<p>The US Preventive Services Task Force has issued a draft recommendation discouraging the use of PSA tests for prostate cancer screening in men without symptoms that are highly suspicious of prostate cancer:</p>
<p>Let 'em say what they want. Routine PSA testing found my husband’s prostate cancer early. A routine mammogram found my breast cancer early. Neither of us had any symptoms. For us, screening tests were invaluable.</p>
<p>I think the issue is that very few men actually die of untreated prostate cancer and yet we are removing prostates and rendering men impotent and incontinent when it’s really something that doesn’t need to be treated so aggressively. Both my father and my BIL had their prostates removed this year. Really makes you wonder…</p>
<p>Excellent article in NY times a few days ago about this:</p>
<p>The problem is once someone is told they have cancer, they want it out asap when, in reality, the cancer might never cause them problems. So the recommendation comes from the fact that people are being scared into thinking they have a cancer that needs to be treated when it could be watched. </p>
<p>My mom recently had a tiny breast cancer removed (stage 1) via lumpectomy which has left a huge, disfiguring divot in her breast. It was not an aggressive form of BC but, of course, she really just wanted it out and, trust me, doctors aren’t going to argue with someone who wants a cancer removed (even when the doctor thinks it’s unnecessary)…too much liability. Unfortunately, the psychological and physiological ramifications of removing prostates and leaving holes in women’s breast can last a lifetime.</p>
<p>DH has an elevated PSA amount. It lead to a biopsy that showed inconclusive results. Two years later he started urinating blood – and we assumed the worst. Turns out it was only BPH but, after a two-day hospitalization, cystoscopy, and another prostate biopsy, everything turned out to be completely benign.</p>
<p>An elevated PSA does not indicate cancer. They need to develop a better test.</p>
<p>My eighty-some year old father-in-law used to have high PSA’s when he would have his routine tests. Several times in a row after these elevated annual PSA levels he had the biopsies, which he said were painful, and they never found cancer. So they quit doing the biopsies. That’s when I started noticing the articles about unnecessary prostate procedures. I read some articles that said at his age they should have just left him alone.</p>
<p>MomLive: I don’t know how old your mother is, but you can bet if I found a cancer in my breast, I’d have the damn thing cut out. Speaking of a better test, why, after all these years and all the research money, don’t we have imaging equipment that can reliably find breast tumors in young women? Mammograms are still hit and miss.</p>
<p>A psa is a blood test, not a biopsy. Biopsies do not produce incontinence. They are done by needle. </p>
<p>My dad had a high PSA and was found to have cancer. He had the screening test done on a walk in basis at the mall. It likely saved his life. The PSA was free. I see no reason to discourage it.</p>
<p>My H had prostate cancer, discovered by routine PSA testing and followup in his mid-fifties. He had no symptoms. The tumor was eventually discovered to be contained within the gland–an important point–but only just: it extended right to the bladder. I firmly believe that if he had not had PSA testing, biopsies, and surgery, he would be dealing with cancer outside the gland right now, and on the road to dying of it. As my father died of it last year.</p>
<p>When my father was diagnosed with prostate cancer, almost 20 years ago, diagnosis and treatment was not as effective as it is now. After two elevated PSAs they did a needle biospy. ONE needle biopsy in ONE site, I believe. No cancer. They went back and did another several months later, and found cancer. But by that time it had invaded the seminal vesicles.The prognosis is much worse if it has moved outside the gland. My H had, IIRC, 10 sites. 6 of them contained cancerous cells, 5 didn’t. What if he had had a single site biopsy?</p>
<p>Once the biopsies are taken, they are analyzed for degree of cell change and so forth. Everyone with a positive biopsy is not a candidate for surgery. Some are slated for “watch and wait.” There is ample research and statistical analysis to back this up. If you are interested, check out the JHU prostate cancer websites to find out about the systems of classification. It is not simply a matter of people becoming hysterical because ANY cancer is found or there is a single elevated PSA. My H’s PSAs were carefully scheduled and monitored for over two years. </p>
<p>Then there is treatment protocol. These days, my father would have had radiation targeted to the area as a followup to surgery, because of the invasion of the seminal vesicles. (And radiation is infinitely better than it was, too.) The likelihood is that he would NOT have had recurrences, he would NOT have had to spend years on hormone therapy, decreasing his quality of life, he would NOT have had to spend years fighting bone cancer and complications, and he might very well be alive today, enjoying his otherwise extremely healthy and active old age with my mother. (Who is 88, lives in her own house, swims and walks every day, works outdoors, takes care of her great grandchildren, doesn’t take ANY medications except for a multi-vitamin, and has recently started day trading again!) People talk as if all 85 year olds are frail, dementia-ridden nursing home patients who can barely hold on to life and should just meekly die because the stats say they have lived long enough.</p>
<p>The problem is that we never know whether the cancers discovered will turn into something that will eventually spread and be life-threatening. We can “believe” that the stage 1 breast cancers and the few prostate cancer cells that are treated are life saving, but we don’t really know. This is true particularly for the elderly. There is some evidence to show that the outcome is similar for breast cancer that is caught earlier rather than later. The aggressive cancers are life-threatening no matter what stage they are caught and the less aggressive ones can be “cured” once the lump is felt. Are mammograms really worthwhile?</p>
<p>The studies I have seen suggest there is no difference in death rates between men who have been screened vs. those who were not screened. My understanding is that usually (not always) aggressive forms of cancer are so aggressive that unless you are being screened much more frequently than yearly, it’s not likely to be caught early enough to make a difference. In other words, you can be screened today with normal results and two months from now end up with an aggressive cancer that puts you at stage 3 or 4 before your next screening, so it’s all about lucky timing. </p>
<p>I’m not arguing against screening but I do think people need to understand the pros and cons of doing this:</p>
<p>And I can certainly understand wanting to get the cancer out of your body at all costs, I would certainly feel the same way. The word cancer automatically conjures up scary feelings for all of us.</p>
<p>Yes, you can count on them to find tumors. But, there may not be much difference in the morbidity and the mortality for women who find cancers early via mammogram, or later when they are able to be felt with self-breast exam. The question is not whether mammograms can find tumors when they are very small, but whether finding small tumors is life-saving or not, as with PSA screening.</p>
<p>I agree with MomLive in that I would want the cancer discovered early and out of my body. But this may be more of an emotional reaction rather than one with real scientific validity.</p>
<p>Every so often, I read of some experimental new test that detects prostate *cancer<a href=“as%20opposed%20to” title=“maybe prostate cancer, maybe BPH, maybe nothing”>/i</a> much better than PSA testing does. But it never seems to become available.</p>
<p>My PSA came in above 8 when it should have been a third of that. My PCP said it felt quite normal and put it down to prostatitis (sp?) and put me on antibiotics. It came down to about 4 point something, still higher than desired. Given that my dad died of prostate CA, this is close to my heart, and I’m due for some imaging screens now. Every doc I talk to seems to discount the PSA just on its own merits when there are other screens done; so while these recommendations are encouraging, I am still quite nervous about it.</p>
<p>Let me say I am not a doctor or any kind of health professional. My opinions are based on admittedly skewed life experience, anecdote, and some reading. However.</p>
<p>When you read that a woman who has a lumpectomy, say, has the same chance of mortality as a woman who had a mastectomy for essentially the same cancer, what they don’t necessarily say is this. Some of those lumpectomy women then have recurrence in the breast, and go on to have a mastectomy anyway to get it taken care of. Some lumpectomy women, of course, don’t have a recurrence. And, some of both die anyway. I think we need to be honest with women, that while the MORTALITY may be the same, the necessity for future follow-up treatment may not be. For some women, this would be a decision point. Just saying.</p>
<p>And, lots of women find lumps in their breast that didn’t show up on mammograms. Maybe statistics say that, on average, you are not going to live longer if you find your tumor a little earlier. But do you want to be the woman who is the outlier to those averages? I don’t.</p>