Prostate Test Finding Leaves a Swirl of Confusion

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    Oct 12, 2011 8:42 PM GMT
    The fact that cost savings plays such a role in making decisions like this is scary when there is no recourse from what a government health panel will or will not cover. That's why competition works.

    http://well.blogs.nytimes.com/2011/10/10/prostate-test-finding-leaves-a-swirl-of-confusion/?ref=science

    For men living with a diagnosis of prostate cancer, the news that the P.S.A. test does more harm than good has been unsettling and confusing.

    After all, that is the test that first led to their diagnosis — and, often, a painful and traumatic course of treatment.

    And now they tell us it doesn’t work?

    “You will find mixed opinions from those of us who had to deal with it,” said a 78-year-old man from Boston who was left impotent and incontinent after his prostate was removed 11 years ago. “My current feeling is not anger; it’s sadness that I probably made the wrong choices and the consequences were both negative and not expected.” (He and another man quoted in this column asked not to be identified.)

    This week, the United States Preventive Services Task Force is expected to announce its recommendation against routine testing for blood levels of prostate-specific antigen, the protein that can be a signal of prostate cancer. The panel says research shows that over all, the test does not save lives and leads to unnecessary surgery and radiation treatment for slow-growing cancers that would never have caused harm. As for faster-growing, invasive cancers, there’s no proof that P.S.A. tests and earlier treatment offer any overall benefit.

    Many men do remain convinced that the test saved their lives by helping their doctors detect cancer in its earliest stages. But others are now left second-guessing their decisions, questioning a medical system that pressured them not only to undergo screening, but to be treated aggressively once cancer was detected.

    Ten years ago, several doctors urged William Lewis of Washington, now 69, to have his prostate removed after a spike in his P.S.A. levels led to a biopsy and a diagnosis of cancer. But his own research led him to a “watchful waiting” program at Johns Hopkins School of Medicine, where he now undergoes regular checkups and biopsies to make sure his cancer hasn’t progressed.

    “My urologist said, ‘Definitely prostatectomy,’ as did other people,” Mr. Lewis said. But “absolutely nothing has showed up that would suggest treatment is in order.
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    Oct 13, 2011 1:55 PM GMT
    I take it you've studied the accuracy of PSA tests in detecting cancer?



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    Oct 13, 2011 2:14 PM GMT
    Wow riddler. You really showed your ignorance here. Trying to turn changes in prostate cancer screening protocol into a political issue is a stretch. The problems with prostate cancer detection and course of treatment have been well documented for quite a while. In essence, it all boils down to the cure being worse than the actual problem.
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    Oct 13, 2011 2:23 PM GMT
    meninlove said I take it you've studied the accuracy of PSA tests in detecting cancer?

    I don't see the relevance or appropriateness of your question. Riddler did not dispute the article or the PSA test issues. I discussed this point with a physician yesterday who agreed with the concern about the false positives and the resulting procedures. It is not just a cost issue, but no one can deny that can play a role in follow-up decisions.
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    Oct 13, 2011 2:34 PM GMT
    socalfitness said
    meninlove said I take it you've studied the accuracy of PSA tests in detecting cancer?

    I don't see the relevance or appropriateness of your question. Riddler did not dispute the article or the PSA test issues. I discussed this point with a physician yesterday who agreed with the concern about the false positives and the resulting procedures. It is not just a cost issue, but no one can deny that can play a role in follow-up decisions.


    The problem arises if you receive a positive test for prostate cancer. The cancer may be a slow growing type and the patient will most likely die of other causes (not prostate cancer). In this situation, treatment is not warranted. So why is PSA screening for all men over 50 medically necessary when only a small percentage of positive tests result in detection of fast growing type prostate cancer?
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    Oct 13, 2011 3:58 PM GMT
    southbeach1500 said
    catfish5 said
    socalfitness said
    meninlove said I take it you've studied the accuracy of PSA tests in detecting cancer?

    I don't see the relevance or appropriateness of your question. Riddler did not dispute the article or the PSA test issues. I discussed this point with a physician yesterday who agreed with the concern about the false positives and the resulting procedures. It is not just a cost issue, but no one can deny that can play a role in follow-up decisions.


    The problem arises if you receive a positive test for prostate cancer. The cancer may be a slow growing type and the patient will most likely die of other causes (not prostate cancer). In this situation, treatment is not warranted. So why is PSA screening for all men over 50 medically necessary when only a small percentage of positive tests result in detection of fast growing type prostate cancer?



    I think the PSA test is being blamed for something that is not its fault, rather, it is the decision to treat the cancer that should be questioned.

    PSA test is not being blamed for anything. Rather, the medical necessity of blanket testing all men over 50 yo is being questioned.
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    Oct 13, 2011 4:34 PM GMT
    southbeach1500 said
    catfish5 said
    southbeach1500 said
    I think the PSA test is being blamed for something that is not its fault, rather, it is the decision to treat the cancer that should be questioned.

    PSA test is not being blamed for anything. Rather, the medical necessity of blanket testing all men over 50 yo is being questioned.


    Besides DRE, I don't know of any other "first step" way of identifying a possible problem though.

    The PSA test is not expensive at all (and covered by most if not all insurance), not invasive and has no side effects. It is a valuable tool in the toolbox of tests and procedures that can be done to detect prostate cancer.




    If you have prostatitis or infection, you will get a false positive resulting in further unnecessary tests (and expense). The argument is that men shouldnt be tested unless they have a family history of prostate cancer or have a high risk for prostate cancer.
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    Oct 13, 2011 4:53 PM GMT
    Health care providers have an obligation to provide evidence based care. There is no scientific evidence supporting the blanket testing of all men over 50 for prostate cancer. You cant just provide care based on what feels right or on a few anecdotal cases.
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    Oct 13, 2011 7:26 PM GMT
    southbeach1500 said
    catfish5 saidHealth care providers have an obligation to provide evidence based care. There is no scientific evidence supporting the blanket testing of all men over 50 for prostate cancer. You cant just provide care based on what feels right or on a few anecdotal cases.


    How should prostate cancer be diagnosed then, if the PSA test is not part of the testing process?



    PSA should be used in cases where a patient has a family history or is at high risk for prostate cancer.