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Subscribe to RSSThe recommendation Monday by the prestigious United States Preventive Services Task Force (USPSTF) that the widely used PSA test for prostate cancer no longer be used routinely for men of any age is likely to be met with howling.
There are plenty of doctors who offer PSA testing. Not a few celebrities, such as former New York Mayor Rudy Giuliani, have made public service announcements urging men to get tested based on their own experience with prostate cancer.
The true believers are not going to be swayed by this recommendation not to test, despite the fact that the task force carefully reviewed all the evidence on PSA testing. The recommendation against PSA testing is likely to meet the same fate as the earlier task force recommendation against annual mammograms for women in their 40s — disbelief, followed by testing as usual. That is unfortunate.
We all want to believe that early detection of cancer is a good thing. A large number of doctors are committed to early detection too. But, using a bad test is actually worse than not testing at all.
The wish for a good test is understandable. Prostate cancer is the second leading cause of death from cancer in men. If there is a test that can help detect it early then how can that possibly be bad? And if so many men swear by the test, saying it saved their lives, then what can the USPSTF possibly be thinking in saying men should not bother with PSA testing?
The answer is that bad tests are bad when they are hugely inaccurate. The PSA test is an outstanding illustration of this.
PSA testing produces far more misery than good. Positive PSA tests often are inaccurate, detecting only an infection not cancer. As many as 70 percent of men with poor test scores do not have cancer. This leads to lots of worry and unnecessary procedures for the majority of men who will get a false result. Frequently, unnecessary surgery leads to incontinence, impotence or other nasty complications.
Even when cancer really is present in older men the tumor is usually growing so slowly that leaving it alone makes more sense then undergoing surgery to have it removed.
No man should trust his life to a test that is wrong more often than it is right. Nor should payers keep paying for a test that does far more harm than good. It is time to admit that the PSA has flunked and to renew research to find a better test.
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I have one brother who died because he was not tested and one brother who is doing good because he was tested and treated. I also have a husband who is going in for treatmentin about 10 days so I don't believe they know what they are talking about!!!
Rationed Obamacare, one denied test after another.....first they went after Mamograms....This is just the beginning, if Obamacare isn't ruled Unconstitutional or otherwise repealed....
Hmmm... I don't think that you can necessarily blame this all on Obama (take a look at Romneycare in MA)... Health insurance companies have been rationing care (by denying claims and having high premiums) forever... I wouldn't be surprised if this was influenced by the insurance companies and their lobbyists. That said, we need a single payer system rather than forcing every American to pay an insurance company for medical care...
Krytanjo is right. You can lay the blame on a number of different entities, but most likely the one that is the root cause is the insurance companies. I can say with 100% certainty that I would not have had early detection if it had not been for a PSA test my doctor wisely ordered in my early forties due to a high incidence of cancer (including prostate cancer) occurring in my family. It led to the biopsy which led to extremely early detection, which kept the severity of my side effects from surgery much lower, with a better cure outlook, than if I had not had the test. I did not have any symptoms, it was the PSA that clued my doctor and I into the problem. Until they find something better, I highly recommend getting the PSA if your risks are high due to family incidence or if over fifty. 4 years later I am 47 and a cancer survivor.
Mike, you did see that the article said the ruling was a recommendation which would likely result in "testing as usual" due to disbelief. I know you're one of the many looking to blame anything on Obama, but there is no action for which to blame him. It was a suggestion that will and can be ignored. No "rationing."
As far as the evil rationing thing goes. We do it now, it's based on income.
If there is any malice in the new SUGGESTION, the insurance companies are far more likely a culprit. They'll do anything to get out of paying. A few years ago when I started a new job my insurance kicked in right way. Great! But a month later my then 6 year old son broke his arm (both bones snapped, not a hairline fracture). I had to fight with the insurance company for more than a month to get it covered because they did not believe that it wasn't a "pre-existing condition." It was a broken arm!!
I have one brother who was not tested in time and died and another brother who was tested and treated and is doing fine. I also have a husband who is going to be treated soon so I don't belive they know what they are talking about!!!
Dr. Caplan, I have several points. First, you say that the test is "wrong more often than it is right". There is no evidence that it's "wrong"; perhaps the conclusions one draws from it are wrong, but the test itself has been shown repeatedly to be sensitive (about 90%) but not specific (about 33%), with sensitivity increasing with age and specificity decreasing with with age. This is why the test must be interpreted in the particular clinical scenario. Certainly a very high PSA in a relatively young man (<50 years old) must be looked at as a false positive before biopsies are performed; urinary tract infection and prostatitis must be ruled out as these would be more likely causes. In men who have had even mild perineal trauma (long distance cyclists, etc), the elevated PSA may also not be indicative of cancer or even hypertrophy. However, in an appropriately aged male (>50 in Caucasians, younger in African Americans) who has symptoms of prostate enlargement, the PSA is an invaluable indicator that there may be a problem. Second, you agree that prostate cancer is a leading cause of death in the US. The PSA is far less than perfect but we have no other easy, quick indicator to replace it. By the time a DRE (a relatively late indicator of disease) is positive, cancer may already be present. Although, as you say, prostate cancer is extremely slow growing, I have personally lost several patients to prostate cancer that could have been detected a decade before it was fatal if the levels of PSA had been followed. Third, I would agree that the patient who receives aggressive treatment must be chosen carefully and in light of comorbidities; an 85 year old whose life expectancy is limited by other conditions is not a candidate. PSA isn't a perfect test (there is no perfect test for anything) but it's better than nothing; sound clinical judgement is essential. I am disappointed that USPSTF chose this position; I, for one, intend to ignore it.
Just following the example set by NHS in England , the system embraced by Donald Berwick , the ex czar appointed by Obama !
Death by prostate cancer in England is much , much higher than the US !
And the sheep will be led to slaughter !!
Dr. Bob, what do you think the reason is for this panel's decision? Is it simply that they are more concerned about the dangers of unnecessary surgery rather than the 1/1000 lives saved? For me, saving even one life, one father, husband or brother is worth a biopsy done on someone without cancer.
If the results are interpreted correctly as you mentioned above, there are even less issues. Thanks for your post.
I'm not a doctor (I just act as one on the vine LOL) however I think this is just like any other test a physician does. If the PSA test had many cases of false negatives, it would be thrown out. It doesn't, it provides positive results which must be investigated further. As a result of the test, some people do have surgery, others do not. To decide that a test should not be used is wrong.
Using a sledge hammer to hang a picture nail is not the correct use of the tool. However, for as many holes as are put in the wall, many pictures are adorning the wall. The test is a tool. It may not be the most elegant tool and it may be that other tests will be more effective. Until those test are found, if all you have to hang pictures is a sledge hammer, swing away, just try not to hit the dog on your back swing.
From what I have read, eventhough men under fifty might have false positives more frequently, from what I understand, if you are young (under fifty) and have a high PSA, it is a better indicator that you may have cancer than someone that has a high PSA result who is older. Without a PSA, or visual (an MRI) or digital detection of a possible tumor, there wouldn't be a means to consider who should get a biopsy, other than based on symptoms, which could be very misleading.
Clearly orchestrated by the insurance companies. PSA test saves lives but it costs money. It is amazing to me that some loser decides to go against your doctor's recommendations. DENIED is the favorite word of the insurance companies and their lackeys.
Fewer breast exams and now no PSA test !
Quite a coincidence these reports are coming out AFTER the passage of Obama Care .
I am 73 and was told at my yearly physical in Feb no more PSA ! I am in extremely good health and my family lives to very old ages , so what does this mean for me ?
Direct your anger at Obama Care , not the insurance companies as this is a result of government meddling !
Tallman... I doubt this is due to Obamacare (more likely lobbying by the insurance companies)... plus if you're so against Obamacare, then you really won't like Romney. Take a look at Romneycare in Mass... it's very similar. Basically 6 of one and a half-dozen of the other...
If you have a relatively young male (early 50's) who has a family history of PC you're negligent as a doc if you're not requesting a psa test. Doing so probably saved my life. Stage 1 gleason 7. Get smart guys!
I really do not understand this decision. Men should get tested so that they can make the decision that may help them live a longer life. At age 45 I had a UTI and my primary decided to do a test as a baseline. The reading was only 1.7, but each of the next two years the number jumped, 2.2 and then 2.9. A biopsy was done and the cancer was found. At the recommendation of my urologist I went for a second opinion, weighed all my treatment options and ultimately decided on surgery. When the full biopsy was done over 35% of the gland was cancerous. What if I waited till I was 50, what if as the USPSTF recommends, I did not get tested. I guess I just would have waited until symptoms presented themselves at which point it may have been too late. Obviously a decision made not with the interest men, but in the interest of keeping health care costs down.
puzzled-
That's not actually using the PSA test guidelines...which is part of the problem. The fact is, The PSA test has ranges of normal and not and all of your tests were within normal.
This is what was published in Dr William Catalona's Winter edition of Quest that I had posted on the site..."My Gleason before surgery was
3+3=6 but 3+4=7 after. Dr Catalona got it
out just in time as it was encroaching on
the prostate’s membrane.
Would this task force have been willing
to be the ones that would have had
to tell my two teenage daughters and
wife: ‘We are sorry but we were wrong. It
should have been caught earlier.’
I think not.”
William M. Moore, Patient"
This panel is messing with not only the patient's life but also the others that are in their lives...significant others, kids, parents, extended family members, friends. Who in the hell do they think they are making this determination? I bet that they would be thinking different if it was their arse in our shoes!!!!!!! I have a support group here on Facebook that is just for men. PM me if you are a male and in need of support or not needing the support and just want to see the outcome of this terrible disease or search us at "Prostate Cancer Men's Support". we are just trying to get thru this and do not feel that we should have to have the wait and see comments. Look at all the other cancer screenings and treatments and we are stuck with the most barbaric treatments available. Instead of telling us how to live our damn life...Get better damn treatments!!!!!
Yeah, I wonder what they recommend to their own families?
Ask Dr Kaplan and others supporting this study if they will fore go a PSA test ?
Wanna bet what the answer will be ?
Had routine PSA test at 50 with no other problems. Wish I had test earlier. PSA was in the 60's. Had biobsy which found prostate cancer. Had prostate removed and radiation. Cancer return 10 years later. Have been very blessed. 20 years later from intial PSA still fighting prostate cancer. 20 Years ago cancer had not spread to lymph nodes yet. This is pure Obamacare.
There is something very important that has been left out of this discussion.
A total PSA test alone does not give the clinician the best answer. A free PSA test should also be ordered together with the total PSA (of course, both should be drawn before a DRE or digital rectal exam is performed). Inflammation (prostatitis) and glandular atrophy will raise the Total PSA score, but should not affect the free PSA (which shows how much circulating, unbound-by-tumor PSA there is). A high total PSA and a low free PSA is suspicious for cancer.
Not too long ago, the Danish goverment did this experiment of not paying for PSA screening, until enough men died of prostate CA to justify paying for it again. Socialism at work.
Are y'all ready for Obamacare? This is just a small taste of what's to come- when the government instead of your doctor decided what tests you should have done.
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The mortality rate is too low. Too many old people are still alive. Stop mammograms and PSA screening, that ought to help the statistics! Until the mortality rate rises and we get these damn old people off the medical care, Obama care just cannot be practical.
Sounds too stupid to be true, doesn't it? Or does it?
Two tests that keep people alive by finding cancer early...
The insurance companies don't want to pay, so they rewrite the policy to rid themselves of liability.
And if men start dropping like flies with prostrate cancer, then they can conduct a new study to find out why, which will be NEW news to the next generation.
Like the radiation levels in Japan, washing up on our pacific coast at levels higher then Chernobyl, so instead of causing panic, they just upped the amount of radiation on the books and said it was acceptable?
my psa was 0.97 when i was 52 yrs old. had my yearly physical and my family doctor did a rectal exam.
he found something he did not like, so sent me to a urologist and he checked me with rectal exam and also felt something. so did a biopsy and found cancer. 3 + 4 = 7. had my prostate removed in 2009.so i had my psa done again 2 months later , it was 0.39. in about 3 months it it started to rise 0.45.. he sent me over to have radiation for 5 days a week for 37 days. with hormone treatments , once a month for 1 year. so after 3 months or so checked it again, it was undectectable. so had it checked every 6 months. now it is 0.09. the cancer doctor said, it will always have a reading after prostate surgery. so i guess i was lucky when i had my yearly physical and my doctor found something he didn't like.so i wonder if the psa testing is accurate, since my psa was 0.97 and still had cancer. if it wasn't for my yearly physical exam, who knows how long when they discovered the cancer.
My Dad is alive today because of PSA. Obama will see to it that men everywhere will die unnecessarily.
guess what? no one gets out of here alive
True, but they should not die prematurely from easily preventable causes.
I love how all the nut jobs are blaming "Obamacare" when the law isn't even in effect yet and the person who wrote the article has nothing to do with the government..... Absolutely amazing the degree to which the reich wing nut jobs will go to attack something they know nothing about.
Health and Life insurance companies use PSA results to decline people; that's not good. A better test will be found and in the meantime we should stop using a bad test. My dad had treatment for prostate cancer that he never should have had. It made the end of his life miserable.
I guess that I would be one of the "acceptable" statistics that the committee is willing to lose so some other guys might not get Ed or wet thier shorts for a while after surgery.........If I had kept up on PSA tests over the last 5 years like I had for the previous 5 years, I would not be dying now from metastatic cancer that started in the prostate and now is in my bones and lymph system......do listen to the "experts", listen your own urologist and discuss the outcome of your PSA test with him, make a decision based on an array of info he has about you and your medical history, and then do what you both think is best....the test is just a blood test that is totally harmless and would have saved my life if I had taken the time to get it in the last 5 years........hoping for a great finish and shouting to the world - GET A PSA TEST EVERY YEAR AFTER 50, AND SCREW THE EXPERTS!.