Not anymore. He was 45 ~4 years ago when he started this thread.
How does this factor in, given the statement that a PSA screen is of use primarily/only for “older men”?
How many consider 45 yr olds to be “older men”?
Yup. I’m looking forward to getting my invite for an exam at the end of this year.
I heard someone on the radio who was part of a big project to get men to go for prostate screenings. The host asked why they say it is for men over 50 and not just something all men should do, and the spokesman said that their are possible complications, including death, from the exam itself. That it is a very small risk, but it exists. And so they chose 50 as a point where your chance of dying from prostate cancer that you could have found with an exam exceeds the risk of dying from the exam.
It seems like a pretty good benchmark to me: if I am more likely to die from the test than from not having the test, I should not have the test. Sort of like my appendix: if I ever get to the point where it is more likely to be the cause of my death than the surgery to remove it, it should come out. But until that time, it stays in.
So find out the risks and decide for yourself which seems riskier: having the test or not.
[quote=“SpyOne, post:45, topic:629656”]
I heard someone on the radio who was part of a big project to get men to go for prostate screenings. The host asked why they say it is for men over 50 and not just something all men should do, and the spokesman said that their are possible complications, including death, from the exam itself. That it is a very small risk, but it exists. And so they chose 50 as a point where your chance of dying from prostate cancer that you could have found with an exam exceeds the risk of dying from the exam.
I fail to see how a screening test could be life-threatening? A PSA is merely a blood test, and a digital exam is barely invasive. Perhaps they were referring to an actual tissue biopsy? Still and all, it seems over the top to say that death might be a complication for a prostate test.
The issue isn’t the PSA or DRE itself. But rather that if they’re suspicious, that triggers a cascade of more and more intrusive tests. Some of which do have non-zero albeit very small fatality rates.
When damn near zero 45 year olds have actual prostate cancer and of those very few who do, there’s no improvement in their long term survival stats by finding it at 45 versus at 50 or 55, there’s no upside to the earlier detection.
So if one patient nationwide dies during a prostate biopsy from a tornado hitting the clinic, the stats favor not screening by a score of 0 saves to 1 loss.
Why do we teach math above arithmetic? Nobody ever uses it?
This discussion is why we teach math - so people can grasp concepts of scale and probability.
And maybe, just maybe, understand/evaluate the significance of: a test designed to track fluctuations of PSA in one class of patients (those with disease) being used as a detection mechanism in all patients.
Did you read the opinion of the actual doctors in the thread, who provided actual facts?
None of the doctors I work with bother with a screening prostate exam (the 65 y/o CMO says that even if he had it, he’s way more likely to die of something totally unrelated), so that’s the opinion of five more docs.
Frank Zappa died of prostate cancer at the age of 52.
https://en.wikipedia.org/wiki/Frank_Zappa
Doctor’s do a PSA along with blood tests anyway. Makes no sense not to have the test done and the DRE. People are going to argue that it is a waste of time and money, well, so is watching football and I don’t see a movement to stop that activity.
As for having a concern that you are wasting a doctor’s time. This is their job. Prevention is very important. Someone could be pre-diabetes and not know it without a test. People take better care of their cars than their own health.
No I don’t. Nor do most other primary care physicians I know and work with and supervise.
Not for average risk folks who don’t have any symptoms anyway.
Nor is it recommended that we do so. In fact, it is recommended that we do not. Here’s a link to a lovely document for health consumers as to why: [Screening for Prostate Cancer](file:///C:/Users/Owner/Downloads/prostatecancerfact.pdf).
It’s from the US Preventive services Task Force. It concludes (as do most medical experts) that the expected harms of PSA screening are greater than the potentialbenefit. And it explains in layman’s language why that is.
And I agree with their conclusions based on the data we currently have. ** More low-risk symptom-free men are likely to be harmed by prostate cancer screening than will be helped by it.** At least that’s what the best information we have now indicates.
Yes, some men will die because they did not get screened. But evidence shows that it’s more likely will live because they didn’t.
That’s why we should not screen for prostate cancer with PSA and digital rectal exam. And continue the search for better screening tests and procedures.
What do I do if I have a patient who still really wants to be screened, after having the above discussion with him? I’ll generally offer a digital rectal exam only. And if that’s abnormal I will check PSA and refer him on to urology. Because an abnormal rectal exam is a good reason to get a PSA checked.
Now I’ve done it again, I’ve gotten sucked back into arguing this point yet one more time, in the name of fighting ignorance. Each time I swear it’ll be my last, because it’s frustrating to see people at the SDMB continue to ignore the science and push the opposite view while citing anecdote and personal belief over evidence-based medicine. I truly am a sucker for punishment. :smack:
And bozos who refuse to wear seat belts have a favorite case of some freak accident wherein the driver was ejected just before the wreckage went over a cliff and exploded in a fireball.
The best bet is still to wear a seat belt.
I have never had a PSA. I do have blood drawn3-4 times a year.
Your score: Wrong again - it is NOT routine.
There have been 3-5 real MD’s in this thread all saying: “More likely to harm than benefit”.
But don’t let educated and informed people change your mind.
American anti-intellectualism. Truly a sight to behold. :rolleyes:
Fighting the good fight is what we do. As Cecil said, it’s taking longer than we thought.
Each of us chooses our Sisyphean task. You’ve chosen a very worthy one. Buck up me hearty; once more into the breach!
It’s the idea that so many posters are really a 5th column within our own ranks, though!
It wears me down too; 5th columnists indeed!
Maybe you can write this off as “Charitable Activity” on your tax returns?
You are donating your time as a physician to benefit the ignorant*.
-
- the fact that they are ignorant by choice is an entirely separate issue,