Feds Nix PSA

[nullorchis]

"Trust me, I'm from the government". Yea. Right. I see nothing wrong with having a PSA test. It's just a blood test for pity sakes. Any and all available tests to detect possible cancer should be used. Digital, even biopsy. Granted, some cancerous prostates will not result in major health issue or death; those afflicted will die of other causes before a cancerous prostate will become a problem. For me, I want nothing to do with cancer. If in doubt, rip it out. I'm demanding all possible tests be done. On a regular basis.

[unencumbered]

My current doctor must not read my chart because I was billed $107 for lab work to check my PSA. Dumbass I am a eunuch I do not need a PSA. I am waiting until the next time I see him to ask how worried I need to be about prostate cancer. Sorry back to the thread.

If you are taking testosterone, its good to have a PSA test, along with a T level test. You can still get prostate cancer if you're taking too much T. If your PSA level is too high, you can reduce the amount of T to bring it down.

[moi621]

"Trust me, I'm from the government". Yea. Right. I see nothing wrong with having a PSA test. It's just a blood test for pity sakes. Any and all available tests to detect possible cancer should be used. Digital, even biopsy. Granted, some cancerous prostates will not result in major health issue or death; those afflicted will die of other causes before a cancerous prostate will become a problem. For me, I want nothing to do with cancer. If in doubt, rip it out. I'm demanding all possible tests be done. On a regular basis.

Problem is there is no evidence aggressive management cures the more aggressive forms of the disease.

Are you so ready to experience the associated nerve damage, down there?

Moi
Prostate Cancer Atheist. Before it was popular.

[moi621]

"They" continue to agree with me.
The first time I uploaded this thought, years and years ago
I was soundly thrashed by the "Cancer, Cancer" alarmist.
Some alarms aren't worth hearing.

New England Journal of Medicine July 19, 2012 pg 203
Among men with localized prostatic cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all cause or prostate cancer mortality as compared to observation, through at least 12 years of follow up.

Learn tomorrows' medical opinions today.
PM Moi

Moi
All those men's man parts, carved up and left numb to the world
for no good reason.

[ned123]

time for my two cents worth. Without PSA (screening) it is a screening not a diagnostic tool, I would be on my last legs. The key with psa is to get a baseline and then follow it over time. Any steep rise and you should move on to a more diagnostic arena. Of course you also need to get a digital rectal exam as well.
The PSA test is usually way over charged for by most labs and docs. But I get mine for less then $20 at a local lab.
I agree that in many cases active surveillance (no longer watchful waiting) is the best choice for many men once diagnosed. But you need to be active, and get regular psa and biopsy's. At a certain point you need to be ready to be active about treatment, maybe never.
With that said, I came in at a gleason 9, later downgraded to a gleason 7. What that means is I had to take action. Without doing anything I would defiantly die of the disease. After studying all my options, I opted for robotic surgery. I've studied all the statistics, and found that the general outcome for me is better than having done nothing at all. As has been mentioned, I have indeed suffered many of the side effects from the surgery. For example I am now totally impotent, and also have slight incontinence issues. I can still orgasm, because those are different nerves. But I remain totally limp and completely dry when I do. But being a member of this group you can understand that when I say I am fine with that I am indeed fine with it.
I have attended many meetings and have heard many presentations by many professionals in the field. And of course there are lies, damn lies, and statistics. But the one that stands out to me the most is very simple, since the advent of the PSA test, the deaths from prostate cancer have been cut in half.
It is not so much the test itself but the follow-up Procedures of our for the $$$ medical system that seems to be the problem. As a patient, you have to take charge of your treatment. As my doctor said, he's a hammer, and everything looks like a nail to him. So he advised me to do my research and to talk to other certain specialists. Without a cheap and simple blood test I would be on my way To a certain and painful death.

[moi621]

It is hard to rationally convince someone their trip to Hell was not necessary.
Example: Ladies who opt for a full radical mastectomy when lumpectomy would suffice.

The deaths from Prostate cancer have been cut in half. Why?
Earlier intervention or improved treatments over the years? Both happened simultaneously.

I guess we can agree a PSA alone is no reason to cut.
Personally, I don't like needle biopsy as it allows an escape for walled off malignant cells.
This procedure should only be done when surgery is gonna happen, so the surgeon knows the pathology of what he is going after and the field of clearance required .
Ultrasound is probably the most reasonable and with signs of change, make a decision.

Moi

[AtomicMush]

I have been on TRT since my boys were removed last year for signs of cancer. That's another whole story... As a routine, I had a PSA test done and the results were 2x from a year prior. The doc took me off TRT and wanted a biopsy and suggested surgery based upon statistics! I said no! Instead, I went to a large university urologist, and had an MRI performed on my prostrate. The results showed two areas of concern. I then agreed to a "targeted" biopsy, going after the areas of interest. This was done comparing the MRI to real-time ultrasound, directing the needles to the areas of interest. This was done under general, and included external as well as trans-rectal biopsies. Twenty-two needles were taken. The results, negative for cancer, no malignancy. Did I mention, my PSA fell back to normal just prior to the biopsy?

Seems PSA is impacted by anything stressing the prostrate as well as changing T levels. Even having sex raised the PSA temporatily.

I spent over $12,000 on this odyssey, but I am confirmed cancer free, and have restarted my TRT.

Be careful with the PSA. Take several tests over a time period, and try to rule out things that can impact PSA. There is an article from I believe Chapel Hill University that helps explain my experience with fluctuating PSA. Oh, and stay away from small town surgeons. They live to cut. My butchered scrotum is proof.

[ned123]

Until the advent of the PSA screening, the most common way men found out they had prostate cancer was to come to the doctor complaining about back pain. What that meant was it had metastasized in their bones. Moi, indeed treatment has improved, but as you mention, earlier intervention happened as well. What do you think the introduction of the psa test was. Without it as a starting point for the whole screening and diagnosis process, the numbers would not have dropped as they have.

Also I do take offense at your comment regarding convincing someone rationally that their trip to hell was unneeded. I think it is patronizing and down right insulting. You have your opinions and that is fine. I will not address your lack of wisdom on this subject, and just suffice it to say that I hope someday you don't go to your doc with unexplained back pain.

AtomicMush good for you, this is just the kind of effort and questioning one needs to do, when given this sort of news. Yes your doc was right to be attentive regarding a doubling of you psa, and yes there are a ton of reasons it could be up. of course suggesting surgery even before a biopsy set off red flags and you spotted them. But you didn't just leave it at that, you sought out the best people you could find to figure out what was going on. There are those that would sight this as an example of unneeded testing, but even at a cost, I am sure you sleep much better knowing you are good to go.

Again the PSA is not perfect, and I am sure over time they will come up with better screening tools, but for now I think it is fool hardy to not take advantage of this simple screening test.

About equal numbers of men die of prostate cancer as women do of breast cancer. Mammograms, and breast exams save lives, yet both have false positives, yet they don't dare tell women they are wasting their time. The ladies are too smart and too organized to ever fall for that. Yet men will just bury their heads, rationalize, and continue to allow themselves to die a decade sooner than women.

Oh by the way just for your info, 9 of the 15 members of the task force are women. 2 are nurses, and one an administrator.

[devi]

My current doctor must not read my chart because I was billed $107 for lab work to check my PSA. Dumbass I am a eunuch I do not need a PSA. I am waiting until the next time I see him to ask how worried I need to be about prostate cancer. Sorry back to the thread.

For my fortieth birthday, I went to a health fair and decided to go ahead with getting a prostate check anyway. It was done the old fashioned way with the physician changing gloves and washing between victims -er patients. He was a good man and told me that he couldn't even find my prostate at all but at any rate if it was there anywhere it certainly couldn't swollen by any account. He also said that this test is for men of normal size and that I'd probably never need another examination again.

[moi621]

In the Before Time

Prostate cancer was detected when a man would have
urinary retention and it was more then just an enlarged prostate.
Then there is the finger up the rectum feeling for prostate symmetry and lumpiness.
Today we have prostatic ultrasound too.

Many of us feel you are either wired for the Prostate cancer that is gonna kill you
and there is nothing you can do about it or
you have the prostate cancer that is so sluggish, it hardly qualifies to be called a malignancy.
I am waiting for evidence the earlier detection of the fast, killer Prostate cancer is effectual.
The two populations of Prostate cancers have not been distinguished except ex post facto by their behavior.
But, usually the fast, nasty one is in fifty year old men like Bill Bixby or Frank Zappa.

Moi
Prostatic Epidemiologist

[AtomicMush]

I think I have two messages:
1) Don't trust just one PSA test, take a few over time to confirm that it is not transient. PSA does fluctuate for MANY reasons.
2) Know your body and trust your instincts. Do not fall for the statistical crap. Instead, find out what is going on inside you. I did. Had the results been different, I would have not hesitated to have the needed surgery. But, do everything you can to identify what you may or may not have going on, then make a decision. Blind faith in your surgeon and statistics will only make one person weathy.

I have confirmed my health, and fired my small-town Uro. I am much better off today for it. Even though I have no balls, I grew enough of them back to ask the right questions.

[ned123]

Gosh, so there is really no point in even doing anything. Neat! makes life so much eaiser. We are all going to die so why worry. Just so I get this right, you get prostate cancer and you will either out live it or you will die from it. No need to even think about it. No need to ever get treated. It basically isn't worth mentioning. and I guess there is no need for a "prostatic epidemiologist".

[Dave]

Gosh, so there is really no point in even doing anything. Neat! makes life so much eaiser. We are all going to die so why worry. Just so I get this right, you get prostate cancer and you will either out live it or you will die from it. No need to even think about it. No need to ever get treated. It basically isn't worth mentioning. and I guess there is no need for a "prostatic epidemiologist".

no that wasn't the point of anything.

The PSA test has been proven over time to be an unreliable guide to prostate cancer. It gave as many false postitives real posistives. ALSO, certain prostate cancers required minimal to no treatment because the treatment shortened the life span of the man. That's what first clued the doctors behind this push against the PAS. They saw men that went untreated or got minimal treatment live longer with less discomfort that men who were undergoing radical treatments, chemo-therapies and x-rays. These were clearly cases of overtreatment and not undertreatment.

What the Feds did in this ruling was to acknowledge that one PSA is never definitive and a course of treatment should not be embarked upon with one PSA to back it up. The new guidelines say that other factors must be considered and routinely giving the PSA is not a good screening tool.

Treatment of men for prostate cancer was falling into the realm of "Give me an antibiotic for a cold or virus" when it is obvious an antibiotic does not affect viral illnesses.

[moi621]

Gosh, so there is really no point in even doing anything. Neat! makes life so much eaiser. We are all going to die so why worry. Just so I get this right, you get prostate cancer and you will either out live it or you will die from it. No need to even think about it. No need to ever get treated. It basically isn't worth mentioning. and I guess there is no need for a "prostatic epidemiologist".

That's how I would manage it.
When I get it, discovered by some symptom such as difficulty urinating,
I would follow it first. If there is evidence it is aggressive, I might consider
treatment. Many in the medical community have felt this way from experience before the data appeared.
Think of all the unnecessary protatectomies. No victim will cop that it was needless.
And people have been programed that all is preventable with good screening. <sigh>

Nor will I get scoped. The importance of cancer screening has really decreased in this post tobacco era. Nicotine excites all malignancies. ALL! No nicotine, less need for "screening" this or that.

Moi