PSA isn’t like blood glucose, there is no absolute “that’s too high” number. It’s more about the trend and we know that PSA increases as men get older.
Doesn’t change what I said. It’s a cheap/non invasive diagnostic tool that can be repeated.
Your utterly missing the point there @Magiver.
Yes, the PSA test is cheap and easy. But if it’s high and /or trending higher, then everything else you do subsequently in response to that is expensive, invasive, and scary.
Even though for most of the older men you do that subsequent stuff to, it’s 100% a false alarm, wasted money, wasted disability, and wasted cancer scare.
Because the test gives lots and lots of false alarms.
Thats why it’s not recommended for younger or older men, and needs to be very judiciously interpreted for the folks in the key age 50-70 bracket. Because it’s a crappy test that only loosely correlates with actual disease. But it’s the least crappy cheap test we’ve yet been able to devise.
And it’s not a crappy test because it measures PSA wrong, it’s a crappy test because PSA is only loosely correlated with health. Repeating the rest is unlikely to do anything.
Unless I’ve misread the news reports it was the beginning of the discovery of aggressive cancer in Biden. Which is the same for every other man who has prostate cancer and needs to work through the process. That process starts with a PSA test. Otherwise it’s straight to an expensive scan or surgery with the first complaint of symptoms.
I don’t think anyone is saying that the test is useless in people with symptoms. Just that it shouldn’t be applied as a broad screening tool in asymptomatic people, since that leads to to many false positives, and that outweighs the benefits of early detection.
That’s a odd if not dangerous statement to make. It’s a ground level non-invasive test. It’s flaws are well known in the medical field. If Biden’s doctors had started the process earlier he might not be fighting bone cancer today. The idea that it shouldn’t be given to men of a certain age because it might lead to something bad ignores all the other tests that would follow which can save a life. At best the argument should be one of better informed, better enabled.
It’s been over 50 years since the PSA test was invented. Protocols for it’s use have certainly advanced over time.
Someone mentioned upthread that there may have been political reasons for not giving the test. That sounds likely to me. If they do the PSA tests and the results are high, the doctors pretty much have to address it. There will be announcements that Biden may have cancer and global markets and political opponents will react. But if they don’t do the test, then there’s nothing to announce and no fallout. They took the chance that he has a typical prostate and would die of something else even if he did have prostate cancer. But he ended up being the rare case where it turned out to be the “die of it rather than with it” kind of prostate cancer.
No, the medical community long ago established that additional testing is not always better when you are working with imperfect tools that might actually misinform you. If your test was 100% accurate, then sure, test everybody for everything, but in reality every test has a false positive rate. If you know the test false positive rate, the rate of disease in the population, the benefit of early detection of the disease, and the harm caused by investigating false positives, you can use those statistics to determine if the test is actually worth doing as a general screening. I trust the relevant medical associations to gather and interpret this knowledge appropriately; they certainly have more expertise and access to much more complete information than I do. And they seem to have decided that the risks of broad screening with the PSA test outweigh the benefit. Unless you think they stopped recommending testing just for the hell of it?
And I don’t believe you are an epidemiologist. This isn’t a “do your own research”.
There have been multiple studies on this and there is widespread evidence that the flaws outweigh the benefits in some groups. 60 year old Black man? That’s someone at higher risk that if prostate cancer was identified would likely have a higher survival rate with treatment. 82 year old white man? No.
Or he might be in exactly the same place.
Biopsy-detected prostate cancer, including high-grade cancers, is not rare among men with PSA levels of 4.0 ng per milliliter or less — levels generally thought to be in the normal range. –New England Journal of Medicine
One of the things we know about the PSA test is that it is only loosely correlated with actual dangerous cancer, and the correlation further weakens as a man ages. In older men, both false positives (leading to invasive treatment for what is actually nothing) and false negatives (missing actual dangerous cancers) rise, so the predictive value and usefulness of the test diminishes. Current medical opinion is that beyond age 70 or so, the test isn’t worth it: you are more likely to get a false result (positive or negative) than a true and helpful result.
And yet that’s exactly the statement that was made by the medical board overseeing the Ontario Health Insurance Program.
You’re baselessly speculating about a medical situation about which you have very little information, and are not qualified to evaluate even if you did.
So you take the test and get a positive result (likely a false positive). You run it again and, naturally, get a positive result again. Now what?
There’s basically a whole hospital dedicated to Biden’s care. That’s something that most people don’t have at their disposal. They could use the facilities they have to determine the next step. For instance, they could do a prostate MRI to see if there’s anything to be concerned about. That’s not recommended for normal people because of the high cost, and normal people have to worry about things like cost, deductibles, and insurance coverage. That’s not the case with the President. He has access to whatever he needs at any time for free over at Walter Reed.
I think the context of the specific comment I was responding to was that Magiver was trying to justify the value of the PSA test in general. And in general, overtesting with a flawed test like the PSA may lead to an unnecessary biopsy with significant adverse consequences.
Moderating:
It’s long past time to drop the debate about whether PSA testing standards are adequate to have prevented Biden’s cancer.
This thread is about the fact that he does have prostate cancer and the implications of that for him going forward.
For those who wish to continue a discussion about the general standards for PSA testing, please take that discussion elsewhere. Thanks.
You’re baselessly speculating that earlier detection would not improve the situation. I just saw the Moderator not so my statement stands independent of the PSA test.
Moderating:
Heed the mod note or not, at your peril.
Note my update since I didn’t see your note.
Moderating:
Which is why you didn’t receive a warning for failing to heed it.
No, it doesn’t. You’re still arguing the issue, and now you’re trying to find a basis why your statement should stand despite the mod note. I construe this as arguing moderation in the thread. I’d drop it now, if I were you.
I will give you a formal warning if you continue to try to justify posting your opinions about inadequate PSA testing in this thread.
Getting back to the political aspects… A friend was speculating that Biden covered up earlier bad PSA results, because of the political implications. And when i first heard the news, i would have believed that. Trump published a (low) PSA number from his check up, he’s obviously getting tested.
But after learning that the test isn’t recommended after 70, and Biden seems to have last been tested at 72, i think he just got unlucky. Trump is a hypochondriac, and I’m sure he gets lots of optional tests. Biden has always struck me as an optimist, especially about his own health and well-being. I bet Biden has always avoided tests that aren’t actually recommended. It’s generally the smart thing to do, and just feels like his style, to me.
Also, this seems to have been discovered at an annual checkup. If it’s really an aggressive, fast-growing tumor, everything might have been normal a year ago. I know a couple of women who found breast cancers less than a year after a normal mammogram. Not because the mammogram was wrong, but because the cancer was aggressive, and had grown from nothing detectable to a lump they could feel in less than a year.
And also, since Biden dropped out of the race, in July (nearly a year ago) there hasn’t really been any political reason to pretend to be healthier than he is. I mean, no doubt they guy has some pride, but enough to delay treatment? I doubt it.
So I’m pretty firmly in the “he just got unlucky, and just got bad news” camp.