About 10 years ago, at the annual medical, my GP told me that he no longer ordered the usual panel of blood tests during medicals. He believed that finding problems in patients without symptoms leads to questionable treatment that are not necessarily in the best interests of the patient. I could ask for the tests I wanted, & the standard panel too. But uncovering a "problem" invariably leads to treatment & treatment morbidity.
In the new study (1200 scans):
"Significant findings, unrelated to prostate cancer, were identified in a total of 5.7% of scans (n = 68) with 3.2% (n = 38) of findings being unsuspected neoplasms."
Not sure how I would have reacted 15 years ago if another cancer had been detected at the same time. Even today, I'm disinclined to go looking for another dread disease.
J Med Imaging Radiat Oncol. 2019 Mar 6. doi: 10.1111/1754-9485.12864. [Epub ahead of print]
Unexpected significant findings non-related to prostate cancer identified using combined prostate-specific membrane antigen positron emission tomography/CT and diagnostic CT scan in primary staging for prostate cancer.
McEwan L1, McBean R1, Yaxley J2, Wong D1.
Author information
1
Wesley Medical Imaging, The Wesley Hospital, Brisbane, Queensland, Australia.
2
Wesley Urology Clinic, The Wesley Hospital, Brisbane, Queensland, Australia.
Abstract
INTRODUCTION:
There is increasing scientific evidence that whole-body Gallium-68 prostate-specific membrane antigen (68 Ga-PSMA) positron emission tomography/computed tomography (PET/CT) improves the sensitivity of prostate cancer detection above standard staging radiology. Diagnostic IV-contrasted CT scanning offers high-quality recognition and delineation of organs and structures with a high sensitivity and specificity for diagnoses of many non-prostate pathologies. At our institution, imaging for prostate cancer staging and restaging involves a 68 Ga-PSMA PET/CT scan combined with a diagnostic IV-contrasted CT scan of the head, neck, chest, abdomen and pelvis. In this study, we aimed to determine the incidence of significant findings unrelated to prostate cancer identified when this combined imaging approach is utilized for prostate cancer imaging.
METHODS:
In this single-centre retrospective review, 68 Ga-PSMA PET/CT and diagnostic IV-contrasted CT scans undertaken for prostate cancer staging over a 12-month period (n = 1200) were reviewed for significant findings not related to prostate cancer. In cases with a significant other finding, follow-up imaging and/or pathology results were reviewed, where available. The overall incidence of significant other non-prostate cancer findings was determined, as was the incidence of unsuspected neoplasms.
RESULTS:
Significant findings, unrelated to prostate cancer, were identified in a total of 5.7% of scans (n = 68) with 3.2% (n = 38) of findings being unsuspected neoplasms.
CONCLUSION:
Diagnostic quality IV-contrasted CT combined with 68 Ga-PSMA PET/CT for staging of prostate cancer identified significant other non-prostate cancer findings, including renal, lung, gastrointestinal and haematological malignancies. Many of these conditions impact on patient management and required further investigation or treatment prior to management of the prostate cancer.
I agree that there maybe some false positives in more advanced screenings, but I personally like to KNOW of them, although I may chose the wait-and-see approach.
It has always seemed to me that such a rationalization for not testing assumes poor diagnostic skills or practices on the part of the provider doing the post testing diagnosis.
The problem isn't the testing, it is the inadequacy of the provider reaction to the testing.
This result indicates a deficiency in the docs, not the testing.
My husband who always has taken care of himself was discouraged by Kaiser to take annual PSA tests. When he randomly said yes to the doctor to take the test even though she had discouraged it when he was getting ready to retire, it had already spread to his bones. That’s why tests are needed earlier than later. It’s the response that counts.
my husband's dad died of an aggressive form of prostate cancer, so my husband asked for a PSA test at 40. his doctor wouldn't give it to him bc he was too young blah blah blah. my husband insisted & sure enough at 40 years old it was already 4. even then his doc said it was probably just inflammation & blew it off. it wasn't until a year 1/2 later that he had a vasectomy & his urologist caught it. can't help but think our sons should be checked even earlier...at 30 perhaps.
Sometimes one has to bypass inflexible docs. If in the U.S., get a Life Extension test. (Or if testing more frequently than insurance allows.) They go on sale soon.
When I want a test, I call LEF & they email a requisition, which I take to my local LabCorp. The results are sent to LEF & emailed to me. In one instance, I received the result in less than 24 hours after the purchase.
When they go on sale, I buy several. They are good for 6 months (because of the LabCorp system), but if they expire, LEF will reissue if you contact them.
The National Preventive Services Task Force would have no one past 70 tested, it's not just Kaiser. For a while they said no one should be tested unless they ask for it. Wouldn't want to distress anyone. Meanwhile prostate cancer being detected when it is already advanced. Absolutely Crazy.
The majotity of cases are diagnosed at 70 or above.
The age 70 nonsense is based on the belief that most men will be dead within 10 years, & current treatments would keep most alive until a comorbidity killed them. But many men who survive to age 70 in good heath could live another 15 years or more.
Perhaps men over age 70 who are in poor health should be advised against taking the test, but the patient should make the decision.
There is always the Life Extension route to a PSA test.
Yes. Regular screening for Psa and all sorts of other screenings should begin at maybe 40. Catch all of these diseases early when cure is a possible. Like a yearly medical census thing. Free for everybody. Why are they doing exactly the opposite? Don't want to treat a lot of poor people who will demand treatment? Need to wait till they are 65 and Medicare will kick in? Be a lot less people on Medicare cause they didn't make it to 65? The conspiracy theories come quick to someone who was not psa tested till 66 and found to have stage 4 prostate cancer.
I was curious as to where the age 70 cutoff came from. As I suspected, it's totally arbitrary. No medical or scientific rationale behind it other than the arbitrary "those with a life expectancy of 15 years or less". There is no conspiracy. It's just that nobody cares about old men. We're a nuisance anyway.
Living in cold climates all my life, I always thought I would be cremated just like Sam McGee. I learned quite a bit about him while living in the Yukon in my childhood days and even hung out in his cabin on a few occasions.
As it turns out, he was buried in the end and not cremated. Go figure.
I want my cremated remains combined with salt into a cube.
Family and friends are invited to whatever type service my family chooses. I expect a small number of people to attend, but I’d like for this cube to be placed into the water at the junction of the Atlantic Ocean and the Mediterranean Sea halfway between the coasts of Europe and Africa. That seems to be a nice central location in human history. Most research places the beginning of humans in Africa and most of my past is rooted in Europe. Rather nice symmetry will surround this goodbye.
My husbands Axumin scan showed suspicious lesion in the bladder wall. He will soon have a cystoscopy to check the bladder. However, this is only after getting a second opinion from radiologist and MO He had a kidney stone accidentally show up ten years ago on regular ct scan.
Ah, incidentalomas--a colleague had an MRI for back pain and a small renal cancer was found. But then again, we know the USPSTF takes a dim view of some routine screenings.
You said your doc was negative about too many blood tests and that "He believed that finding problems in patients without symptoms leads to questionable treatment that are not necessarily in the best interests of the patient."
I am glad to have had yearly Psa tests and blood tests because my local doctors and myself believe that the best time to know when you have a cancer problem is EARLY ENOUGH. By age 55, I was beginning to see ppl my age and older just get sick and die. How come that happened? It was because both docs and patients thought they'd never get sick, and when they did get sick they didn't last long, and in 1990s I watched as 3 men went down to Pca one after the other, in just 3 houses nearby so I guess the same was happening all over town. My dad died of melanoma, 60, he ignored a black spot on leg, his mum died of Oa, one of my sisters got Oa, died, 60, other had both breasts off, and docs stuffed them around for a year after symptoms began, and I wondered when my turn would come for Pca, and I did not have to wait long, and I had a Gleason 9 at 62, inoperable, probably spread widely, and unfortunately the Psa was only 5.0 at beginning of examinations, so threshold for action should have been in 3.0, and then I might have got the cancer treated with RP successfully and not have had the fight since 2009.
I think the opposite your doctor. Its better to look for as much as possible regularly and early, because that's when treatment is likely to work best, BEFORE getting symptoms, like piss in your blood with advanced early Pca, and if that is the case, its usually way to late, its spread all over the body.
If you look like you might become diabetic, then your doc does you a favour to tell you and you need to change diet, get fit, or die early. Same with major other killers, heart troubles, lung cancer.
Many doctors are pissed off that so many patients have terrible lifestyles then they come to a doc to get a fix for a problem they brought on themselves.
Here, I pay ZERO $$$ for blood tests because of our Medicare. Some have 20 items to investigate and sure enough they show me and docs more about how my body is coping with Pca and if there is something else likely to kill me. Fortunately, there is not anything right now, but if I get skin cancer or some other thing then I want action when its easy to do, not later when its out of control. I prefer doctors who are over zealous about my health, I expect them to worry about me and I am mightily glad that those I have now are like that. One said to me in 2008, when I was worried about Psa at 4.2, "You are too healthy to get cancer". It sure was true I was healthy for 61, I could cycle 150km in a day and keep up with men 10 years younger. I was just beginning to need to get up at night to pee, and I had lost the ability to ejack semen.
Yeah, because PG was full of cancer.
Fortunately, that doc left the practice and better better ones replaced him but at that time many doctors had very careless attitude to patient health.
The zeal of the doctors who have treated me now for Pca have kept me alive for many years more that may have been possible if I had listened to the crap doctors who did not seem to think it possible a healthy looking man had a major problem.
When the the PsMa scan became available here in about 2015, it upset many men and their docs when it found mets where the men and their docs thought there were no mets. Bravo, we need the truth early, not late.
If there is a history of Pca in a family, a man should be able to have his PG cut out well before any cancer begins.
Hmmm the more you know the better you can deal with issues earlier then waiting until it really has hold on you. But we were told you don’t get the results you just know if you qualify for treatment. So you would not know what was truly found.
I'm going to be cremated and my ashes scattered on an Oregon vineyard so I can come back as an exceptionally fine year. No funeral, celebration of life - a PARTY! Champagne, music, laughter.
Wouldn't the doctor at least screen for high cholesterol, triglycerides, and blood sugar? BTW, speaking of inflexible doctors, mine doesn't seem to listen very well. I mentioned that statins have a benefit in fighting prostate cancer. Could he increase my atorvastatin dose from 10mg to 20 mg? Nope. The lab results indicate that it is doing its job at current dose. Did he hear what I said about PC and statins?
You piqued my curiosity. I just checked, no film just still photos. Those were the days... The Concourse Plaza Hotel, and the Court house, Yankee Stadium, Nedicks .
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