This was my first post two years ago. It was about the scandal of my diagnosis. I don't think much has changed. Basically PSA testing is a good thing.
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Posted later - please see fantastic replies to this post below - excellent additional information on how the PSA testing policy originated.
Nine years ago, a urologist in London, England, having reviewed my fluctuating PSA history, recommended a multiparametric MRI. My urologist back home in Texas knew of mpMRIs, but told me he did not use them. I fired him.
JohnInTheMiddle I am sorry to hear of your late diagnosis and mets. "Scandal" is an understatement.
The USPSTF is a group with ties to the Industrialized Healthcare Complex here in the US. Their job is more to regulate recommendations to minimize the FINANCIAL impact and demand on the US Industrialized Healthcare Complex. There is NO separation between our Federal Government and BIG business so BIG healthcare can write their own recommendations. It's just done under the guise of "healthcare policy".
Decisions are made from studies they read and recommendations are put into place. "Evidence based medicine" is the sophisticated term they choose. Almost every cancer has been well under-treated and every 6 years the ages drop.
Just a basic point about the PLCO trial in the US. It showed no benefit to screening. Why? Contamination in the control of about 50 - 90% of men who had screened too. The ERSPC study showed 20% reduction in 200o and 29% reduction in 2012. BUT the USPSTF / Affordable Care Act recommendation saved the Industrialized Healthcare Complex from having to address a population based screening.
Then in 2018 those involved in both the USPSTF and the Industrialized Healthcare Complex ran their own study of SEVERAL hundred thousand patients with prostate cancer. Their own study showed VERY significant benefits to annual screening.
I have connected all of the dots and hope to have it all compiled to expose the truth. It's about protecting an extremely profitable business, US Healthcare!
Remember, not treating and under treating is extremely profitable too!
Wow CR this is fantastic and adds the backstory. And it shows up in frontline care such as family physicians as almost the moral high ground that we don't want to do PSA. Because it causes more harm than good. The morality of the thing is atrocious. And also the logic. The PSA test does no harm - it's the aggressive possibly profit driven and irresponsible overtreatment afterwards that drives the stats. But the new stats are greater and greater percentage of first-time prostate cancer diagnoses are with men where it is already metastasized. Some great journalist or writer has a book opportunity here.
I have a whole PowerPoint put together!
I fell for the USPSTF BS. After having to beg my GP for a PSA test in 2010 (3.0), then being reassured I don’t have any risk factors and no need to test until again until my 60’s, had PSA 29 at diagnosis at 64yo. Same thing happened to my college roommate, had annual physicals but no PSA test and recently found out he’s stage IV at 75yo. Gross malfeasance by the medical profession.
My longtime and cherished primary care doc did a PSA test for the first time after I turned 65. My PSA was over 5, but he couldn't feel anything with his digital exam. Fortunately, he sent me to an oncologists who not only felt something but soon confirmed PCa. That was 10 years ago and it's been a long ride. I am perhaps one of the many men harmed by the USPSTF recommendations. I say "perhaps" because earlier detection of my cancer is contrafactual. I was diagnosed as a 3+4 and the highly regarded surgeon who took out my gland told me I'd "do fine". Not exactly how it turned out but I've survived many treatments and I have plenty of bigger things (the Sixth Extinction anyone?) to worry about. 🤨
Actual clinical studies on DRE show poor diagnostic accuracy. Which in the context of how DRE is presented - that a negative result is the same thing as a clean bill of health every year - is criminal. And given that this research is well known and available, it's an indictment.
The whole argument of "over-treatment and we don't want to scare men needlessly" that underpins reduced PSA testing is weak. So what, if PSA tests reveal indolent 3+3? That's why we have Active Surveillance.
I haven't been to my PCP in more than a decade until October 2023. He didn't tell me but just ordered a PSA test (I'm 52) along other tests and it was elevated, 4.x ng/mL.
Yes, I went through "expensive" procedures with more tests, MRI, biopsy and all they found is low volume 3+3. I guess that's what they wanted to avoid? I'm glad that I'm now on Active Surveillance - not sure why they think that adult men can't handle that.
Still confused about PSA and Testosterone testing
PSA 5 years later
Rising psa
PSA test didn't detect my cancer. What about post treatment monitoring?
PSA drop VMAT-radiation 
