I mentioned to my roommate that I'd just as soon have the analog version.

"No you wouldn't," he said. "That's when they shove a record player up your butt."

[groovedaddy]

3. I was having a physical at a clinic when they sent this rather rotund

Physicians assistant in to perform the "digital." I took one look at his fingers and declined the test!

[TechBear_Seattle]

9. Thanks for the laugh

:toast:

[the other one]

2. My uncle is going to be upset about this.

He made a lot of money when he helped to develop the PSA test.

Of course now he is up to his eyeballs in bad real estate in Florida, so I guess he got what he deserved. He at least he still has his car with the radio that he uses to listen to Rush Limpballs when he drives.

[heidler1]

4. I'm 83 years old my last PSA showed 23 which is very high. I have had one biopsy 12 years ago.

There was no sign of cancer. I pissed blood for several days afterword and decided it was a bad idea to poke holes through my lower intestine into my prostate. I read many times that men my age will probably die of something else before prostate cancer does them in. So I ask my doctor "whats the point in knowing if you probably shouldn't get it operated on even if you know you have cancer?" He did a kind of dance which made me think he saw me as a money machine and it was his decision as to how he should be allowed to play the machine.

[unc70]

6. Given your age, I probably agree with your decision

I have one friend about your age who seems much younger. A biopsy confirmed CaP for him and he decided to have the radiation pellets, I think.

[unc70]

5. Get the PSA and DRE screening. The American study is useless

Just read the entire NYT article and you will see that they did not compare screening with no screening; they compared aggressive screening with a general population group of men who were only monitored. Over half of this later group did what most of us would do and received PSA screening as part of their regular medical care or as a result of having symptoms.

Prostate cancer kills more people each year than any other type except lung cancer. Slowly and painfully. Almost all men eventually develop small prostate cancer tumors, most of which remain contained in the prostate and cause few problems and would only be found by an autopsy. It is those other ones that are the problem. Unfortunately, we don't yet have any test to determine which ones are aggressive and can be deadly.

Ones like mine. My PSA has always been elevated, gyrating up and down mostly because of infections. I had my first biopsy before I was 50, and it found nothing. DRE found nothing. Last summer my PSA spiked and remained over 10; a biopsy found two small tumors, one with Gleason 7 (3+4).

I opted for surgery; negative/clear margins, no lymph nodes. Unfortunately, the cancer was starting to grow out of the prostate and its capsular. The surgeon still attained the desired margins. Now I just have to wait and hope that the PaC had not escaped before the surgery.

Get a baseline PSA early, maybe at 40 and certainly by 50. Get a PSA annually after 50 and watch for sudden increases. If the PSA is high or increases, see a urologist, as good as possible. Most men will have other prostate issues by their 60's so you will need one anyway. Get a biopsy when it makes sense.

If you must decide among unpleasant treatment options, consider factors like your age, overall health, and ability to deal with side effects. Get the best care you can at a medical center with a comprehensive approach. You will have fewer side effects and recover normal functions more quickly.

Do not bury your head in the sand or believe the BS happy talk. Get screened.

[Orrex]

7. Great post!

:yourock:

[unc70]

8. Thank you.

I think I need to pull several of my posts together into something for my journal. I hate the impact that mediocre research filtered through the MSM is likely to have. Almost every guy would love a reason to avoid a DRE, much less a biopsy, and it only gets worse from there.

But the PSA/DRE combo is all we have now, and we should use them until better tests become available. If your life expectancy is at least ten more years, get tested and get appropriate treatment.

Even I became more complacent over the years and should have reacted more urgently last year when it first appeared that my test results had changed. I might have had surgery 4-5 months earlier.

[TechBear_Seattle]

10. Well stated. Thank you n/t