An important article on cancer testing and treatment

[johnst_nhb]

Getting diagnosed with cancer and dying of cancer are 2 different things.

If you live long enough you’ll have “cancer” and in fact you’ve probably had it numerous times in your life already.

I’m not saying this is you, but most folks really don’t know what “cancer” actually is. They just see the etiology of those who are unfortunate enough to have it detected and/or in a terminal spiral.

[jfsully]

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?

It means you get to stage your cancer and then decide if it is worth treating or not. Your chances of dying from prostate cancer, once diagnosed, are not random. Staging it can tell you the urgency of treating, as prostate cancers are not all the same. Many men are diagnosed and then told to do active surveillance or to totally forget about it. Others are told to treat it if they plan to live more than 10 more years. But you can't know what category you fall into without the biopsy. So if you are old enough that 10 years is long enough, don't bother with testing at all. But maybe you are 50 and would like to hang around to try and meet your grandchildren. If you have aggressive prostate cancer, you might want to treat it.

Nobody should be recommending that every guy get screened. The USPSTF recommends that men 55-69 discuss screening with their doctor. They do not recommend screening men 70 or older, for all the reasons discussed in this thread.

[gallon_of_cheese_a_day]

Congrats on the pull, Browndog. Excellent post.

[johnnys]

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.

For what it's worth, the big city academic hospital endocrinology department head who I saw to start TRT lost interest in checking PSA after 18 months or so when nothing changed. He's also the first doc who cared about A1C over time rather than the current "borderline" value I've had for 15+ years. I think he's a keeper.

[Mark Rippetoe]

This today from the New York Times": Debating the Value of PSA Prostate Screening - The New York Times

I interviewed John Horgan, author of the pice in the OP, yesterday for an upcoming SS Radio. It was a good conversation.

[jfsully]

Is anyone actually out there recommending universal PSA testing? Aside from maybe the manufacturer of the test?

[Mark Rippetoe]

It's not being recommended for women, if that's what you mean. As far as I know, all men over the age of 35 are recommended to get the test.

[Richard Seaman]

As far as I know, all men over the age of 35 are recommended to get the test.

That is not my understanding. However the recommendations vary somewhat among organizations. But, I'm not a medical professional. This is just what I read and have been told.

Final Recommendation Statement: Prostate Cancer: Screening - US Preventive Services Task Force

Final Recommendation Statement: Prostate Cancer: Screening - US Preventive Services Task Force

However, for men doing TRT annual screening is recommended AFAIK. My impression is that the idea TRT causes prostate cancer is pretty much debunked, but the idea that TRT could make an existing cancer grow faster is a common belief.

[Mark Rippetoe]

I'm talking about what the doctors in the office tell their patients.

[Richard Seaman]

I'm talking about what the doctors in the office tell their patients.

I'm sure you know more about that than I do. Quite a few years ago my then PCP stopped doing PSA and DRE. At first I didn't notice, but after a couple years I asked why. He stated the then task force recommendation was the reason. At the time they recommended against. I was slightly annoyed he didn't discuss it with me before making the decision, especially since he told me he still got a PSA for himself. But I was comfortable with the decision, just wished he'd discussed it. They've since amended to "discuss with patient", for those in the 55-69 group. I'll be 70 shortly and my current PCP doesn't recommend it, but the urologist who prescribes my TRT does.