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Re: PSA dumped -- AUA "outraged!"

I'm not starting and certainly won't be joining in any discussion on the pros and cons of PSA testing because the two far ends of beiefs can never be reconciled. There is a good piece on The "New" Prostate Cancer Infolink with links to the actual recommendations and statements in support from Otis Brawley and against from Catalona. It makes interesting reading.

Most people may not know precisely what was recommended - and supported by a variety of organizations. This is it:

For men of any age, the USPSTF recommends that doctors and patients do not screen for prostate cancer because the potential benefits do not outweigh the harms. However, the USPSTF realizes that some men may continue requesting the PSA test and some physicians may continue offering it. The decision to start or continue screening should be an informed one that reflects an understanding of the possible benefits and harms and should respect an individual man's preferences.

Speaking personally I simply do not understand what the fuss is about. Men who are concerned - whether they need to be concerned or not - can still request PSA tests. Doctors who believe in the value of PSA tests can still order them. The aim is that both parties - the doctor and the man should have a clear understanding of the limitations of the test. What is wrong with that?

I am an alien as far as the USA is concerned, so I can only observe actions in the USA from afar, but it seems really odd to me that there are enormous outcries about Government treating people like children on the one hand and not treating them like children on the other. Surely adult sentient men should be given the known facts, ascertained by scientific studies on the potential benefits and harms associated with PSA tests. It is interesting in a country like South Africa - generally regarded as a Third World country, people cannot be given and AIDS test without first having counseling about the potential outcomes of the test. Would it be so hard to do tha same thing about PSA tests in the USA, Canada, UK, Australia and other First World countries?


All the best - if anyone gets too heated on this thread, I'll emove their post. Opposed ideas, politley expressed are fine, but I won't accpet rudeness or what are termed 'flaming' posts.



Terry in Australia

Re: PSA dumped -- AUA "outraged!"

I think the message given at the threshhold has great impact. If family practice doctors say, "I'll give you a PSA test--which, by the way, the USPTF says you don't need--ONLY if you ask me for one, and only after I tell you all the bad side effects," the rate of PSA testing will drop off considerably. Personally, few men I know, myself included, would have actively solicited a PSA test under those circumstances. I would have been even quicker to suggest that we dispense with the DRE.

However, my fear is that we are about to give back some of the 40% reduction in US prostate cancer deaths experienced during the modern PSA-testing era.

Re: PSA dumped -- AUA "outraged!"

The claimed 40% reduction has to be viewed with a wider lens than the one used by prostate cancer activists. The apparent reduction comes off the highest mortality point reached. This came after the intorduciton of PSA tests. Of course the humber of men diagnosed rocketed up, but curuously the number of disease specific deaths also rose, for reasons that ahve never been fully explained. Having reached a nadir, the number of deaths started falling back towards those incdiences recorded in the 70s when The War on Cancer was declared and some years before PSA was discovered.

Of course one is always awre of the old quote about lies, damned lies and statistics, so I have alsways looked to a measure which seems reasonable - the percenatge of male deaths from prostate cancer as a percentage of total male deaths. In 1976 that figure was just under 3%: in 2006, the last time I looked at the figures it was margnally higher, but still just under 3%.

All the best

Terry in Australia

Re: PSA dumped -- AUA "outraged!"

Arthur,

How do you think a man would feel if his doctor, instead of saying

"I'll give you a PSA test--which, by the way, the USPTF says you don't need--ONLY if you ask me for one, and only after I tell you all the bad side effects."

said,

"There is a good deal of dispute about the PSA Test. Before I tell you my views, would you like to read through this document. We can then talk about any of the relevant issues and you can make your decision."

A man who calls himself A.Black has been building a very informative website The Palpable Prostate and he has put some very good information there concerning the USPTF recommendation. I think anyone who reads both sides of the argument will be in a better position to make up their own mind on this contentious subject.

All the best
Terry in Australia

Re: PSA dumped -- AUA "outraged!"

Terry -- At the end of the day, I tend to agree that the patient should be given information and a choice, but that the information should be completely unbiased, accurate and current. The Palpable Prostate site is excellent! Rich data, and I could not detect a hint of bias. Incidentally, the data in that link confirmed my recollection about the absolute decline in prostate cancer deaths, independent of the increased detection rate:

•Deaths Declining. Since the 1991-1994 time period when deaths from Prostate Cancer in the US peaked at an annual rate of 39 deaths per 100,000 men the rate has declined to approximately 24 deaths per 100,000 men [statistics cited by National Cancer Institute]. This time period correlates well with the introduction of PSA screening.

The other link to the draft disclosure and consent bore a slight bias against the PSA, in my opinion.

Re: PSA dumped -- AUA "outraged!"

I have personal experience with PSA tests being ordered without being informed about the downside and the results have been disasterous. Rising PSA numbers have led to three rounds of biopsies involving a total of fifty four cores in which only one core had twenty percent of Gleason six. The first round was uneventful. The second round of eighteen cores led to two infections, sand in my urine and a catheter. The third round of eighteen cores led to an ecoli infection and sepsis which landed me in the hospital for five days with IV antibiotics around the clock. In addition, with all the Cipro family of antibiotics, I wound up with Achilles Heel Tendonitis. I now have recurrent bacterial prostate infections which increase my PSA results.

Re: PSA dumped -- AUA "outraged!"

Gregory -- Your anecdotal experience clearly demonstrates one downside to automatic PSA testing. I don't know that your experience is typical, but more importantly, if all 3 biopsies were at the same testing facility, I would have serious reservations about the quality control at this institution?

Re: PSA dumped -- AUA "outraged!"

You wrote: "Wow. Frankly, I can't imagine what a group of outraged urologists are like."

They're really p****d off.

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