...but does the USPSTF care?

[pjoshea13]

urologytimes.com/view/rates...

-Patrick

[Garp41]

I think it goes back to when the govt. recommended against PSA testing.

[cesces]

I met the guy who did this.

I don't think he cares.

[witantric]

This is tragic. Especially because it is so easy to screen. I have been encouraging my friends and relatives to get PSA tests. It is amazing how many folks are not even aware what PSA is

[NWLiving]

Bill’s PSA was only tested by Kaiser in 2014 because he requested it at an annual appointment. By that time it had already bit into his ribs.

[AlvinSD in reply to NWLiving]

After I was diagnosed by Kaiser at 52 (Gleason 9, lymph node mets, one bone met), I was after all of my brothers to get screened. My brother (44) went to his Kaiser Primary Care Doctor and asked about screening. “You’re too young!” Kaiser PCP says and won’t order the PSA or do an exam! I told my brother to write him an email describing how I was diagnosed with a metastatic Gleason 9 cancer at 52, you are asking again to be screened and, if he refuses, explain his rationale for not doing it considering our family history. The PCP doctor finally agreed. My brother is now being monitored with PSAs every six months because the first one came back elevated.

Kaiser is a complete joke when it comes to prostate cancer screening and care, especially when it comes to younger men. It’s all about the money for them and investing in screening men <55 is going to make them lose money. It’s going to save lives but at a huge financial cost—Kaiser doesn’t care about anything else. They like the way the USPSTF has the guidelines currently. Urology is one of the top paying specialties at Kaiser. More screening is going to send more men to Urology (already totally backed up with patients, takes forever to get in now) and necessitate hiring more Urologists. More cancer is going to be found and there will be more surgeries and other expenses. Now, for a place like Kaiser, they can’t bill Medicare for the surgery on a younger man (not on Medicare). So, the only income they are making is from the co-pays and deductibles—they basically lose money. More screening, biopsies, surgeries and treatments on more younger men is a money losing proposition all around for them.

Incidentally, my initial elevated PSA was done outside of Kaiser. I found it after a treated bout of prostatitis and went to see my Kaiser PCP. Got sent to Urology after it repeated high (twice around 20) after 6 weeks of antibiotics. Urologist does no exam whatsoever, chalks it up to prostatitis and says let’s wait and repeat the PSA and if it’s still high then we will do the MRI (I wanted the MRI then, I knew something was very wrong as my PSA had never stayed high like that after antibiotics). Three months later, I finally got the MRI: already metastasized, 3 x 2 cm tumor with seminal vesicle involvement. If I had waited until 55 to get screened as Kaiser recommends my outcome would be much, much worse. I have a friend who is also a Kaiser patient, also diagnosed on his own at 52 because Kaiser didn’t want to do the PSA. (They even referenced USPSTF guidelines!). Fortunately my friend went and got it done outside Kaiser (he also had some areas of aggressive cancer found in surgical pathology)

It’s very ironic how Dr. Eugene Rhee (Kaiser Southern California Regional Urology Chief, past-president of the California Urologic Association and practicing KP Urologist in San Diego) works to promote PSA screening legislation but in reality Kaiser does not want to aggressively screen younger men: we are an acceptable loss to them .

I could start another thread on the total lack of comprehensive (really, any) support for men with prostate cancer My friend I referenced above has experienced the same thing in his Kaiser region Zero support for men with Kaiser You are on your own…figure it out

I will never recommend Kaiser to anyone based on my absolutely horrific experience with my prostate cancer diagnosis, their Urology “Team” and total lack of support for men with prostate cancer

[Hidden in reply to AlvinSD]

A PSA test costs what? $50? I blame that USPSTF gang of morons for this reluctance to use this inexpensive screening test. DRE's also seem to be rare unless the patient insists on it, as I had to do.

[witantric]

Heart breaking 😪 I have heard so many stories like this. Hope your partner Bill is OK.

[cujoe]

Hi, Patrick,

I was listening to NPR on my way home from doc appointment in the Triangle today and noted a boasting report about how cancer rates had dropped something like 40% over the last X-number of years. It seems most of it was/is due to smoking cessation causing a big drop in lung cancer, with pancreatic flat-lining, and PCa initially going down and then (after PSA screening was reduced) back up again.

The commentary contributed it mostly to better cancer screening, but did note the increase in PCa deaths related to screening reduction.

So, it seem the big headline about the reduction is essentially much like relative risk vs absolute risk in RCTs, i.e., pick the number that makes the best headline and let that be the one to use in the press release. I recently listened to a Andrew Huberman interview podcast with Dr. Peter Attia where Attia deconstructed the flawed NIH study of HRT (started circa 1993) for menopausal women. Seems the headline-making relative risk number was something like a 27% increase in breast cancer risk, while the absolute risk was the difference between 4 cancers/K vs 5/K - or 0.1 % for the ABSOLUTE risk.

If you would like to listen to this portion of the podcast - which is very instructional about how to ID flaws in patient selection, methodology, and statistical outcomes of RCTs - you can pick up that podcast segment in the list just below.)

Dr. Peter Attia: Exercise, Nutrition, Hormones for Vitality & Longevity | Huberman Lab Podcast #85 (While IMO the entire podcast is worth your time, the link below is cued to the HRT segment.)

youtube.com/watch?v=DTCmprP...(Not working as expected?)

Expecting the USPSTF to admit that they made a mistake - with PCa patients obviously dying as a result, is a bridge WAY to far. I know for a fact that the delay in me getting to surgery was a direct result of my urologist being seduced into recommending extended Active Surveillance for anyone with a 6 Gleason - apparently, in my case, regardless of cancer extent in biopsy results.

We often learn too late that we need to be informed advocates for all aspects of our health care. Take nothing for granted, question everything, and get multiple opinions when considering any treatments.

Hope all is well with you and that you got connected with our mutual friend, "Ironman".

Keep it S&W, Ciao - Captain cujoe

[pjoshea13 in reply to cujoe]

Hi Cujoe,

I remember Dr Myers' solution to the over-treatment of Gleason 6 men: "Just don't call it cancer!". .But that ignores the fact that 25-30% will progress during active surveillance. Those men need to be treated preemptively imo. And it isn't very helpful to tell all Gleason 6 men that they don't have cancer.

We have so many possible liquid biopsy contenders that could be added to PSA for improved cancer specificity. And perhaps we could cut biopsise by 80-90%?

Best,-Patrick

[cujoe in reply to pjoshea13]

Patrick, I was just this morning re-reading parts of Dr. Meyer's Beating Cancer book and he mentions that patients almost never get tested for anything other than PSA, even such basic hormones like T & DHT. I would add at least SHBG, E2, and free T to that list.

At my Dec appt, I asked my MO for his insight on my 2 sequential <20 E2 labs (walk-in labs done and paid for by Moi). He said +/-, "We don't test for E2, so we don't know?" I thought to myself ~ Duh?, Then maybe you should consider testing for it? All further evidence that it is up to us as individuals to seek and find what we need to fully understand our disease.

Ciao - cujoe

PS BTW, I've tested since and my latest E2 was 27, so I'm guessing it might be a lagging result of the 2 months of Lupron I did several months prior to the labs. My PSA immediately recovered from the Lupron mono, but it must have taken time for the E2 conversion to get going again.

[AlvinSD]

Big corporate medicine like Kaiser Permanente doesn’t care either. They lose money if they screen younger men. (See my reply below.)

[pakb]

My husband had SYMPTOMS for over a year- 4 ER/Urgent care visits for retention, and was self catheterizing for a year, father had Pca, and still never did a PSA or DRE until 2 weeks AFTER tissue removed from his TURP showed cancer. He was put on bicalutimide after his TURP by urologist for 2 weeks- never a PSA or DRE until we sought out a MO. So he'd already been on bicalutimide for 2 weeks when initial PSA was done. All because he was under 50 years old. We didn't even know what a PSA was. First MO we went to dropped his jaw when he found my husband hadn't had a PSA. I now tell everyone I can to get a PSA as soon as the can. Just fir baseline if nothing else.

[groundhogy]

to me the guidelines/protocols used by front line general practitioners and urologists do not look like they are set up to save the maximum number of lives.

They do, however, look like they are set up to generate a steady percentage of fat, juicy, scrumptious cancer victims. These poor souls keep the gears of the industry turning.

Sure, some guys (and their families) will get lucky and get cured. Those guys give hope that cures sometimes happen.

A guy that gets cured is one-and-done. He gets his prostatectomy and dissapears for good. A guy that shows up just a little bit late will go on to engage the industry for the rest of his miserable life.