One of my best friends went in for his annual the other day since I had a Prostate Cancer Diagnosis and a Radical Prostatectomy. I had a lot of conversations about all the information I found, going through the biopsy, the treatment decisions and recovery after surgery.
To my surprise he declined to have his PSA checked at 54 after hearing all this info from me! He said the doctor explained that he has a 10% chance of getting Prostate Cancer. I read it's more like 1 in 8. And I also read a study where they biopsied prostates from men in their 50's that died of other causes (car accident, etc) and if I recall around half of them had some degree of prostate cancer. Many men probably have it but it never progresses to the point of needing treatment or at least they reach that point when they are so old they are much more likely of dying of something else.
His doctor said basically only a small portion of the 10% of men diagnosed die from it. True. He didn't tell me the figure but I would guess the doctor was basically saying statistically you have about a 1 in 1,000 chance of dying from it. Yet for males, cancer is the second leading cause of death and prostate cancer is the second most cause behind lung cancer! Did he explain to my friend that's because most men are diagnosed at a late age, not in their 50's and die from something else first!!
I find this highly irresponsible of his doctor. I think my friend, having heard what I went through, is scared of having to go through the same thing and has chosen to just put his head in the sand. I can't believe the doctor didn't advocate getting a PSA test. Maybe he did but have stats that made it sound like it wasn't that important as my friend isn't stupid and knows a lot more about Prostate Cancer (through me) than he did before.
I'm just flabbergasted at his decision to not have his PSA checked. I can see someone in their 70's or 80's declining but in your 50's? I didn't want to preach about it to him as it's really between him and his doctor but WOW.
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It's a reasonable decision because PSA is a lousy test. A false positive (which is likely) will send him down a path of unnecessary intrusive and anxiety-causing tests. A false negative, which is also likely, will lull him into false security. He may be more amenable to a Prostate Health Index (PHI) or 4KScore test - they are more specific and less likely to find insignificant prostate cancer.
PSA tests may not be totally reliable but they are non invasive. In my humble opinion, any doctor that uses the word "cured" in the same breath as cancer is irresponsible. Yes, there are some lucky patients who after RP remain cancer free. But a simple blood test insures the results stay the same.
I remembered (not quite correctly) that one man in 6 will be diagnosed with prostate cancer, and one man out of every 6 who's diagnosed, will die of it.
So it's not "one out of 1,000" -- it's more like 24 men in a thousand, who'll die of it.
The original recommendation to avoid PSA testing came from a group of doctors which didn't include any urologist. I think it's been withdrawn, or modified, now.
Almost everyone in the "patient community" recommends regular PSA testing for all men over age X (X varies with who you're talking to).
That comes with the warning:
. . . "And remember that not all prostate cancers require treatment."
Well it shouldn’t surprise you too much if you’re telling him all about what you’ve learned and urging him to get a PSA test, and his doctor’s response is basically nah don’t worry about it which one he’s listening to. Men don’t like going to the doctor, and they definitely don’t want their junk (or anything near it) examined.
Im not disagreeing with Tall Allen about the unreliability of PSA testing, but it’s hard enough as it is to convince men to even get that, much less the better testing. Reading PSA’s over time is at least something. How can we push for better testing protocols that patients will buy into when they won’t even ask for PSA’s now, and doctors don’t order them? What chance do we have?
When I ask my older male friends if they get their PSA checked most of them think it’s the same as a colonoscopy, or don’t know what it is, or just assume the doctor is doing it.
They also usually don’t know any of their other numbers either, other than the ubiquitous weight, temperature and BP every time they come in. They just trust they’re getting these things ‘if they matter’. Cholesterol, triglycerides, fasting glucose, Shingles vaccine. Dexa scan. Maybe yes, probably no. If they even go for checkups.
The things the doctor tests for may or may not include all this, but it hardly matters because so many don’t hear what the doctor says anyway-if he says anything. I know guys who are 50 pounds overweight that think they exercise because they play golf with a cart on weekends and their doctors tell them they’re doing fine. At least that’s what they tell me.
If he was my friend and countered with that doctor retort (assuming it’s even true) I’d tell him I agree dying of prostate cancer is not what he should be concerned with. Trying to survive the symptoms and consequences of the drugs he’ll be on to fight it if he doesn’t catch it early is.
1 in 1000 die from it? Even if it were accurate, it completely misses the point. Being alive and fighting it can go on for decades, but it’s hard. If his doctor is ‘highly irresponsible’ as you say, it’s more for creating a false equivalency. Not dying from advanced Pca bears no resemblance to not dying without it.
Even if most men don't die of Pca, what do the statistics say about untreated Pca that metastasizes in other parts of the body? Doesn't that change the math a bit for being or not being concerned? I think it depends on where you look for statistics, but I've seen rates as high as 1/5 men will get Pca and up to 1/2 will have it by 80 or older. How many men die of other cancers that started as Pca and went undetected or untreated? I don't know if there are any statistics for that but if the numbers are high then it is obviously a bigger concern. Also, if the probability of dying from Pca is as low as 1:1000 why would any of us be concerned about it and seek treatment in a chain that never ends, if that is the only number that we ever had to consider? Did all of us that decided to get treatment overreact thinking we were that 1 in 1000?
I was 56 when my Dr asked it I wanted a PSA test. I had no symptoms and nothing wrong I was just trying to get a physical after trying for 9 years as I thought it wise. Of course it's not as easy to get checkups anymore without symptoms or something wrong which is why it took so long. So on my first visit to my new GP I took the test. Never even heard about it before that which was my own ignorance. No cancer that I know of in my family. PSA 156 and high platelet count. DX 3 years ago last Sunday. At least there's still a small chance I caught it in time despite being on the stage 3 stage 4 fence.
If you are doing an annual health screening which usually involves a series of blood tests anyway, and especially if you have some sort of medical insurance, it seems like you may as well go ahead and include PSA as one of the things to check. I know guys that were diagnosed with prostate cancer in their 50's, but at least they caught it early before it had a chance to start exploring the rest of their body. 🤔
My former PCP didn’t push the test unless he felt something suspicious in the DRE. His rationale was that about 75% of high PSA tests turned out to be false positives, according to him, and he was concerned about healthy patients going through the stress of the diagnosis procedures and potential unneeded treatments. He did give everyone the option of having the test though. I declined it for a few years after turning 50. I opted for the test a year before I was diagnosed. My PSA was normal then. About 16 months later when I had the next test it was 56. Had some relatively mild BPH symptoms.
I was petrified of getting the biopsy reading about what it entailed. My Dad, who already went through it and then Cyberknife said it's not that big a deal. I thought he was just saying that to make me feel at ease. Turned out, it was a very easy and essentially painless procedure (for me at least.) Wasn't fun peeing blood for a week. I can understand though if you don't have insurance with a very low deductible, cost can factor in.
Very good points made about looking at other tests than just total PSA to give more certainty as to the necessity for more investigational procedures. That 4-7 range is probably the most difficult. I was a 32 with a normal feeling prostate that was average to below average in size. Checked for UTI (even though I had no symptoms) just to be sure before doing the biopsy. I had a 2cm tumor in my transition zone about 15% Grade 4. Could not be felt on palpation because of the location in the middle of the prostate (only 20% of the time it's located in the transition zone - I got lucky in that respect as statistical long-term outcomes are better than the more common peripheral zone tumors.) I'm not good at forcing myself to go to annual checkups. The blood draw just about makes me pass out and I was otherwise physically fit with no issues. Just coincidentally my previous checkup 4 years before in my late 40's was just months before my Dad was diagnosed. I should have gone in right away in hindsight and got my PSA checked. It was probably in the teens if not higher back then which also at that level would have been a no-brainer for a biopsy barring BPH/UTI, in my personal opinion. I had gone in for a checkup mainly to schedule a colonoscopy and then when doctor asked about family history, I told him Dad was diagnosed with PCa since my last visit hence the PSA test after. Kind of mad Doc didn't suggest it at previous visit, but I think most still recommend starting at 50. I've heard that has come down to 45 now?
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