New prostate cancer test advice overturns dogma - Don't Do The Test!

  • metta

    Posts: 39099

    Oct 09, 2011 7:43 AM GMT
    New prostate cancer test advice overturns dogma


    http://news.yahoo.com/prostate-cancer-test-advice-overturns-dogma-212821035.html
  • wild_sky360

    Posts: 1492

    Oct 09, 2011 3:19 PM GMT
    Too many variables affecting PSA results. My own physician advised the same. But don't forgo the digital exam. An experienced physician can detect abnormalities this way, regardless of variables.

    The problem with false positive results on a PSA is that it forces the ordering physician to take further action, like biopsies and other potentially harmful procedures on healthy tissue.
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    Oct 09, 2011 6:30 PM GMT
    This isn't really new. The US Preventative Services Task Force has never endorsed universal PSA testing, ever. It's always been "insufficient evidence." Prostate cancer is one of the cancers that are well known for people dying with them, not from them.

    You ask the urological and cancer societies, and of course they endorse testing. The tide had turned to more and more testing that it's almost criminal not to do it, and that's unfortunate. Yes, you get people like Art Deco who have high risk factors who get the most aggressive prostate cancers, but he's not in the majority.

    There's a famous case of a resident who went through the appropriate counseling for PSA testing, and got sued by the patient who got prostate cancer. The jury found for the patient, because it was "standard of care" to do the test, when it clearly was not. The moral of the story, unfortunately was this:

    http://www.kevinmd.com/blog/2004/05/doctor-sued-uspstf-guidelines-prostate-cancer-screening.htmlDuring that year before the trial, my patients became possible plaintiffs to me and I no longer discussed the risks and benefits of prostate cancer screening. I ordered more laboratory and radiological tests and simply referred more. My patients and I were the losers.

    Instead of evidence based medicine, fear of litigation (not just theoretical because a real life jury does not allow EBM to win in court) drove this resident and those who read this essay to do more tests.
  • nanidesukedo

    Posts: 1036

    Oct 09, 2011 6:33 PM GMT
    q1w2e3 saidThis isn't really new. The US Preventative Services Task Force has never endorsed universal PSA testing, ever. It's always been "insufficient evidence." Prostate cancer is one of the cancers that are well known for people dying with them, not from them.

    You ask the urological and cancer societies, and of course they endorse testing. The tide had turned to more and more testing that it's almost criminal not to do it, and that's unfortunate. Yes, you get people like Art Deco who have high risk factors who get the most aggressive prostate cancers, but he's not in the majority.

    http://www.kevinmd.com/blog/2004/05/doctor-sued-uspstf-guidelines-prostate-cancer-screening.html

    There's a famous case of a resident who went through the appropriate counseling for PSA testing, and got sued by the patient who got prostate cancer. The jury found for the patient, because it was "standard of care" to do the test, when it clearly was not.


    I worked with that doctor earlier this year...it's a shame that he got sued over something so stupid as that when the patient refused the test..
  • nanidesukedo

    Posts: 1036

    Oct 09, 2011 6:40 PM GMT
    nanidesukedo said
    q1w2e3 saidThis isn't really new. The US Preventative Services Task Force has never endorsed universal PSA testing, ever. It's always been "insufficient evidence." Prostate cancer is one of the cancers that are well known for people dying with them, not from them.

    You ask the urological and cancer societies, and of course they endorse testing. The tide had turned to more and more testing that it's almost criminal not to do it, and that's unfortunate. Yes, you get people like Art Deco who have high risk factors who get the most aggressive prostate cancers, but he's not in the majority.

    http://www.kevinmd.com/blog/2004/05/doctor-sued-uspstf-guidelines-prostate-cancer-screening.html

    There's a famous case of a resident who went through the appropriate counseling for PSA testing, and got sued by the patient who got prostate cancer. The jury found for the patient, because it was "standard of care" to do the test, when it clearly was not.


    I worked with that doctor earlier this year...it's a shame that he got sued over something so stupid as that when the patient refused the test..


    Frankly, I still use the PSA on all patients below the age of 75/80....but I use it in conjunction with a digital rectal exam to assess the prostate. After 75 or so, the PSA is kinda questionable in its usefulness as Prostate cancer is very common and typically very slow.. I think it's very useful when used in conjunction with a manual exam.
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    Oct 09, 2011 7:23 PM GMT
    nanidesukedo saidFrankly, I still use the PSA on all patients below the age of 75/80....but I use it in conjunction with a digital rectal exam to assess the prostate. After 75 or so, the PSA is kinda questionable in its usefulness as Prostate cancer is very common and typically very slow.. I think it's very useful when used in conjunction with a manual exam.


    Just started seeing a MD in the GLBT area in Seattle. I have been motivated in the past to allow them to focus on HIV patients.

    But, I have to quote him because I thought it was funny.

    "any doctor who does a digital prostate exam on a 25 year old is a pervert."

    Around 2005, there was an HBO special (about 3 hours long) on cancer. I'm an electrical engineer, not medical. The primary message they conveyed is early detection is your best if not only chance.

    Testicular cancer is another one... But, I have a rather large spermatocele on the driver side. So, I let a urologist do an ultrasound.



  • nanidesukedo

    Posts: 1036

    Oct 09, 2011 7:27 PM GMT
    RobertF64 said
    nanidesukedo saidFrankly, I still use the PSA on all patients below the age of 75/80....but I use it in conjunction with a digital rectal exam to assess the prostate. After 75 or so, the PSA is kinda questionable in its usefulness as Prostate cancer is very common and typically very slow.. I think it's very useful when used in conjunction with a manual exam.


    Just started seeing a MD in the GLBT area in Seattle. I have been motivated in the past to allow them to focus on HIV patients.

    But, I have to quote him because I thought it was funny.

    "any doctor who does a digital prostate exam on a 25 year old is a pervert."

    Around 2005, there was an HBO special (about 3 hours long) on cancer. I'm an electrical engineer, not medical. The primary message they conveyed is early detection is your best if not only chance.

    Testicular cancer is another one... But, I have a rather large spermatocele on the driver side. So, I let a urologist do an ultrasound.




    lol...well, your doc is correct. digital prostate exams aren't recommended unless the patient is 40 years or older or gives you a reason to think something might be going on back there. There's a reason men dread going for their physical after their 40th birthday ;)
  • Posted by a hidden member.
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    Oct 09, 2011 7:36 PM GMT
    RobertF64 said

    "any doctor who does a digital prostate exam on a 25 year old is a pervert."




    trauma exam
    malaena
    suspected haemorrhoids (for all you weights freaks)
    spinal/nerve damage

    anyway, prostate exam isnt the only reason to do a DRE.

    Although the patient should never feel both hands on their shoulders when you do it...
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    Oct 09, 2011 7:39 PM GMT
    Like prostatitis...which can happen in those under the age of 40. I've learned about doing the 4 glass urine test but I've never done it. Best reserved for the professionals...short of doing it in sexicon_lol.gif
  • nanidesukedo

    Posts: 1036

    Oct 09, 2011 7:44 PM GMT
    q1w2e3 saidLike prostatitis...which can happen in those under the age of 40. I've learned about doing the 4 glass urine test but I've never done it. Best reserved for the professionals...short of doing it in sexicon_lol.gif


    Ohhh...the fractionated urine samples that includes the "milking" of the prostate?

    interesting thing about prostatitis is that it is recommended not to putz around with it too much or you risk systemic infection/sepsis...
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    Oct 09, 2011 7:50 PM GMT
    umm, wouldnt DRE in prostatitis be really painful? slash, you'd treat empirically...
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    Oct 09, 2011 7:55 PM GMT
    Yes, prostatitis is often treated empirically, but if urinary tract infections recur again and again, I guess a urologist would be asked to prove that they are actually coming from the prostate rather than something else, say, a bladder or kidney abnormality. It would commit the patient to long term antibiotics after you have positive results from the 4-jar urine test, obviously done not when an acute flare is happening, but rather when the patient is not symptomatic.
  • nanidesukedo

    Posts: 1036

    Oct 09, 2011 8:05 PM GMT
    tokidokiau saidumm, wouldnt DRE in prostatitis be really painful? slash, you'd treat empirically...


    yes, it should be empirically diagnosed and treated...As stated about, putzing around with a prostate that is infected can cause release of some really nasty bacteria and, supposedly, lead to sepsis.