PeterRS Posted May 19 Posted May 19 News today that former President Biden has an aggressive form of prostate cancer that has already spread to his bones. While we will all wish him well in such difficult times, there is one issue I find somewhat baffling. As I understand it, prostate cancer is a slow growing cancer. Even so, it is the second highest form of cancer death in the USA. As it is one of the most common cancers in men, generally men over a certain age (is it 50?) are recommended to have regular prostate cancer checks through either physical examination or simple PSA blood tests. How often did the White House doctors check his for this cancer? How did the cancer develop so quickly? Surely it had to have been identified at least in an early stage when he had his last White house medical check. https://www.cbsnews.com/news/biden-prostate-cancer-symptoms-treatments/ Ruthrieston and lookin 1 1 Quote
vinapu Posted May 19 Posted May 19 4 minutes ago, PeterRS said: How did the cancer develop so quickly? perhaps not so quickly, it's just that only now we are informed unicorn 1 Quote
PeterRS Posted May 19 Author Posted May 19 1 hour ago, vinapu said: perhaps not so quickly, it's just that only now we are informed Agreed. But if Biden was suffering even from the early stages of prostate cancer while running for office a second time, not telling the public was disgraceful! Treated early, even in older men prostate cancer is curable. Don't those running for President have to issue a doctor's clean bill of health? I know Trump failed to do so in 2016 when his doctor eventually admitted Trump had dictated the letter the doctor wrote! But then Trump is Trump. Maybe - hopefully - he will drop down dead from a heart attack due to all the fast food he consumes. Ruthrieston and t0oL1 2 Quote
floridarob Posted May 19 Posted May 19 3 hours ago, PeterRS said: hopefully - he will drop down dead from a heart attack due to all the fast food he consumes. Only the good die young, he'll be with us much longer than we can imagine. t0oL1 and Ruthrieston 2 Quote
Members unicorn Posted May 19 Members Posted May 19 6 hours ago, PeterRS said: News today that former President Biden has an aggressive form of prostate cancer that has already spread to his bones. While we will all wish him well in such difficult times, there is one issue I find somewhat baffling. As I understand it, prostate cancer is a slow growing cancer. Even so, it is the second highest form of cancer death in the USA. As it is one of the most common cancers in men, generally men over a certain age (is it 50?) are recommended to have regular prostate cancer checks through either physical examination or simple PSA blood tests. How often did the White House doctors check his for this cancer? How did the cancer develop so quickly? Surely it had to have been identified at least in an early stage when he had his last White house medical check. https://www.cbsnews.com/news/biden-prostate-cancer-symptoms-treatments/ You may wish to inform yourself regarding subjects on which you pontificate. Prostate cancer screening is NOT recommended routinely for anyone. Official guidelines are that it's reasonable to discuss in men 55 to 69, and recommended against from age 70 onwards: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening Population Recommendation Grade Men aged 55 to 69 years For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening. C Men 70 years and older The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older. D I'm guessing that the discovery was made due to bone pain. Biden will be offered hormonal treatment (either physical or chemical castration), and probably will be fine. His other health problems, mainly his dementia, will get to him first. vinapu and floridarob 2 Quote
Keithambrose Posted May 19 Posted May 19 3 hours ago, unicorn said: You may wish to inform yourself regarding subjects on which you pontificate. Prostate cancer screening is NOT recommended routinely for anyone. Official guidelines are that it's reasonable to discuss in men 55 to 69, and recommended against from age 70 onwards: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening Population Recommendation Grade Men aged 55 to 69 years For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening. C Men 70 years and older The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older. D I'm guessing that the discovery was made due to bone pain. Biden will be offered hormonal treatment (either physical or chemical castration), and probably will be fine. His other health problems, mainly his dementia, will get to him first. An unnecessarily aggressive response. There are different views as to the age at which PSA screening should take place. I note that Johns Hopkins, a leading US cancer centre, recommends screening from 55 onwards. They specifically say that screening between 55 and 69 is the age where most men will benefit from screening, as this is the time when treatment makes the most sense. They suggest further checks every 2 to 3 years. Recently, i had a raised PSA level, checked after an enlarged prostate. I am over 70, and my Consultant arranged an MRI scan, which is non invasive, and which he said would be definitive. It was negative, luckily. Another in 2 years. Also, it's misleading just to refer to prostate cancer. Like all cancers, it comes in lots of different forms. tm_nyc, Ruthrieston and Lucky 3 Quote
PeterRS Posted May 19 Author Posted May 19 4 hours ago, unicorn said: You may wish to inform yourself regarding subjects on which you pontificate. Prostate cancer screening is NOT recommended routinely for anyone. Official guidelines are that it's reasonable to discuss in men 55 to 69, and recommended against from age 70 onwards Recommendation Grade Men aged 55 to 69 years For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Your response makes several points which have absooutely nothing to do with my post. If you had read it clearly, you would have noted that I never pontificated about anything! I stated merely that there is a recommended minimum age for screening. I then put a question mark after 50 because I do not now what that age is (or did you fail to note the question mark?) I should have thought that obvious. Then you mention that prostate screening is not recommended routinely for anyone. Perhaps you can then answer why the best hospital in Bangkok, Bumrungrad Hospital, has prostate screening as part of its annual Executive Check-ups. That hospital recommends screening starts at 50. I do not know how good or otherwise the WebMD site is but it makes clear that "about 10% of men newly diagnosed with prostate cancer are under 55." Additionally it states "Around the world, there’s been an increase in early onset prostate cancer in men between 15 and 40 years old." It then adds about your country, "In the U.S., the average 5-year survival rate for prostate cancer is between 95% and 100% for men ages 40-80. For younger men, the 5-year survival rate is lower. For men ages 25-34, it’s 80%. For men ages 20-29, it’s 50%. For men ages 15-25, it’s 30%." https://www.webmd.com/prostate-cancer/prostate-cancer-in-younger-men Quote
Members unicorn Posted May 19 Members Posted May 19 36 minutes ago, Keithambrose said: ...There are different views as to the age at which PSA screening should take place.... I'm sorry, but I'm not of the RFK, Jr. ilk who feel that any "opinion," regardless of its basis of known scientific facts, is "valid." This is not an issue in which the experts are "guessing." This issue has been studied extensively in almost countless studies around the globe, involving hundreds of thousands of men. Although there are plenty of different recommending bodies which have gone through the scientific studies and their data (unlike yourself), and there is some disagreement as to whether screening in the 50-69 group should be discussed and/or offered, every single organization composed of members who've looked at the data agree on one issue: screening those 70 and over is harmful. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening#fullrecommendationstart Recommendations of Others The American Academy of Family Physicians39 and the Canadian Task Force on Preventive Health Care40 recommend against PSA-based screening for prostate cancer. The American College of Physicians41 recommends that clinicians discuss the benefits and harms of screening with men aged 50 to 69 years and only recommends screening for men who prioritize screening and have a life expectancy of more than 10 to 15 years. The American Urological Association42 recommends that men aged 55 to 69 years with a life expectancy of more than 10 to 15 years be informed of the benefits and harms of screening and engage in shared decision making with their clinicians, taking into account each man’s values and preferences. It notes that to reduce the harms of screening, the screening interval should be 2 or more years. The American Urological Association also notes that decisions about screening, including potentially starting screening before age 55 years, should be individual ones for African American men and men with a family history of prostate cancer. The American Cancer Society43 adopted detailed screening recommendations in 2016 that highlight the importance of shared decision making and the need for informed discussion of the uncertainties, risks, and potential benefits of screening. It recommends conversations about screening beginning at age 50 years and earlier for African American men and men with a father or brother with a history of prostate cancer before age 65 years. To disagree with every recommending organization on the planet only shows both arrogance and ignorance. There are people whose job it is to review the data. They are not "guessing." And, no, the MMR vaccine doesn't cause autism, even though RFK Jr. may have a different opinion. Quote
Members unicorn Posted May 19 Members Posted May 19 11 minutes ago, PeterRS said: Your response makes several points which have absooutely nothing to do with my post.... Yes, it did. You asked "How often did the White House doctors check his for this cancer?". Since he was in the 70+ age group during his entire time in the White House, the simple answer is that if his doctors knew what they were doing, never. (And I provided a link to the professional guidelines in order to substantiate the advice) In all likelihood, the former POTUS will do fine with hormonal treatment. Quote
floridarob Posted May 19 Posted May 19 My Dr told me years ago to make sure to ejaculate daily or twice daily if possible to help avoid prostate problems, he said you have the Dr's permission to jerk off, I told him not to worry, I was doing it enough with or without his permission. If he only knew how often I was receiving prostate massages after that 😝 32 minutes ago, unicorn said: In all likelihood, the former POTUS will do fine with hormonal treatment. That's reassuring.... I like Joe, he's always seemed like he had a heart and cared about others, the polar opposite of what we have there now. tm_nyc, unicorn and vinapu 3 Quote
Members unicorn Posted May 19 Members Posted May 19 46 minutes ago, floridarob said: My Dr told me years ago to make sure to ejaculate daily or twice daily if possible to help avoid prostate problems... There is some epidemiological evidence that those who ejaculate at least 20 times a month have a lower risk for prostate cancer. However, the evidence is not based on randomized clinical trials, so must be viewed with some suspicion. Twice daily seems a bit overboard.... 😉 https://pubmed.ncbi.nlm.nih.gov/27033442/ "...During 480831 person-years, 3839 men were diagnosed with PCa. Ejaculation frequency at age 40-49 yr was positively associated with age-standardized body mass index, physical activity, divorce, history of sexually transmitted infections, and consumption of total calories and alcohol. Prostate-specific antigen (PSA) test utilization by 2008, number of PSA tests, and frequency of prostate biopsy were similar across frequency categories. In multivariable analyses, the hazard ratio for PCa incidence for ≥21 compared to 4-7 ejaculations per month was 0.81 (95% confidence interval [CI] 0.72-0.92; p<0.0001 for trend) for frequency at age 20-29 yr and 0.78 (95% CI 0.69-0.89; p<0.0001 for trend) for frequency at age 40-49 yr. Associations were driven by low-risk disease, were similar when restricted to a PSA-screened cohort, and were unlikely to be explained by competing causes of death...". Quote
Members Riobard Posted May 19 Members Posted May 19 I think that some of the confusion and lack of consensus regarding screening benefit is related to the inappropriate interchangeability of the terms ‘harmful’, on the one hand, and on the other hand ‘superfluous’. Harmful seems to relate to more invasive physical diagnostic procedures (I am deliberating omitting considerations of associated psychological stress of diagnostic procedures at this point), the threshold that strikes me as invasive being needle biopsy, as well as diagnostic financial cost burden to public funds particularly where depletion is in public income taxes paid to support health infrastructure. The latter considers the number of men needed to assess at a cumulative financial cost that is justifiable (yes, subjectively of course) in terms of the predicted offset of morbidity and mortality rate. I submitted to PSA screening beginning at age early 60’s based on lab costs covered by social medicine insurance based on primary care recommendations and family history of metastasized prostate cancer that at that time and remains a risk marker. It’s just venipuncture in the context of other routine blood draws. Along with consistent PSA elevation and eventual manageable (no intervention) BPH I began prostate/bladder MRI screening every few years commencing mid-60’s. However, I chose to pay out of pocket for private clinic imaging and at that time consistently paid out of pocket for PSA, GP check-up in general, Urologist consultation, and once only biomarker 4K. Almost 10 years on I am not among the proportionally high number of men at my age with prostate cancer. However, I personally undertook the financial cost and responsibility of testing, essentially capitulating to practitioners’ urging from the point of view of “being on the safe side”. My MRI PI-RADS score consistently at level 2 or lower, where level 3 is equivocal in terms of the possible next step of biopsy, has spared me the conundrum and complications as well as diagnostic limits of invasive needle biopsy. So, on balance no regrets, I didn’t burden public coffers, and I spent money I won’t miss for some degree of peace of mind. I haven’t been unnecessarily treated or had my prostate prematurely yanked out when in fact it will not have been implicated in my eventual demise. One size does not fit all. I paid and stayed within the bounds of the “uselessness” aspect of screening that itself should not be conflated with the level of true harm implicit as foundational for those guidelines that lean towards non-screening. If the appended article content had been accessible a dozen years ago I doubt my trajectory of testing would have been different. The key is shared decision-making. I have no idea what Biden’s check-up history is but I don’t think being in high office necessarily influences the breadth of medical check-up routine that does or should occur. That said, I would personally certainly drill down deeply into the literature if faced with the prospect of ground zero surveillance commencing today. I have likely turned the corner on the necessity and soft value of routine MRI procedures as nearing age 75, based on the life expectancy aspect. One fly in the ointment is that age longevity way way beyond 77 runs in the family even where the grim reaper’s scroll had prostate cancer listed. Decisions decisions. I think there may be at least one typo in the article but if you notice it simply apply logic by looking at theme and sentence structure to determine author intent. https://www.ncbi.nlm.nih.gov/sites/books/NBK556081/ vinapu and lookin 1 1 Quote
Members unicorn Posted May 19 Members Posted May 19 1 hour ago, Riobard said: I think that some of the confusion and lack of consensus ... Well, there's really no lack of consensus, overall, as the data are very clear. (1) It is well-documented that there is NO overall survival benefit for prostate cancer screening. (2) There is a very small benefit in prostate cancer-specific death mortality for those screened (ages under 70), but this is completely offset by the increased mortality resulting from the screening. There is also significant morbidity associated with screening (not just "anxiety," but real morbidity such as incontinence). The only difference between the guidelines is whether it's EVER appropriate to discuss PSA screening. Some, such as the USPSTF and ACS, say it's OK to offer as long as the person being screened fully understands that the only benefit is prostate cancer-specific mortality, not all mortality, and also understands the serious morbidity risks (for those under 70). Others, such as the AAFP and Canadian Task Force, advise that any screening is inappropriate, since there is no overall mortality benefit, and substantial morbidity risks. This represents a very minor difference in opinion. Following the more permissive USPSTF and ACS guidelines, however, which are to fully inform patients of the risks and benefits, few men actually choose to go ahead, though some do. Not a single person who's actually reviewed the data thinks screening is appropriate for those 70+. Quote
Keithambrose Posted May 19 Posted May 19 8 hours ago, unicorn said: I'm sorry, but I'm not of the RFK, Jr. ilk who feel that any "opinion," regardless of its basis of known scientific facts, is "valid." This is not an issue in which the experts are "guessing." This issue has been studied extensively in almost countless studies around the globe, involving hundreds of thousands of men. Although there are plenty of different recommending bodies which have gone through the scientific studies and their data (unlike yourself), and there is some disagreement as to whether screening in the 50-69 group should be discussed and/or offered, every single organization composed of members who've looked at the data agree on one issue: screening those 70 and over is harmful. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening#fullrecommendationstart Recommendations of Others The American Academy of Family Physicians39 and the Canadian Task Force on Preventive Health Care40 recommend against PSA-based screening for prostate cancer. The American College of Physicians41 recommends that clinicians discuss the benefits and harms of screening with men aged 50 to 69 years and only recommends screening for men who prioritize screening and have a life expectancy of more than 10 to 15 years. The American Urological Association42 recommends that men aged 55 to 69 years with a life expectancy of more than 10 to 15 years be informed of the benefits and harms of screening and engage in shared decision making with their clinicians, taking into account each man’s values and preferences. It notes that to reduce the harms of screening, the screening interval should be 2 or more years. The American Urological Association also notes that decisions about screening, including potentially starting screening before age 55 years, should be individual ones for African American men and men with a family history of prostate cancer. The American Cancer Society43 adopted detailed screening recommendations in 2016 that highlight the importance of shared decision making and the need for informed discussion of the uncertainties, risks, and potential benefits of screening. It recommends conversations about screening beginning at age 50 years and earlier for African American men and men with a father or brother with a history of prostate cancer before age 65 years. To disagree with every recommending organization on the planet only shows both arrogance and ignorance. There are people whose job it is to review the data. They are not "guessing." And, no, the MMR vaccine doesn't cause autism, even though RFK Jr. may have a different opinion. I'm glad to know that a recommendation from a leading cancer hospital in the US is only an opinion. Very reassuring. Quote
Moses Posted May 19 Posted May 19 3 hours ago, unicorn said: (1) It is well-documented that there is NO overall survival benefit for prostate cancer screening. This is just stupid. I started to check PSA since my 40yo - it is free in my country during yearly free check up. At my 55 I got alarming results, got MRI confirming what I have prostate cancer and it was also confirmed by biopsy after MRI. in 3 month after biopsy I got robotic surgery (it is also free here) - robot removes prostate via 4 small holes on the belly, keeps nerves (and erection), I was discharged from hospital in 4 days after surgery and had to visit it again for catheter removal after one more week. I lost natural erection for about 6 months (blue pills was still working), my first orgasm was in 3 days after catheter removal, and after 6 months natural erection come back. So, I can reassure you: if somebody telling you what PSA screening is bad for people below 60 yo - kick him into face: he has maybe political, maybe financial reasons to tell that, but for sure his reasons aren't laying in medical sphere. kokopelli3, PeterRS and vinapu 1 2 Quote
floridarob Posted May 19 Posted May 19 12 minutes ago, Moses said: my first orgasm was in 3 days after catheter removal Where these also robotic? unicorn 1 Quote
vinapu Posted May 19 Posted May 19 24 minutes ago, Moses said: if somebody telling you what PSA screening is bad for people below 60 yo - kick him into face: this is how you guys there sort out your different points of view ? unicorn and floridarob 1 1 Quote
Moses Posted May 19 Posted May 19 Just now, vinapu said: this is how you guys there sort out your different points of view this how we sort scientists from shamans... Quote
Members Riobard Posted May 20 Members Posted May 20 4 hours ago, unicorn said: Well, there's really no lack of consensus, overall, as the data are very clear. (1) It is well-documented that there is NO overall survival benefit for prostate cancer screening. (2) There is a very small benefit in prostate cancer-specific death mortality for those screened (ages under 70), but this is completely offset by the increased mortality resulting from the screening. There is also significant morbidity associated with screening (not just "anxiety," but real morbidity such as incontinence). The only difference between the guidelines is whether it's EVER appropriate to discuss PSA screening. Some, such as the USPSTF and ACS, say it's OK to offer as long as the person being screened fully understands that the only benefit is prostate cancer-specific mortality, not all mortality, and also understands the serious morbidity risks (for those under 70). Others, such as the AAFP and Canadian Task Force, advise that any screening is inappropriate, since there is no overall mortality benefit, and substantial morbidity risks. This represents a very minor difference in opinion. Following the more permissive USPSTF and ACS guidelines, however, which are to fully inform patients of the risks and benefits, few men actually choose to go ahead, though some do. Not a single person who's actually reviewed the data thinks screening is appropriate for those 70+. Right, the arbitrary recommended age cut-off for discretionary PSA screening is 70 (+ / - the relatively small differences of opinion), notwithstanding the parallel guidance for younger age and the less robust evidence for non-screening in the age category leading up to 70. For example, I think Amer Urology Assoc stretches it to 75. This is largely governed in Canada by the average male life expectancy of 79 years. Diagnosis of prostate cancer at age 75 combined with expected post-diagnosis survival of minimally 10 years approaches age 85 or greater, and collective life expectancy currently for age 75 is about 10 years (95% confidence interval bounds round to 10), as standard deviation around the mean of age 79 upticks the likelihood of death delayed to about age 85. This doesn’t mean that absolutely zero PCa cases could be caught upon triggering by PSA values alone at old age with some possibility of mitigating associated disease and extending life that otherwise would have been truncated by PCa prior to when other cause mortality would otherwise kick in, but diminishing returns for widespread screening obviously dictate surveillance legitimacy in spite of outliers essentially not served well by the arbitrary screening guidance cut-off. Quote
Members Riobard Posted May 20 Members Posted May 20 1 hour ago, Moses said: This is just stupid. I started to check PSA since my 40yo - it is free in my country during yearly free check up. At my 55 I got alarming results, got MRI confirming what I have prostate cancer and it was also confirmed by biopsy after MRI. in 3 month after biopsy I got robotic surgery (it is also free here) - robot removes prostate via 4 small holes on the belly, keeps nerves (and erection), I was discharged from hospital in 4 days after surgery and had to visit it again for catheter removal after one more week. I lost natural erection for about 6 months (blue pills was still working), my first orgasm was in 3 days after catheter removal, and after 6 months natural erection come back. So, I can reassure you: if somebody telling you what PSA screening is bad for people below 60 yo - kick him into face: he has maybe political, maybe financial reasons to tell that, but for sure his reasons aren't laying in medical sphere. Well perhaps I can assist in damping down the hyperventilating. @unicornwas making the distinction between all cause mortality (any cause of death) that is not robustly affected by PSA surveillance versus prostate cancer mortality (death attributed to prostate cancer and associated metastasis) that may be more subject to attenuation by screening because some cases present early and are caught by PSA testing that may spur further investigation. That said, it is not definitive that your PSA values age 40-50 were causally predictive of the unfortunate cancer diagnosis that was eventually made by the more reliable diagnostic procedures of MRI and biopsy that (I presume) were instigated by PSA values, perhaps a dual blood draw spread apart by standard time lapse for confirming legitimacy of next level assessment, some years following the age 50 guidance threshold in which PSA screening is considered prognostically superior, more accurately in semantic terms less prognostically inferior. Your specific category and presentation of prostate disease has not been dismissed by academic and clinical bodies that nevertheless do not generally support routine PSA screening below age 50. Your argument related to the liabilities of non-testing before age 50 was not supported by the timelines you provided. Perhaps you weren’t deliberately cherry-picking given that our personal experience naturally lends itself to confirmation bias in opinion. vinapu 1 Quote
t0oL1 Posted May 20 Posted May 20 I am sure he is getting the best care available. I wish this therapy was available to me three years ago. Nerve sparing robotic therapy evidently did not help me, as in the majority of cases here in USA. Another link I read said it had been used successfully on prostrate cancer but I could not find that video. lookin 1 Quote
PeterRS Posted May 20 Author Posted May 20 I have a Swiss friend who was diagnosed with prostate cancer aged 52 about 12 years ago. He elected for surgery and as a result changed his sexual requirements. He maintains he would be dead by now but for that diagnosis. A dear friend of many years in my home town died of prostate cancer aged 54. It is obvious from the above discussion that even the medical profession in different parts of the world may be uncertain of the benefits of screening other than at an older age. I think we should recall, however, that some personalities have died of prostate cancer at what might seem a relatively young age. The actor Gary Cooper aged 60. Guitarist Johnny Ramone aged 56. Writer and activist Eldridge Cleaver aged 52. Serial killer Carl Eugene Watts aged 52. Activist Stokey Carmichael aged 57. English soccer player and announcer Clive Charles aged 51. President of Ghana Kwame Nukruma aged 62. We are all responsible for our own lives. I'll therefore continue to get screened for prostate cancer whatever the benefits or otherwise. Note - that is not a recommendation for others to do so. lookin, Ruthrieston, Moses and 1 other 4 Quote
Members Riobard Posted May 20 Members Posted May 20 15 hours ago, Keithambrose said: An unnecessarily aggressive response. There are different views as to the age at which PSA screening should take place. I note that Johns Hopkins, a leading US cancer centre, recommends screening from 55 onwards. They specifically say that screening between 55 and 69 is the age where most men will benefit from screening, as this is the time when treatment makes the most sense. They suggest further checks every 2 to 3 years. Recently, i had a raised PSA level, checked after an enlarged prostate. I am over 70, and my Consultant arranged an MRI scan, which is non invasive, and which he said would be definitive. It was negative, luckily. Another in 2 years. Also, it's misleading just to refer to prostate cancer. Like all cancers, it comes in lots of different forms. Our situations are similar in terms of bundled sequential testing but actually don’t support the value of screening past age 70. Other posters are suggesting the value of screening is that prostate cancer is ubiquitous; the rates are high and only ambiguous in terms of the grade of risk they pose. A clean bill of prostate health is nevertheless tempered by the increasing probability of prostate cancer with age, notwithstanding that the older one’s age at diagnosis the less likely prostate cancer as future cause of death. What perhaps changes the picture is the advantage of early detection in the context of prostate-sparing and pelvic nerve complex protection intervention developments that I think have not yet been adequately integrated into surveillance guidance. The simple binary of mortality or increased longevity seems to me to be a perspective that lacks attention to progressively emerging early intervention possibilities that preserve life quality and function. At this point, follow up of PSA and MRI in one’s 70s … and I’m in that parade … is often pursued as if diagnosis is an inevitable eventuality in spite of no evidence of risk higher than the next guy without having had any screening or disease. The negative result prompts follow up surveillance but we’d likely never have had an MRI but for the combination of PSA above normal range and BPH, both inadequate prognosticators at which juncture MRI is the next step. Essentially, a negative MRI has triggered the next scan, ie, 2 years on. Blood draws and MRI with/out gadolinium contrast are tolerable, but in the same way a PSA value prompts MR imaging, the latter often prompts the far more invasive procedure of needle core biopsy. Perhaps the relief and gratitude of a clear MRI PI-RADS score promotes willingness to undertake more MRI regularly. But an equivocal score then graduates you to the prospect of a negative initial biopsy result as determinant of repeat routine biopsy procedures because they are also equivocal in accuracy. There has be a point at which further surveillance breaks the imperative of harm avoidance. So much invasiveness to just get to the step of sufficiently differential diagnosis to explore novel intervention such as brachytherapy radiotherapy seeds gland insertion, focused laser ablation, etc. This insidious cascade effect that begins with the no biggie PSA test surely influences guidance according to progressive age category. We are in the same state of health as would occur without screening ever having entered our thoughts. Only a reasonably accurate diagnosis of prostate cancer would have augmented the point of view that screening is salutary. In contrast, repeat and routine STI retesting is not so much a hamster wheel scenario; it’s done based on true behavioural risk accompanying the notion of community prevalence, not merely because the last one was clear. Quote
Moses Posted May 20 Posted May 20 https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1320681/full Quote To summarize, the aforementioned studies indicate that PSA screening is effective in reducing mortality specifically related to PCa. The overdiagnosis and overtreatment of PCa occur because of the low long-term specific mortality of PCa, which is due to the inert nature of PCa and advancements in comprehensive treatment technology. Hence, it is crucial to enhance the suitability of PSA screening for specific age groups, modify the screening frequency, and determine the optimal PSA levels. This will aid in the development of a personalized screening program, thereby enhancing the effectiveness of PSA screening in diagnosing PCa. In my opinion, denying the need for regular PSA screening in men under 60 is a crime. The motives for such denial by state bureaucrats are obvious: reducing costs for social medicine and reducing the burden on health care - it is no coincidence that this point of view was activated precisely during the outbreak of covid - a time when medicine was overloaded. As an individual, any of us should not care whether the system is overloaded or not. "I feel sorry for the state, but I feel even more sorry for myself." Any individual between the ages of 40 and 60, if he wants to live long and happily, should ignore the moans of medical bureaucrats about the unjustified nature of screening - timely screening has reduced the mortality of men in the 40-60 category from prostate cancer by almost 40%. I agree that after 75 years of age, starting PSA screening is quite pointless - if you are diagnosed with cancer, then with a high degree of probability you will die from something other than cancer, because prostate cancer develops very slowly and, as ironic as it may sound, you will not live enough to die from prostate cancer. But if you are impressionable and suspicious - do PSA screening for your own peace of mind, and if the results are alarming, repeat in 3-6 months. You can even do PSA screening yourself by buying a one-time home test at a pharmacy for $2, like those for HIV or Covid. It is important to understand that a positive test is only a reason to repeat it in a few months. Two positive tests are only a reason to talk to a doctor about this topic and undergo (also twice, with a break of 3-6 months) tests for quantitative determination of PSA levels. MRI with contrast makes sense only if the PSA level is high (in my country the threshold is 3). And only if both the blood test and the MRI with contrast show the possible presence of a tumor, only then does it make sense to do a biopsy. This is a truly invasive procedure: from a special "gun" through the rectum, 9 to 16 needles with hooks on the end are simultaneously shot into your prostate and they are pulled out back with samples of your prostate tissue, and then these pieces of your meat are examined under a microscope. And before agreeing to a biopsy, you should weigh what you plan to die from - in 10 years from prostate cancer or in 5 years from anxiety. PeterRS and vinapu 1 1 Quote
Moses Posted May 20 Posted May 20 Long post from above shortly: If you are above 40 yo and below 60-65 yo, and your doctor tells you what you don't need PSA screening - it is right time to change your doctor. PeterRS 1 Quote
