I am just learning that it's uncommon for men 70+ to get PSA tests... why??

[themaguffin]

What am I missing.

For context, this was brought up in a discussion about Biden's diagnosis.

[Johnny2X2X]

1. Simple really

"The US Preventive Services Task Force (USPSTF) recommends against routine PSA testing in men 70 years and older due to the potential for false positive results, overdiagnosis, and the risk of overtreatment. This is because men in this age group are less likely to benefit from early detection of low-risk prostate cancer and more likely to die from other causes. "

It's the same reson why doctors don't seem to care about my mother's dimentia, something else will likely kill her first.

[JohnSJ]

11. It is faulty reasoning which is using outdated recommendations. PSA is simply a data point, and if it

is elevated, and cannot be explained by an enlarged prostate, infection, etc., it simply indicates further diagnostics should be explored. Those further diagnostics would entail a prostate MRI, etc., and if suspicious areas are observed which are PIRAD 4 or 5, a directed biopsy(s) should seriously be considered, and if the biopsy is positive, one of the genetic tests should be done of the positive biopsied sample to determine the risk from an aggressive prostate cancer, or if active surveillance is a viable option.

It is absolutely unethical and immoral to effectively write-off someone because they are 70, by assuming they won't live more than 10 years, so they shouldn't waste time on an inexpensive test, that would indicate if further tests are warranted, a potentially prevent a lot of suffering for those who have an aggressive prostate cancer at an early stage, can be prevented.

The technology has advanced to such a degree in the last 20 years, that there is enough tools to safely diagnosis if someone has a prostate cancer that needs to be treated, ideally at an early stage.

Faulty assumptions are made, where a lot of people can go through a lot of unnecessary suffering that could have been prevented.

In addition, if treatment is necessary, the treatment advances are numerous, superior and more effective than just 10 years ago.

[NoRethugFriends]

12. A high PSA without prostate cancer is not a false positive for cancer

[Bernardo de La Paz]

15. What is your reasoning? Semantics?

Technically all high PSA reliably indicates is high PSA, hence if there is a "false positive" it is the reading itself, not any inferences about cancer.

Is that your thinking?

[NoRethugFriends]

19. My thinking is that I clearly didn't wind up finishing the post. My bad. I corrected it.

[CTyankee]

23. the husband of a dear friend died of dementia back last July. I was shocked. I had no idea one could die of dementia but

that was listed as cause of death in his obit in the newspaper.

[Midnight Writer]

24. In Alzheimer's, the brain deteriorates to the point it cannot handle basic bodily functions,

such as swallowing or breathing or even keeping the heart beating. When the brain dies, we die.

[Bluetus]

31. I think you are correct

And there is some basis for the reasoning. For example, prostatectomy is a major surgery. The system doesn't like to spend money on major surgeries for people who, actuarially speaking, might have only a 5 year life expectancy anyway. So a primary form of treatment is off the books.

And they say that most prostate cancers grow slowly. Most, but not all. I had a faster growing variety. If I had not insisted on annual PSA tests, I think I would probably be dead now.

So I would say it slightly differently from your answer. They don't recommend the tests because they don't really want to know the answer. They are willing to let the 5% or so who have fast-growing cancer suffer

[marble falls]

2. Because the common "wisdom" is that if you're 70 or older, the relief is a hard thing on an older fellow ...

... and that the individual is most likely to die before the cancer can kill them.

[J_William_Ryan]

3. No idea.

I’m 66 and get an annual screening.

I have BPH so I’ll continue the screenings until I stroke out, since an enlarged prostate is a symptom of cancer.

[JohnSJ]

14. BPH can effect PSA values, but based on prostate size, density, PSA velocity, etc. They can reasonably

distinguish the PSA contribution from BPH, and if further diagnostics, such as a Prostate MRI is necessary to determine if a directed biopsy is warranted.

We have the technology, and it is absurd to write off anyone over 70 as NOT "needing a PSA test", because a committee believes it would cause "over diagnosis". There is no reason today for that to occur with the current technology available, and these recommendations not to perform PSAs on men over 70 are at least 12 years behind the times.

[Bluetus]

32. I completely agree about the annual PSA

and/or digital exam. These are very low cost tests. To think that we don't value a person even enough for a $50 investment once a year says a lot about us.

When we get into MRIs and biopsies, that is a different matter. MRIs are expensive. And there are not many procedures more tortuous than the standard prostate biopsy. But you wouldn't do either of those without either seeing an elevated PSA or having a concert from a digital exam.

Some 70-year-olds are on their deathbed, but many of us are not. I just returned from the gym where I have been rehabbing so I can return to organized sports. If I still had a prostate, I'd be doing a PSA test annually for at least another 15 years if I am lucky enough to still be alive. (As it is, I have an annual PSA tests for 10 years after the removal.)

[hlthe2b]

4. While I am not necessarily in agreement, mind you:

The United States Preventive Services Task Force (USPSTF) guidelines advising against PSA testing for men aged 70 and older were revised in May 2018. Prior to that, the USPSTF had previously recommended against PSA testing for all men. The 2018 update specifically addressed men in the 55-69 age range, allowing for individual decision-making with their doctor after discussing the potential benefits and harms of the test, while continuing to discourage PSA testing for those 70 and older.

I am not a urologist, but I do understand the issues with this highly sensitive, but poorly specific test. What that means is that men with benign prostatic hyperplasia (BPH), a very common non-cancer enlargement that comes with age can also trigger an increase in PSA, so a digital exam is recommended. That said, the USPSTF also looked at the risk-benefits of aggressive treatment, whether surgery, radiation, or chemotherapy in men over the age of 70 with likely concomitant medical risk factors (e.g., heart disease, hypertension, etc.) and determined that the treatments and diagnostics from false positive PSA readings or even indicated treatments might pose more risk than benefit in this older age group. That is the thinking (along with some unnecessary cost issues, because MRI is the indicated test to sort it out at considerable expense).

Does any of the above really apply to a current or recent President whose medical care is basically unlimited? Probably not, but there are issues that Biden's physicians would have taken into account--whatever they might be.

[JohnSJ]

17. Those recommendations in regard to PSAs are outdated. PSAs are simply a data point which indicates

whether further testing should be considered. That testing would be a prostate MRI, which would determine whether a directed biopsy should be considered or not.

With the technology available today, including the advancements in the treatment of Prostate cancer, PSA screening, followed by a prostate MRI if an elevated PSA cannot be explained otherwise, would spare a lot of men over 70 a lot of suffering if they were diagnosed at at early stage, and not avoided simply because someone recommended it "wasn't necessary" to have PSAs after 70.

[hlthe2b]

20. These are the official recommendations. While I clearly stated I as a professional do not necessarily agree

I am explaining the data-driven decisions that this body (United States Preventive Services Task Force (USPSTF), who make official recommendations, used. They are not looking at the individual but rather population-driven risk-benefit guidelines. It is the latter that is infuriating to you and others (and me) because, on the individual level, these guidelines often ARE inappropriate. That is why INDIVIDUAL PHYSICIANS are expected to look at the individual and their needs, risks, and benefits to drive a course of diagnostics, screenings, and therapy. And, in most cases they do. But, you need to realize these controversies likewise have arisen over mammography and breast screening guidelines, colonoscopy, and nearly all screening for which there are some available measures or screening tests that may lead to unnecessary and costly work-ups.

So, no, the guidelines are from 2018 and not outdated. You and I may disagree with them, but that is because you and I are considering the individual patient, while the guidelines are population-based.

[JohnSJ]

29. Yes, I agree it does need to be individualized, but the fact that the decision by too many physicians

do not test PSAs on men over 70 to me indicates that the recommendations for PSAs are confusing at best.

[karynnj]

25. Thanks for this very helpful post

I wonder if Biden has BPH which would have from your explanation in itself have explained increasing PSA. That coupled with the fact that they are saying the cancer is very aggressive might have meant that PSA tests didn't flag that he might have cancer.

I am also remembering that John Kerry explained that his PSA was still in the normal range, but Teresa pointed out a clear upward trend. This led him to get a biopsy that would not normally have been done. He has early cancer which he treated aggressively.

[hlthe2b]

27. Yes. He does. It was included in an earlier medical report released publicly.

[dutch777]

5. I am not over 70 yet but I demand a PSA test at every yearly exam. You can choose to not treat if it is non-aggressive.

form of prostate cancer as another poster noted, folks have slow growth prostate cancer for 20+ years with little ill effect and die of old age of the heart and other organs all the time. I have a 55 year old nephew whose bone head doc NEVER gave him a PSA test and he shows up with Stage 4 prostate cancer and had an awful treatment regimen. He survived but with lots of issues caused by how aggressive they had to be with surgical and other treatments to save his life.

[MarineCombatEngineer]

6. I'm a truck driver, so naturally I go for a physical every year at the VA including a PSA test,

also, every 2 years, I have to renew my DOT Medical Cert.
As far as why most over 70 don't, I guess that's their decision.

[OLDMDDEM]

7. My last PSA was 7.9. Supposedly, normal is 4.0 I am told. My doctor says the 7.9 is my normal.

I have been over 7.3 for over 25 years.

[woodsprite]

26. Hubby was just told his normal seems to be 6.4

The uro told him that he had patients with numbers as high as 18 that have not developed any cancer or other issues. He said trends were much more predictive than the actual number of there are no other anomalies found.

[OLDMDDEM]

28. Everyone is different. Our son is worried because his is over the 4.0 norm. My norm being in the

6's is fine with me. I feel fine and plan on making more people miserable.

[Luvcatz14]

8. Over treatment is no joke

They over treated my dad and he was never the same. It made his life a lot harder. And he ended up dying of bladder cancer which was not related to the prostate.

[malaise]

9. I read that they say do the test between 50 and 69. n/t

[Littlered]

10. Hmmmm

It’s been part of my annual screening for as long as I can remember.

[surfered]

13. Here's the American Cancer Society recommendation

https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html

[malaise]

21. Thanks

Rec

[surfered]

33. Hope you don't have a problem 🙏

[malaise]

39. No problem

[surfered]

16. My experience:

When your PSA reaches 4.0, a dose of antibiotic is given in case of a prostate infection .

If the PSA does not decline after 2-3 weeks, a biopsy is performed. If cancer is discovered and based upon your Gleason score, your doctor will discuss treatment options.

If your Gleason score is low, depending on your age and whether or not the cancer is thought to be slow growing, active surveillance is an option.

Under this protocol, you will have PSA screening and a digital exam every six months.

If your PSA gets to 10, you will need to take action: either surgery or radiation with hormone therapy.

[dugog55]

18. The PSA test does not reveal anything really.

Every male's PSA numbers go up as they get older. When a biopsy is suggested, give it second thoughts, over 2000 men a year die from the biopsy. Also, from talking to friends that have had a biopsy, it is a month or so of bleeding from your ass or in your urine. Also, since the needle is introduced through the anus, sepsis is a high possibility if a blood vessel is nicked. And, if the biopsy does not hit the specific area where the cancer resides, you can get a false negative.

Recently there is a new test called PSE, prostate specific episwitch, it is knew and you may have to search for a lab that does this test. But it is 94% accurate. You can get information at 94percent.com. If that fails, just google PSE test.

[Mike Nelson]

22. I'm missing...

... the same thing. I thought it was routine - as part of the blood test. It's part of mine. I don't recall anyone ever asking "permission" to test PSA, either. They just did. Of course, I wouldn't mind and understand tests are not always conclusive. I expect the PSA test will continue to be part of my annual check-up. Okay, by me!

[obnoxiousdrunk]

30. Is this the test

where the Doc inserts a finger or is it a blood test ?

[Aristus]

35. See my reply below.

n/t

[Aristus]

34. I order a PSA for every fifty+ year-old male coming in for an annual physical exam.

PSA is not the most reliable test in the world. But one can reduce the risk of a false positive by drawing the patient's blood for the test before the exam, including the digital rectal exam. If one palpates the prostate gland, and then draws blood for the test, it can results in a false positive. I don't know where the idea came from that medical providers enjoy it when their patients suffer. It seems like tarring with an unnecessarily large brush.

[uponit7771]

36. Don't think it's providers but HCIs that don't mind if people suffer

[Aristus]

37. Health insurance companies for sure, at least.

The very backbone of capitalism is the causing of suffering by limiting the supply of money, and routing what is left to the people at the top.

[uponit7771]

40. There no doubt needs to be public options for HC like USPS which Americans like cause they do a decent job when

... MAGA billionaires don't gimp them.

[Meowmee]

38. It depends on your doctors

Basically, it’s an attempt to save money. But it doesn’t save money and it ends up killing people who have cancers which go undetected. This happens in all areas of treatment / testing, especially for older people.