An important article on cancer testing and treatment

[dalan]

I’ve been on TRT 8 yrs. I KNOW what my Dr thinks of it. That’s why I do an annual PSA blood test. I do it to appease him mostly. Mine is well within range.
Just curious of your take since you had an opinion on the subject in general. Not looking for medical advice.

I know this much - for MOST general physicians, if you are on TRT and get a hangnail, the doctor will blame the TRT.

On another note, GP's look at numbers and ranges, that's all they see. Most of them don't even know that hard training itself can impact certain blood work. I wouldn't speak on PSA specifically because mine has never caused any alerts, real or not, just speaking on blood work results in general. To be clear, I'm not suggesting findings way out of whack should be ignored, just that in some cases, some doctors don't understand the context of some of the results.

[FatButWeak]

From Wikipedia:



Do you see anything here that is interesting, that may in fact indicate something other than prostate cancer?

Hmm....are you suggesting doctors wish to scoop up and sterilize otherwise healthy men with vigorously free swimming sperm in their broad net?

Seems to make sense - just about every leftie, establishment program is designed to make us weaker, docile, dumber and less fertile. Easy folks to control, I guess.

But thats not what your after, is it Rip?

[Yngvi]

In regards to prostate cancer, there are several problems with the current medical model:

PSA levels are often a terrible indicator.

Biopsies are often not great either. Biopsies claim an ~ 30% sensitivity and ~90% specificity. Some autopsy data suggest over 50% of men over 60 have prostate cancer. However, the percentage of untreated men who die of prostate cancer is less than ~2.5%. Think about what this means.

A large part of the problem is exactly how they determine what is and what is not cancer. It is currently unclear how good the tests actually are at making this determination.

[Mark Rippetoe]

Biopsies are often not great either. Biopsies claim an ~ 30% sensitivity and ~90% specificity. Some autopsy data suggest over 50% of men over 60 have prostate cancer. However, the percentage of untreated men who die of prostate cancer is less than ~2.5%. Think about what this means.

Very important, gentlemen.

[Gbraddock]

I’ve always heard the saying that most men die WITH prostate cancer versus FROM prostate cancer.

[jfsully]

In regards to prostate cancer, there are several problems with the current medical model:

PSA levels are often a terrible indicator.

Biopsies are often not great either. Biopsies claim an ~ 30% sensitivity and ~90% specificity. Some autopsy data suggest over 50% of men over 60 have prostate cancer. However, the percentage of untreated men who die of prostate cancer is less than ~2.5%. Think about what this means.

A large part of the problem is exactly how they determine what is and what is not cancer. It is currently unclear how good the tests actually are at making this determination.

90% specificity is pretty good for a diagnostic test, meaning few false positives. To complement that, you need a good screening test, with few false negatives. Unfortunately, we don't have that.

I think that saying 2.5% of men with untreated prostate cancer will die from it is misleading. There may be other sources for this info, but what I have seen suggests that the 2.5% is the case for 10-year survival with a low-grade (low Gleason score determined on biopsy) prostate cancer. If you plan to live 20 years from diagnosis, your odds of dying from prostate cancer go up. If you have a more aggressive tumor (high Gleason score), your chances of dying from it go up. Decent article with some fancy math here: What if I don’t treat my PSA-detected prostate cancer? Answers from three natural history models. (preview quote: "The risk that an untreated PSA-detected tumor would lead to death in the absence of any primary treatment is 23–34% for men under 60 with Gleason score 2–7 and 63–83% for counterparts with Gleason score 8–10." The key here is "men under 60." This is younger than the average age at diagnosis, and you therefore have more years for the cancer to develop. The odds are better the older you are diagnosed.

If you're old and have other things likely to kill you: ignore the prostate cancer and don't bother with PSA. If you're young and plan to live several more decades, you should educate yourself and decide whether to screen, but if diagnosed with cancer you should probably treat it. You can define for yourself what "young" and "old" mean.

There's no one-size fits all answer here.

[Soule]

Sorry to derail gentlemen, but I was curious if the boards think there is a healthy demand for a do-it-yourself prostate exam kit? Billion dollar idea. Will need good lawyers.

[Mark Rippetoe]

Soule, why would it be better idea to overdiagnose/misdiagnose/worry to death at home than at the doctor's office?

[Soule]

Soule, why would it be better idea to overdiagnose/misdiagnose/worry to death at home than at the doctor's office?

True — this is why i come here, coach!

[Yngvi]

90% specificity is pretty good for a diagnostic test, meaning few false positives. To complement that, you need a good screening test, with few false negatives. Unfortunately, we don't have that....

You are missing the point. What does it mean when a test claims 30% sensitivity, 90% specificity and diagnoses half of the male population with cancer, but relatively few die from the cancer?