Author Topic: PSA testing: again with a change to the recommendations  (Read 3437 times)

MillCreek

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PSA testing: again with a change to the recommendations
« on: April 11, 2017, 11:34:00 PM »
http://www.latimes.com/science/sciencenow/la-sci-sn-prostate-cancer-screening-20170411-story.html

First, almost every male over age 50 should get it; then the standard was almost no one should get it; and now the standard is that it should be an individualized decision. 

I have been getting it at five year intervals, starting at age 50, and I think I will continue with that. I will pay out of pocket if need be.
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MillCreek
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

RoadKingLarry

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Re: PSA testing: again with a change to the recommendations
« Reply #1 on: April 11, 2017, 11:56:30 PM »
PSA screen has been part of my annual blood work up for 6-7 years now. Don't see the big deal.
It's relatively inexpensive and if there is a significant change in results then do further testing/diagnosis.
Some of the recent changes in screening recommendations seems almost like they want to cut back on that whole early detection thing.
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Angel Eyes

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Re: PSA testing: again with a change to the recommendations
« Reply #2 on: April 12, 2017, 12:47:28 AM »
I was wondering what this had to do with Palmetto State Armory.

Never mind.
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Hawkmoon

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Re: PSA testing: again with a change to the recommendations
« Reply #3 on: April 12, 2017, 12:51:22 AM »
I was wondering what this had to do with Palmetto State Armory.

Never mind.


Silly person.

PSA = Public Service Announcement
- - - - - - - - - - - - -
100% Politically Incorrect by Design

RocketMan

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Re: PSA testing: again with a change to the recommendations
« Reply #4 on: April 12, 2017, 06:31:04 AM »
Pacific Southwest Airlines went out of business years ago.  Why is it important now?
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lee n. field

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Re: PSA testing: again with a change to the recommendations
« Reply #5 on: April 12, 2017, 08:47:49 AM »
http://www.latimes.com/science/sciencenow/la-sci-sn-prostate-cancer-screening-20170411-story.html

First, almost every male over age 50 should get it; then the standard was almost no one should get it; and now the standard is that it should be an individualized decision.  

I have been getting it at five year intervals, starting at age 50, and I think I will continue with that. I will pay out of pocket if need be.

I get a PSA every 3 months.  It's what they're watching.  Pretty much all they're looking at.  When it starts to change my days are probably numbered.

$25 at the health dept, vs. hundreds at the local health borg's lab.
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Fly320s

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Re: PSA testing: again with a change to the recommendations
« Reply #6 on: April 12, 2017, 09:12:32 AM »
Pacific Southwest Airlines went out of business years ago.  Why is it important now?

But PSA Airlines is in business now.  It is a American Airlines regional carrier flying CRJs.
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zxcvbob

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Re: PSA testing: again with a change to the recommendations
« Reply #7 on: April 12, 2017, 09:21:46 AM »
Pisa International Airport?
"It's good, though..."

grampster

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Re: PSA testing: again with a change to the recommendations
« Reply #8 on: April 12, 2017, 09:21:52 AM »
If not for PSA testing each year, I'd probably be dead now.
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Ben

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Re: PSA testing: again with a change to the recommendations
« Reply #9 on: April 12, 2017, 09:23:09 AM »
I get the PSA and the finger once a year. I've been doing so as per the doctor's recommendation since I was around 47 because my dad had prostate cancer. My best friend got prostate cancer in his early 40s.

It seems like the article is not clearly written? They seem to be indicating that it's not the exams that are more harmful when done annually or shouldn't be done annually, but rather further testing, like biopsies, if results come back as other than "normal".

I would expect this is an opinion that will change as technology improves. Even with prostate surgery, there have been pretty great advances. When my dad had his surgery in the 90s, it led to slight incontinence that he has to this day, and I think it has gotten progressively worse over the years. A friend of his had the surgery around five years ago and had zero incontinence or other side effects.
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lee n. field

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Re: PSA testing: again with a change to the recommendations
« Reply #10 on: April 12, 2017, 11:46:08 AM »
I get the PSA and the finger once a year. I've been doing so as per the doctor's recommendation since I was around 47 because my dad had prostate cancer. My best friend got prostate cancer in his early 40s.

It seems like the article is not clearly written? They seem to be indicating that it's not the exams that are more harmful when done annually or shouldn't be done annually, but rather further testing, like biopsies, if results come back as other than "normal".

I would expect this is an opinion that will change as technology improves. Even with prostate surgery, there have been pretty great advances. When my dad had his surgery in the 90s, it led to slight incontinence that he has to this day, and I think it has gotten progressively worse over the years. A friend of his had the surgery around five years ago and had zero incontinence or other side effects.

<sigh>

Doesn't always work that way.

In about 20 minutes I'm going to see a urologist.  For the first time since getting shuffled off to get radiation, almost 2 years ago.  Somehow everything got sidelined, and no one I'm seeing now seems interested in dealing with ongoing issues.
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MechAg94

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Re: PSA testing: again with a change to the recommendations
« Reply #11 on: April 12, 2017, 11:57:27 AM »
Pressure Swing Adsorption. 

http://www.xebecinc.com/technology-what-is-psa.php
https://www.uop.com/equipment/hydrogen-separation/pressure-swing-adsorption/

We use it for hydrogen purification.  We will be doing testing of that system at the end of the year. 
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Ben

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Re: PSA testing: again with a change to the recommendations
« Reply #12 on: April 12, 2017, 12:06:02 PM »
<sigh>

Doesn't always work that way.

In about 20 minutes I'm going to see a urologist.  For the first time since getting shuffled off to get radiation, almost 2 years ago.  Somehow everything got sidelined, and no one I'm seeing now seems interested in dealing with ongoing issues.

Yeah, I should have said that in the 90s you could generally expect side effects. Now I think it's a lesser probability of side effects, but they are of course still possible. At least that's my interwebz understanding.
"I'm a foolish old man that has been drawn into a wild goose chase by a harpy in trousers and a nincompoop."

bedlamite

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Re: PSA testing: again with a change to the recommendations
« Reply #13 on: April 12, 2017, 12:17:05 PM »
I wonder what it takes to become a Professional Sports Authenticator?
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Marnoot

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Re: PSA testing: again with a change to the recommendations
« Reply #14 on: April 12, 2017, 12:26:08 PM »
I thought this was a good summary of the core reason for the change in advice to not globally recommend screening. The gist being much, much higher chance of needless incontinence and/or impotence as an end result of getting the test, than dying of cancer without the test.

Let’s say 1,000 men get a blood test for prostate cancer, which runs about $40 and measures the prostate-specific antigen (PSA), a protein made by the prostate gland. PSA levels become elevated in cases of cancer—but also benign prostate problems. Of the 1,000 getting a PSA test, 240 will get a positive result back (meaning their PSA levels appear elevated).

Of those 240, biopsies would find that only 100 have prostate cancer. The other 140 were false-positives.

Of the 100 with prostate cancer, 80 would typically choose surgery or radiation—either right away or after a period of “active surveillance” or mild treatment options. In those 80, at least 60 would have to suffer from the complications of urinary incontinence and/or impotence.

Of those 80, three men would be spared from having their cancer spread. And one or two would be kept from dying of prostate cancer over a 10- to 15-year period.

The new calculation of the one to two lives spared tipped the scales for the USPSTF to recommend that men 55 to 69 talk with their doctor and think about it.

MechAg94

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Re: PSA testing: again with a change to the recommendations
« Reply #15 on: April 12, 2017, 12:27:05 PM »
I wonder what it takes to become a Professional Sports Authenticator?
I thought all they did was tell people their stuff was genuine as long as they paid the appropriate fee?
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Ben

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Re: PSA testing: again with a change to the recommendations
« Reply #16 on: April 12, 2017, 02:22:37 PM »
I thought this was a good summary of the core reason for the change in advice to not globally recommend screening. The gist being much, much higher chance of needless incontinence and/or impotence as an end result of getting the test, than dying of cancer without the test.


This is what I'm still not understanding. Are they also suggesting that the physical testing ( the finger) is damaging? Otherwise the test itself only leads you to a decision point on the surgery, unless further testing or procedures (i.e., biopsies, etc.) are being shown to be damaging. But then I guess I have to ask how much more damaging some of that is than a colonoscopy where they remove pre-cancerous growths (which I've had done).
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cordex

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Re: PSA testing: again with a change to the recommendations
« Reply #17 on: April 12, 2017, 03:25:29 PM »
This is what I'm still not understanding. Are they also suggesting that the physical testing ( the finger) is damaging? Otherwise the test itself only leads you to a decision point on the surgery, unless further testing or procedures (i.e., biopsies, etc.) are being shown to be damaging. But then I guess I have to ask how much more damaging some of that is than a colonoscopy where they remove pre-cancerous growths (which I've had done).
I don't think they are suggesting that the initial test causes damage in and of itself (except, perhaps, the mental stress of false positives).  But if they receive a test indicating possible cancer, most people will start the process of getting a biopsy and depending on the results of the biopsy, eventually treatment.  That path includes risks from the biopsy itself and the treatments.

Of the men getting the test you have 14% with false positives, 6% suffering from deleterious side-effects from treatment, 0.3% with a reduction in cancer spreading and 0.2% with their lives extended.

So in essence it is a test which has a 0.2% chance that it may extend an average man's life.  That's certainly non-zero, but I wonder what other tests which are not as commonly performed that could meet or exceed those success metrics.

lee n. field

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Re: PSA testing: again with a change to the recommendations
« Reply #18 on: April 13, 2017, 10:11:27 AM »
<sigh>

Doesn't always work that way.

In about 20 minutes I'm going to see a urologist.  For the first time since getting shuffled off to get radiation, almost 2 years ago.  Somehow everything got sidelined, and no one I'm seeing now seems interested in dealing with ongoing issues.

Aaaand, coming out of it I have a combination of hope that issues will be dealt with, and a foul mood (from time heretofore wasted).
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T.O.M.

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Re: PSA testing: again with a change to the recommendations
« Reply #19 on: April 13, 2017, 10:54:50 AM »
My doc does PSA annually, and the probe.  That's how they figured out I had an infection at one point.  PSA elevated, nothing at all concerning on the probe.  Urologist probe, same result.  Course of antibiotics, PSA fell to normal. 

What's the big deal?  It's a blood test, prbably costs the insurance companies a few bucks at most.  Cheaper than an unnecessary biopsy.
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MillCreek

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Re: PSA testing: again with a change to the recommendations
« Reply #20 on: April 13, 2017, 11:37:35 AM »
^^^The big deal is that based on the results of the PSA, patients may undergo an unnecessary biopsy or further treatment, all of which have their own costs and potential risks.  You have to weigh the biopsy and further treatment against the patient's age and medical condition.  For many men, prostate cancer is diagnosed at an age such that they will likely die of something else before the prostate cancer effects them.

I was reading the chart just yesterday of a patient who died of metastatic prostate cancer at age 59, two years older than me.  They found it by chance two years ago: he was referred to urology for flank pain, and as part of the workup, they did a PSA which was elevated, and then did further imaging and a biopsy which confirmed the prostate cancer.  He ended up having surgery and radiation but still died two years after diagnosis. 
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MillCreek
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

grampster

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Re: PSA testing: again with a change to the recommendations
« Reply #21 on: April 13, 2017, 12:36:51 PM »
One thing I learned after being diagnosed with prostate cancer is the percentages are meaningless dreck.  It becomes very personal. 

I don't have any urinary problems other than the occasional dribble when I thought I was finished...this while urinating while standing.  What I discovered, for me, was peeing sitting down eliminated the dribble problem for some reason.  (Hey, I get some decent reading time.) 

As for the other situation, not getting a boner is a pretty good trade off against death if the cancer metastasizes.  Having an imagination covers that problem to an extent.  Again, the situation gets personal and each person gotta do what ya gotta do.  All the medical drivel is meaningless.

I'm 11 years cancer free...and enjoying every minute of it.  Also, I put it out of my mind immediately after the surgery.  No support groups and agonizing over the situation with other people with whom cancer and cancer recovery becomes an obsession.  Again, ya gotta do what ya gonna do.  I chose to put it in the rear view mirror.
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T.O.M.

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Re: PSA testing: again with a change to the recommendations
« Reply #22 on: April 13, 2017, 02:06:52 PM »
^^^The big deal is that based on the results of the PSA, patients may undergo an unnecessary biopsy or further treatment, all of which have their own costs and potential risks.  You have to weigh the biopsy and further treatment against the patient's age and medical condition.  For many men, prostate cancer is diagnosed at an age such that they will likely die of something else before the prostate cancer effects them.

I was reading the chart just yesterday of a patient who died of metastatic prostate cancer at age 59, two years older than me.  They found it by chance two years ago: he was referred to urology for flank pain, and as part of the workup, they did a PSA which was elevated, and then did further imaging and a biopsy which confirmed the prostate cancer.  He ended up having surgery and radiation but still died two years after diagnosis. 

Okay.  Thanks.  I understand.  If elevated PSA led to an unnecessary biopsy, not worth it financially or otherwise.  In my case, both docs doing the digital exam felt there was nothing to be concerned about.  Urologist did not jump right to biopsy due to the elevated PSA.  Suspected the infection, and said a recheck after antibiotics would be helpful.  It was. Like everything else, a good doc is priceless.  I was fortunate to have good docs.
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rcnixon

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Re: PSA testing: again with a change to the recommendations
« Reply #23 on: April 13, 2017, 10:05:15 PM »
I get a PSA every 3 months.  It's what they're watching.  Pretty much all they're looking at.  When it starts to change my days are probably numbered.

$25 at the health dept, vs. hundreds at the local health borg's lab.

Our days are numbered from the very beginning. We just don't know what that number is.

My PSA went up dramatically in 2008. I had what is so far my favorite medical test, the prostate biopsy. Imaging the doctor shoves a baseball bat up your ass. Then, red hot nails shoot out of it. Twelve times. After that, my prostate surgery was delayed because... stent! I had an LAD blockage. As those things go, the stent wasn't so bad. I got to watch it on the big screen monitor. Some months later, radical prostatectomy. I was good for a while and then those pesky PSAs started back up. And now, appearing live in the radiation oncology suite at Duke University Medical Center... your, truly. Sixty-six grays of rad over six or eight months and seven years later and I am disease free. My oncology urologist released me last November. On the down side, I am now a gelding, but I don't have cancer. Remember, boys and girls, cancer sucks.

lee n. field

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Re: PSA testing: again with a change to the recommendations
« Reply #24 on: April 14, 2017, 09:53:50 AM »
Our days are numbered from the very beginning. We just don't know what that number is.

Of course.

Quote
My PSA went up dramatically in 2008. I had what is so far my favorite medical test, the prostate biopsy. Imaging the doctor shoves a baseball bat up your ass. Then, red hot nails shoot out of it. Twelve times. After that, my prostate surgery was delayed because... stent! I had an LAD blockage. As those things go, the stent wasn't so bad. I got to watch it on the big screen monitor. Some months later, radical prostatectomy. I was good for a while and then those pesky PSAs started back up. And now, appearing live in the radiation oncology suite at Duke University Medical Center... your, truly. Sixty-six grays of rad over six or eight months and seven years later and I am disease free. My oncology urologist released me last November. On the down side, I am now a gelding, but I don't have cancer. Remember, boys and girls, cancer sucks.

Mine is going a little bit different path.   At this point I'm 2 years past an incomplete course of radiation, into "advanced (metastatic) prostate cancer".   There was a spot on the lung that turned out to be prostate cancer (and wasn't that getting that determined a fun time).   Getting a shot of Lupron every three months for it, waiting to see if the PSA ever starts going up.

I got tired of waiting for "the system" to get around to dealing with some related issues, and said "I want to see a urologist."  (In my mind I was saying "I want to see a *$%#&&W@ing urologist!")  It took 3.5 months to see this guy (in the local health borg, but well spoken of by everyone).  Saw him Wednesday.

This guy isn't blowing off my problems, thinks he can deal with them.  <Long rant deleted.>

In thy presence is fulness of joy.
At thy right hand pleasures for evermore.