Posted on 10/07/2011 10:56:02 PM PDT by neverdem
JEFFREY BROWN: Men shouldn't be routinely tested for prostate cancer. That was the recommendation today of an influential government panel that looked at whether PSA tests can extend lives by detecting cancer earlier.
The tests measure levels of a protein made in the prostate. But the U.S. Preventive Services Task Force said they do more harm than good, including unnecessary biopsies, surgery, radiation and impotence. The panel concluded that -- quote -- "The common perception that early detection prolongs lives is not supported by the scientific evidence."
Last year, more than 217,000 American men were diagnosed with prostate cancer; 32,000 died from it. And the recommendations are being met with both support and anger.
We look at all of this now with Rob Stein, who covers health and science for The Washington Post.
Rob, welcome.
So, they're saying they can find no real benefit from these tests?
ROB STEIN, The Washington Post: That's right.
Overall, when they have taken a hard look at the scientific evidence, what the panel is saying is they concluded that there's no overall benefit compared to the risks that men face if they're told to undergo routine PSA testing. These are -- if healthy men are told go in and just get a PSA test on a regular basis to see if you have prostate cancer.
JEFFREY BROWN: And just to back up, that is the current standard practice now?
ROB STEIN: That's right.
The way it works right now is once a guy hits about 50, his doctor usually starts recommending that he get a blood test, which is PSA test, to look for any signs that he might have prostate cancer. And then he pretty much gets it on a routine basis every time if he goes in for a routine physical or a routine checkup.
JEFFREY BROWN: All right, so fill in this picture about the risks, risks that outweigh any possible benefits. What are we talking about?
ROB STEIN: Yes. What they're talking about is, when somebody comes back with a positive PSA test, something that indicates that he might have prostate cancer, it starts sort of a cascade of medical treatments that can lead to some pretty serious complications.
At first, you start off with a biopsy to see if the guy actually has prostate cancer, and that's usually not that big a deal to go through and pretty safe. But in some cases, there can be complications and it can take some time to recover from even that. And then it turns out that -- if he has prostate cancer, then he has to undergo surgery or radiation. And that can have some very serious complications, the biggest ones being impotence and incontinence.
JEFFREY BROWN: Now, it's important to say that this panel -- these recommendations are for men who do not have any symptoms, correct?
ROB STEIN: Right. And that is very important.
This is for men who basically are healthy, there's no sign that they might have prostate cancer, there's no reason to think that they might have a tumor that nobody has picked up yet. It they're -- for men who do have signs, for men who there are indications they have prostate cancer, they should be going in and getting tested.
But this is -- this is for the general, sort of routine, "don't even think about it" recommendation that you just go out and get a PSA test on a regular basis without even -- maybe even knowing you had the test done.
JEFFREY BROWN: And when -- one of the issues here I guess is that prostate cancer develops very slowly, right?
ROB STEIN: Yes. No, that is -- that's a very important point is that prostate cancer, it's a very common cancer, but in a lot of men, they don't even know they have it, and if they never were tested for it, they might never find out that they had it. It grows so slowly, that they would end up dying of something else.
And so that's the big problem with prostate cancer, is right now we can't identify which men need treatment and which men don't. So if you go in, you get a test, you find out you have prostate cancer, pretty much most people are going to get treated. And that could lead to all sorts of complications that could even cause deaths, that could outweigh the benefits of the routine PSA testing.
JEFFREY BROWN: Now, everything here, all this, the PSA testing, has been debated for a long time. It's been quite controversial. And now these new recommendations are extremely controversial, I gather.
Tell us about the reaction.
ROB STEIN: Yes. It's been a very strong reaction to this.
You have to remember this is the same panel that in 2009 caused a firestorm when they raised questions about routine mammography for breast cancer for younger women. And we're starting to see some of the same reactions to this. There's a large cadre of doctors and patients and patient advocacy groups who think that PSA testing is extremely important and saving lots of lives, and anything that raises any questions about it is going to cost a lot of lives.
So people are very upset about this.
JEFFREY BROWN: Well, so how influential is a panel like this? What -- where do you look at for impacts here for -- among doctors, among insurance groups and so on?
ROB STEIN: This is a very influential panel. And that's why people -- the reaction is so strong.
You know, this panel can't make anything happen, but doctors, you know, look to this panel to, you know, decide what advice to give their patients. Insurance companies look at what the panel recommends to decide what they should pay for. And, in fact, under the health care, the federal health care reform legislation that passed, this panel has actually become more influential, because some of the basic benefits that the federal government will require under the health reform legislation will be influenced by this panel's recommendations.
JEFFREY BROWN: So, briefly, Rob, what happens next? Is this a period of confusion for the medical community and men in general? Or what are you looking at?
ROB STEIN: Yes, it's important to note that, at this point, this is a proposal. So the panel is proposing changing its recommendations. They're proposing downgrading their recommendation for PSA testing to recommend not getting routine testing.
It will be open now for a period of time for public comment. This is one of the changes that the panel implemented after the uproar over the mammography recommendations, so the public has a chance to say what they think about it, and the panel will take a look at those comments and decide what to do for their final recommendations.
JEFFREY BROWN: All right, Rob Stein of The Washington Post, thanks so much.
ROB STEIN: Oh, thanks for being -- nice being here.
Now I've seen one of those malignant types in a VA hospital, and it wasn't pretty. It metastasized to the neck. The poor guy was probably terminal, and his tongue was permanently protruding out of his mouth! They need a test for those really malignant types, as most are rather indolent.
There's a video at the source.
Death panel.
The VA won’t give me Plavix after a 6X bypass and 2 stints.
Today they told me that heart stints don’t have any effect on whether I have another heart attack. Now they’re not going to check my PSA level. Death Panel is right.
I’m 52 now and I have been wondering if it’s time for me to get that checked, so this is an interesting article.
Other than having to get up more than twice a night to leak, I don’t have anything that could be considered a symptom. From what I understand, that’s not unusual at this age.
“At first, you start off with a biopsy to see if the guy actually has prostate cancer, and that’s usually not that big a deal to go through and pretty safe. But in some cases, there can be complications and it can take some time to recover from even that. And then it turns out that — if he has prostate cancer, then he has to undergo surgery or radiation. And that can have some very serious complications, the biggest ones being impotence and incontinence.”
That says it all, read it carefully, these people should be fired.
Between the rectal exam and PSA reading from blood tests, your GP will refer you to a urologist if they suspect prostate cancer. The urologist will likely take samples from your prostate. They stick a probe up your rectum and stab your prostate with small tubes taking tiny core samples. Make sure you go for the six sample test and not the 17 as you will bleed for months if you do. The lab will read the samples and determine dispersion and rates of growth from microscopic analysis. This is when you learn your choices of treatment. better hope this all happens before the cancer metastasizes, grows beyond the prostate sack into your body for then it's likely all over for you. The point about impotency in the article is rather silly when you consider the alternative. Most men will get prostate cancer. The trick is getting diagnosed if you have the rapid growth form or not.
Mercy, reading these comments want me to yell out loud! Since when does anyone deserve the right or requirement to get preventive care for possible problems?
If you go though life and only go the to Doctor when necessary, the guess what - costs lower and lawsuits are also diminished. Seems like a plan to me...
Forget all the malarkey about preventive examinations since you will only be subject to tests that the lawyers think is necessary - or they will sue.
Maybe it’s time to go back to the good ole days when we only went to the Doctor when there was an actual problem.
Wonder just how that would effect rates... (Of course, that would have to include medical lawsuit reform)...
I would conclude from that interview that employees of PBS and the U.S. Preventive Services Task Force have received waivers from Obamacare.
go back and read it again.....there is one other piece missing, that they can retest to eliminate false positives.
Sorry... I think all those “preventive” tests are not only costly but not necessary. You might catch 1 in a hundred cases and even some of those are false positives. It causes undue hardship and certainly expands costs unnecessarily.
I have to say that almost ALL preventive tests are useless with what - maybe a 1-2% catch rate (and even those are often wrong). Really, you want to do all of these tests to catch 1 out of a hundred cases of actual disease? This is what Obama care wants - great for the Doctors and Hospitals money wise...
The PSA has no false negatives. That means for the majority of men under about 75, you get a negative PSA, and you have nothing to worry about.
Next level. They take a second test. PSA might show nothing this time. If so, again you're clear.
Next level. They do a biopsy. You get cleared and there's nothing to worry about.
Next level: and here is where the whole frakkin' thing goes sideways: there's evidence of cancer and some people have the nerve to actually get treatment for it! And those treatments may have less than thoroughly desirable outcomes.
This is so outrageously stupid, only a government board could actually come up with it. Is any consideration being given to the question: what are the consequences to your health, stress and anxiety level, and quality of life to be told "yes, you probably have cancer, but it may not be the kind to worry about, so, given that you might become impotent or have some discomfort for a while, we're recommending that you keep the cancer."
Wow. Just wow. Incredibly stupid.
No doctor does the biopsy without a second test, this isn’t the only test that has false positives.....there are hundreds of similar tests.
Undetected cancer is death.
You got it right, that is exactly my issue this this.
Sorry, I still contend that almost all preventive tests are useless and unnecessary but do contribute to the Doctors and Hospital funds. Mostly due to prevent lawsuits.
I can understand your arguments but in my experience, they are and have been useless in both my parents and myself. Your case may be different but do not extend them to everyone.
The test 2.50, with the lab draw 27.50, this isn’t a huge money maker for anyone.
That’s okay - seems that you are a believer in preventive medicine. That is okay for me and you. I just don’t believe in it as it is an unnecessary cost to both individuals and society.
Your way is okay but more expensive. we did not need this kind of preventive treatment until is was available. It seems that the more that is possible, the more we want...
And of course the more the costs...
your issue is that the government is paying for it, don’t get confused
I am more than willing to pay for it
routine doctor visits and preventative care, and routine tests should all be paid out of pocket.
you would have us consigned to the stone age out of your confusion.
Okay, finally something I can understand...heh, those comments by eyedigress had me totally confused...
Yes, I agree with you, if you want to do it yourself and pay for it, that is a good thing. No, I do not want us to go back to the stone age - just reasonable costs afforded by the government (really by you and me).
I applaud actions by individuals to pay for their own health care - it is the forced costs that the government does that really irritates me. It is not their money, but they insist on preventive care (go Obama care - pay for everything even if you only want catastrophic care - insurance)... Sorry to say, but it costs much more to do preventive care for everyone than it does to take care of those needing immediate care.
Yes, I may be on Medicare but have yet to use it and will not unless it is catastrophic...
dila813 - sorry, that response to me was meant for you - I think that I was totally confused by eyedigress. Ended up replying to myself...heh.
Spot on. My 70 year old father was flagged for prostate cancer earlier this year via PSA tests and finally a biopsy. They caught it early and he was treated successfully with the Da Vinci robotic surgery. (I advised him to go to the Loma Linda Medical Center and have the proton therapy treatment as it is much less invasive, but he wanted to get it over with.)
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