Tuesday, June 12, 2012

PSA Testing, I'm getting more annoyed

The more I read the USPSTF recommendations on Prostate Cancer Screening the more annoyed I get. Part of their recommendations are what "practitioners" should tell their patients. The article "Talking With Your Patients About Screening For Prostate Cancer" is for doctors and suggesting to them on how they should deal with their patients, even ones that ask about screening. I really hope there aren't any doctors that actually follow the recommendations in the document!

If you read my previous blog, you'll know I'm "flogging a dead horse" but the recommendation specifically looks at whether screening is a tool to prevent deaths. It ignores quality of life. It also assumes that a high reading that results in a negative biopsy is a false positive and results in unnecessary treatments. I'm not saying there aren't men being unnecessarily treated but I don't think it's as widespread as men that are being screened, detected and appropriately treated.

These articles quotes statistics for some things and uses vague terms or others, for example;
  • 90 percent of men with prostate cancer found by PSA choose to receive treatment. Many of these men cannot benefit from treatment because their cancer will not grow or cause health problems. 
How many constitutes many? Merriam-Webster dictionary defines many as:
  • consisting of or amounting to a large but indefinite number
I could not disagree with this statement any more. I'm yet to meet a cancer that does not grow and cause problems, unless of course you dies before it grows. Again referring to Merriam-Webster dictionary on the definition of cancer;

  • a malignant tumor of potentially unlimited growth that expands locally by invasion and systemically by metastasis.

Here's what should happen (in my opinion), and I'm assuming the worst case here.

1. You get a PSA test with a high reading (high being a relative term).
2. Repeat the PSA. If it's higher still, repeat it one more time
3. You go to your urologist, he'll decide if it's an Infection, BPH, or needs a biopsy.
4. You get a biopsy.
5. You wait a week, it comes back negative, no cancer found!

Great, I'm done. Well not yet. You need to wait 3 months and get another one. If it continues to rise you need to go back for another biopsy, it's quite possible they just missed the tumor (I will write an article on this soon), especially if the prostate cancer is early and small.

I've seen/heard of patients that have gone back 4-5 times before they finally found the cancer, his PSA kept rising though. By the time they biopsied a piece of cancerous tissue his PSA was in the 20+ range.

Use common sense, if your 90 and have heart problems your probably not going to look for a prostate cancer. If your 60 and in great health get a PSA test, in fact if you haven't had one performed earlier as a baseline, shame on you!

I'd really like to know if all the people on this task force follow these recommendations for themselves of their family members. I sure hope they don't and won't.

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