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PSA screening for prostate cancer: a doctor’s perspective
- By Marc Garnick, MD, Editor in Chief, HarvardProstateKnowledge.org
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I was recently diagnosed w/prostate cancer after PSA results, a DRE, biopsy, and an ensuing robotic prostatectomy.
A month later, with only a little incontinence but a great deal of sexual disfunction, my diagnosis shows a PSA of 0.270 indicating some part of a grade 8 tumor remains. Radiation therapy plans are being formulated in September.
I’m 66, in otherwise good health, and after reading all this “new” information re PSA conflicting opinions, I almost wish I had gone in the “wait and see” direction with radiation therapy IF determined to be of necessity.
I google, google and google again ” life expectancy metastatic prostate cancer. ” The answer regrettably is the same, the cancer cells will become resistant to the hormone therapy and I will die.
The bad news came from my oncologists at Dana Farber, two years ago at age 52. If caught early I would not be facing certain death.
At our charity events I have the opportunity to encourage men to ask their doctor for a PSA. Men WILL now use this as a excuse to avoid the test !!!
My wife of 32 years, my two daughters, my two brother would strongly disagree with the “panel.” One of the doctors on the “panel” is a pediatrician.
I attend cancer symposium @ Brigham & Womans Hospital , all the oncologist disagree with this backward recommendation.
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The study concluded that Prostate cancer is being detected with increasing frequency, and many patients are receiving such treatments as radical prostatectomy and radiation therapy. That’s actually pretty intersting.
My PSA went up. I had a bx. It was +. I had a robotic. It had metastasized. My father and 2 maternal uncles died from CA prostate. I’ve had RT. My PSA is undetectable. If I had taken your advice I’d be looking at bone mets by now. No thanks. It’s easy to give advice when you’re not a victim. I prefer being around a little longer. I am 100% continent and things still work ok for being 77 and still practicing. GCB, MD.
From what I have read, prostate cancer does take a long time to develop so long term studies are a must. One the other hand approaches to PSA, to biopsy analysis, and to treatment of prostate cancer have evolved and hopefully improved over the past few decades. So at best the USPSTF studies may show that PSA testing averaged over all practices and all treatments 20 years ago are not very helpful. But advances have occurred based on good science (not faceless statistics). So each man, and each woman who loves a man, needs to ask. Who would you go to for advice about prostate cancer — generalist statisticians with no expertise in prostate cancer or leading experts with lots of experience using the latest techniques. Sure in some cases newer doesn’t mean better, and yes some MDs are just motivated by $$ and ego — so find someone you trust, but don’t in my opinion trust someone who just sees you as another statistic.
Disclaimer: PSA testing in the late 90’s uncovered an otherwise symptomless agressive cancer in my prostate. Anecdotes based on small samples may not be “proof” but certainly are “existence proofs” of the good PSA testing can do — the successful end of the bell curve. Massive statistical studies based an infinite range of conditions aren’t proof of anything, except that there are an equal number of bad outcomes as good outcomes. What the task force should do, if it wants to be truly helpful and not just massage the egos of internists, is find out how to be on the successful end of the bell curve through appropriate use of PSA testing, MD expertise, and present day technniques.
As in his Scientific American article, Dr. Garnick inappropriately puts emphasis on the all-cause mortality results from the European study. The study was “under-powered” to detect such effects. You would need a sample size of several million men to detect declines in all-cause mortality of the order of magnitude of the observed reductions in prostate cancer mortality in the European study. The study’s sample size was designed to be able to be sufficient to detect effects on prostate cancer mortality, but it was never anticipated that the study’s sample size would be sufficient to detect effects on all-cause mortality. Therefore, the study’s failure to do so is not surprising, and tells us nothing.
I agree with Paul. Continue your stance, sir.
Bravo, sir. I know yours is a decidedly unpopular stance among urologists.
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