Indeed, it implies ‘special’ care that’s better than what we’re offering for ‘ordinary’ patients. But in reality PSA studies are not recommended for screening for prostate cancer for those 70 and older because there’s no good evidence that such testing benefits that group of patients. As noted in previous posts and links.
I suppose now they will now. Wouldn’t the POTUS or VP or Senator get top tier care and screening to avoid this exact surprise? I’m both shocked and surprised that he had to experience symptoms before this was found.
I’m surprised as well that they weren’t screening for it. If the President is going to be incapacitated because of a health issue, it’s good to know about that. Even if there’s no treatment option, knowing about the issue as soon as possible means there can be more planning and a smoother transition. This isn’t just a random person working a typical office job. This is a person in the most important job in the world. There are global implications between announcing “The PotUS has cancer, we caught it early, and the next year will be spent having the VP take over” versus “The PotUS has an aggressive form of cancer and has months to live”.
Is it really “top tier” to perform tests that are not recommended?
I don’t generally approve of backseat driving the experts unless I have the numbers and evidence to back that up.
And in this case, it seems a huge case of “well, it could help” rather than anything backed by anything more than gut instinct.
Second guessing or outright contradicting the trained experts is not a great habit, even if done with the best of intentions. They’re not always right but that doesn’t mean we start substituting our suggestions for their medical degrees.
I think you’re making the implicit assumption that more tests and more screening equals top tier care, whereas the medical experts seem to generally take the approach that no, more screening does NOT automatically equate to better care.
If this is really an aggressive cancer, e.g., would a PSA test last year or the year before have found it in the first place? Lacking a prostate, I’m not especially knowledgeable about this particular subject, but I do know for example that so-called “interval” breast cancers (those diagnosed within a year of a negative screening mammogram) are more lethal than those found by screening (cite).
How about “we performed an unnecessary test that returned a false positive, biopsied based on the false positive, and now the president is incapacitated due to infection”? That’s why over testing is not top tier care; most interventions have a real risk, and there’s some very complicated statistics that can go into deciding whether testing is appropriate.
Yeah, it occurred to me that the very fact that it is so aggressive means it would have been less likely to be picked up with routine screening.
I’m not seeing monthly MRIs popping up on the POTUS/VPOTUS calendar.
I don’t even have a prostate, and my perineum clenched up just thinking about that! Maybe it’s the male equivalent of having an IUD inserted, something about which I’ve also heard plenty of horror stories.
I also hope the damage to your sex life was temporary.
I would expect that the President would get some of the best care possible and the risk of infection would be very low. Plus, he would have access to some of the more costly diagnostic methods, such as an MRI, that are non-invasive. They could do a PSA test to check levels and then do a MRI to see if there is anything in the prostate which is cause for concern. That kind of care is often beyond the reach of normal people, but should be easily done for the President. CEO’s have full-body MRI’s to look for any anomalies. It’s surprising and eye opening that the President’s health screenings aren’t at the level I would expect for someone in his position.
As above, “best care possible” does not necessarily mean “run every test possible as frequently as possible”.
That can be counter-productive. Or at least the experts in the thread have stated so, and I don’t have any solid reason to contradict that.
Thank you for the sympathetic clenching. As it happens, it’s not done from the outside (so the perineum is not directly involved), they insert a smart gadget with a camera up one’s rectum and do all the work from there, including the local anesthetic and the sample taking. At least that’s the way it was 13 or so years ago.
Sadly, not, but as time has gone on it has become somewhat less important.
eta: I hope that wasn’t too much information. It’s nice to have strangers on the internet to whom I can complain about such personal things.
Ugh. You have my sympathy for that.
Yes, this exactly. To go above and beyond what we currently consider appropriate as a screening test is to risk more patient harm than patient benefit.
CEOs have full-body MRIs because that’s a fad among people with lots of money. There is zero evidence that such scans actually improve outcomes, because the risks of overtreatment can negate the benefits of earlier detection. Risks of infection, etc., can be minimized, but they are not zero even when everybody does everything right, and the more times you do something, the more likely that somebody will make a mistake. If you have lots of MRIs or CTs, you can develop sensitivity to the contrast or allergies; having the president go into anaphylactic shock would be considered a bad thing, and his having asthma can be a risk factor for that.
That borders on a non-statement. How do you treat a non-diagnosis?
I’ve heard of it being done rectally, or in the perineum, depending on where they want to do the biopsy.
How so? There are never false positives? And never false positives that lead to a misdiagnosis and treatment of a condition that does not exist?
Extra scans tend to reveal “anomalies” that lead to biopsies, surgeries, etc., but are not necessarily clinically relevant. Look at the incidence of men who die “with” prostate cancer but not “of” prostate cancer. Something on the order of half of men over the age of 50, and 75% to 80% of men over the age of 80, have cancer cells in their prostate, e.g., but the vast majority of those cases are slow-growing and will never cause symptoms or affect life expectancy. However, if you treat all of those cases as if they are all life-threatening, then a lot of men will be exposed to the risks of treatment (including urinary and sexual dysfunction, “chemo brain,” infection, etc.). You cause real measurable harm to people who would not have been harmed by the cancer.
Overdiagnosis and overtreatment are issues in mammogram screenings, too; the kinds of breast cancers most commonly found in older women by mammogram are also the kinds that are unlikely to cause problems for 20 or 30 years, so the treatment can harm quality of life more than the disease.
That’s a matter of acting on the results, though, not performing the test in the first place. Biopsies, full-strength CT scans and the like carry risks, but blood tests don’t.
IMO, we’d be a lot better off if everyone got tested for things much more often, specifically so we’d have a better idea of which markers are worth pursuing and which aren’t.
There is the problem that patients tend to demand treatment when they learn of a potential problem, and that the legal system incentivizes over-treatment. But that’s still not a problem with testing specifically.