What do you all think about this

[Darryl]

What do you all think about this

nytimes.com/2023/05/08/heal...

[Tall_Allen]

I think metastasis-free survival is an important endpoint in itself - not just overall survival. Metastases cause pain, suffering, and palliative medications (like ADT, chemo, and opiates). So even though a man may survive an equal amount of time, his quality of life may be impacted.

If a man in good health has already received periodic PSAs with no signal of progression through the age of 70, he has low risk of metastases in his remaining years. But if he hasn't been diligent about getting tested, he may want some (or,better yet, PHI tests). Conversely, if he has "competing risks" from cardiovascular disease or diabetes, he may want to stop PSA testing earlier. In any case, it's a personal decision that a man should make in a discussion with his doctor.

This might be a good tool to inform the discussion:

webcore.mskcc.org/survey/su...

[Nusch]

It’s a case by case decision. I only know, that I should have tested my PSA much earlier. My family doctor was against testing.

[Concerned-wife]

I think the message that gets lost is “The point of screening is to find the aggressive tumors — a small minority, but they kill more men than any other cancer except lung cancer,” Dr. Cooperberg said.

My husband was regularly screened by an otherwise diligent FP, who neglected to refer him with a rising PSA to a urologist until it turned out he was de novo metastatic.

I think the US Preventive task force and media downplayed screening too much.

[dadzone43]

Could not get by the money wall. Tried four times.

[Bethpage in reply to dadzone43]

Try Google in incognito mode. I could read it that way.

[maley2711]

IMHO the real problem isn't testing...it is the followup with the Doctor and a discussion of the results and how treatment might/might not impact the patient's life expectancy and quality of life...ie the pros and cons of AS vs treatment. Concur re the additional endpoint of metastasis-free survival.

[Bob1951]

Try using your browser’s Reader Mode to display the article. I was able to read the webpage with Safari on my iPad. Should work with other browsers.

[Mjex]

I agree with TA's comments. As one of the over 70 crowd, I think that there is a lot of age discrimination built into the article. Of course, life expectancy is important in considering treatment options. Relative age, based on an individual's physical and mental condition, is a better criterion to match treatment options to the individual than a calendar.

[WilsonPickett]

I often ask myself, and I don’t have an answer… Is there such a thing as too much screening? The number of cancers that you can be screened for now, in addition, to other potential threats, seems to be increasing by the week. A balanced and sensible approach is critical, and not easy to formulate.

As for myself and my prostate cancer… What the hell did my ongoing PSA tests hurt? I think my diligence in doing so most of my adult life, saved me from a potentially more troublesome outcome.

[pjd55d]

yeah - the Money Wall got me too.

I was diagnosed when I was 68 with a PSA of 400 - Mets found on an MRI taken for another issue. I had a long time ( 25 yrs ) of medical issues that I was receiving care for including PHV 6 years earlier. I did not receive PSA tests - the Drs did not order them and I was too focused on the other medical issues to even think about it - but I DO wonder why a PSA was not ordered. We all know that early detection usually results in better situation for treatment/cure? As I understand it, the test is very inexpensive.

Anyway - living with it now

[pjd55d]

that should have been HPV

[Inspjones]

I take any recommendations by the USPSTF with a grain of salt. They are the ultimate "bean counters" with a misguided emphasis on mortality and money, instead of focusing on more important issues such as quality of life and early detection. I was a victim of their faulty advice when my doctor stopped testing me for PCa. I found out many years later on my own that I had cancer at 54. Healthy men should be planning to live well into their 90s these days, so screening should be done well past 70 for healthy men.

[j-o-h-n]

Problem is that the Medical Society should never have named it "prostate" they should have named it "sement mixer". I think most men would identify with that term and show more interest in it's condition/health.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 05/10/2023 3:20 PM DST

[NotDFL]

Bad title for the otherwise OK story; shame on The New York Times!

[garyjp9]

I think the USPSTF and the media downplayed screening too much, which is why the number of men being detected with advanced prostate cancer is going up in the U.S. today.

Report

[ragnar2020]

We have seen this argument previously with a resulting rise of more advanced PCa because the disease was not detected earlier. The articles are always written by a source desiring to reduce costs and minimize the beliefs of over testing. I do not buy these arguments.