PSA test knot required, traditional weekly prostate exam still optional ...

[PICK3]

right


No routine PSA tests for men, panel rules - Health - Men's health - msnbc.com


A top panel of U.S. medical experts has issued a final decision on a long-debated men’s health controversy, concluding that no man of any age should routinely be screened for prostate cancer using the popular PSA test.

 

[mistaballoonhands]

It's a shitty test. People will say stupid things like, "How could a blood test hurt anyone?" and think that the government is trying to ration healthcare. I look forward to reading the comments here.

 

[PICK3]

It's a shitty test. People will say stupid things like, "How could a blood test hurt anyone?" and think that the government is trying to ration healthcare. I look forward to reading the comments here.

How could a blood test hurt anyone?

 

[mrplunkey]

It's a shitty test. People will say stupid things like, "How could a blood test hurt anyone?" and think that the government is trying to ration healthcare. I look forward to reading the comments here.

As a one-time population screening tool, it's definitely a shitty test. Your value of 0.8 may be low for you whereas a value of 0.3 may be high for me.

But the panel carefully tip-toed around the issue of one person having years worth of accumulated values and using trend data. I personally believe PSA trend information is very clinically useful.

To me it's similar to an ECG. A one-shot ECG will tell if you've had a major myocardial event, but if you have a mild or subtle problem, you need multiple years of recording.

 

[mistaballoonhands]

Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: A review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2011;155(11):762-771.

Synopsis
This review of the evidence, which was completed some months ago, was slow to come to print given the firestorm that erupted following the recent less-than-enthusiastic assessment of screening for breast cancer. Ah, politics. To develop this evidence review, the Task Force searched MEDLINE and the Cochrane Library, along with a review of reference lists of identified articles, to identify the 5 studies that evaluated the effectiveness of PSA screening. Two reviewers independently evaluated each study for inclusion and one investigator abstracted the data with a second investigator reviewing the data for accuracy. Unfortunately, the 2 largest studies were rated as only "fair" quality and 3 other studies were rated as "poor." Neither of the fair studies found a benefit to prostate cancer screening with regard to mortality, though one (the European study) found a sm all benefit (0.07 percentage point) in men between the ages of 55 years and 69 years.

Harm is common with screening: 12% to 13% of men will have at least one false positive PSA screening result after 3 to 4 rounds of testing and approximately half these patients will have a resulting biopsy. Urinary retention or serious infections occur in approximately 1% of biopsies. Psychological harms from false positive results or overdiagnosis are also reported but difficult to quantify.

Regarding the benefits and harms of treatment for early-stage or screening-detected cancer, one good-quality trial found that prostatectomy for localized prostate cancer results in a 6.1% absolute risk reduction in prostate cancer-specific mortality.

However, the numbers needed to treat to harm are on the order of 200 for perioperative death, 50 for cardiovascular events, 5 for urinary incontinence, and 3 for erectile dysfunction. There have been no randomized trials of radiation therapy versus watchful waiting, so the evidence for mortality benefit (although shown in multiple studies) comes from cohort research. Adverse effects associated with radiation therapy include erectile and bowel dysfunction.


LOE = 1a

 

[mrplunkey]

Did any of the studies look at PSA score trending instead of absolute values?

It's like a stock price. The value of the stock doesn't tell you much. But if you look at the 10-year history of the stock price, it may mean something.

 

[redsamurai]

Did any of the studies look at PSA score trending instead of absolute values?

It's like a stock price. The value of the stock doesn't tell you much. But if you look at the 10-year history of the stock price, it may mean something.

Blah blah blah you know just opt for the weekly D.R.E....tell us about that. Has your doc figured it out and just rolls his eyes when he sees u every week now? Does he discreetly start talking about the local "techno" clubs? That's a hint you know.

 

[mrplunkey]

Blah blah blah you know just opt for the weekly D.R.E....tell us about that. Has your doc figured it out and just rolls his eyes when he sees u every week now? Does he discreetly start talking about the local "techno" clubs? That's a hint you know.

You should stick to racist rants about Jews. Your other stuff just isn't very entertaining.

 

[Headholio]

Did any of the studies look at PSA score trending instead of absolute values?

It's like a stock price. The value of the stock doesn't tell you much. But if you look at the 10-year history of the stock price, it may mean something.

That's a good point, and why I would rather know my PSA score than just skip it. But I think the overall benefit is not realized because of the false positives.

If you have 10 years of data that's great, but then you get a high value. So you do a biopsy to see what's going on, only to find out your prostate was fine, and now you have complications from the biopsy.

The other problem is overtreatment of slow growing cancers. People get all sorts of nasty problems from surgery or radiation therapy, when they would have been better off not knowing they had cancer.

 

[PICK3]

It's a shitty test.

i thought the D.R.E. was a shitty test

 

[redsamurai]

i thought the D.R.E. was a shitty test

Pssst it's the highlight of his week don't ruin it for him.