Quote from: Pedro-bot on November 23, 2012, 01:21:51 PM
No it's not.
It's neither sensitive nor specific.
DRE misses half of all cancers.

USPTF states there to be inconclusive data to support the use of DRE.
Hence, the best approach is joint decision making.

Many factors influence going forward with prostate screening.
Medical history
Family history
Age
Etc

Interpretation of meta analysis is left up to expert panels, which is why there's so much conflicting info out there. I for one do not want to add to that confusion, but I find it difficult to say nothing when I see posts making broad statements on recommendations.
Don't mean to "argue" with ya. Again, get that finger all you want. I'm just saying.

Have you ever had that biopsy?

Quote from: ducpainter on November 24, 2012, 04:14:30 AM
Have you ever had that biopsy?

The recommendation from USPTF is for men NOT under servaillance or in active treatment. If YOU have, the "medical history" part applies to you. Meaning you are not in the randomized population studied for which current recommendations are interpreted from.

Me personally? Nope.

But there's a strong family history of cancer. See my earlier post in this thread.

Always, discuss concerns and questions regarding preventative health screenings with your medical provider.

Quote from: Pedro-bot on November 24, 2012, 06:09:26 AM
The recommendation from USPTF is for men NOT under servaillance or in active treatment. If YOU have, the "medical history" part applies to you. Meaning you are not in the randomized population studied for which current recommendations are interpreted from.

Me personally? Nope.

But there's a strong family history of cancer. See my earlier post in this thread.

My point is that even the biopsy can be inconclusive, and the PSA levels that they use to decide whether or not to perform this intrusive and expensive procedure is arbitrary. The actual PSA test has changed in the not too distant past.

How many biopsies do you subject yourself to before they find what they want to find? No money in not performing procedures.

Undergo the biopsy and get back to me with your thoughts about it.

Quote from: ducpainter on November 24, 2012, 06:18:13 AM
My point is that even the biopsy can be inconclusive, and the PSA levels that they use to decide whether or not to perform this intrusive and expensive procedure is arbitrary. The actual PSA test has changed in the not too distant past.

From your post I can read that you understand the confusion regarding when to screen. Which is why you make the point that screening can lead to find non-definitive information that leaves more questions than those very same questions it's purpose is meant to answer.

More questions leads to prostate biopsy. Biopsy results can put you back in square one. Sometimes.
Occasionally, less than 5% of the time, the biopsy detects a malignancy.

Given that this is a public forum, I want to make sure readers understand that what I am posting should not be used to make personal decisions. My message, to you the reader, is to always discuss this with your medical provider.

#1. The USPTF (US Preventative Task Force) is defined as the following:
Created in 1984, the U.S. Preventive Services Task Force (USPSTF or Task Force) is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, or preventive medications.

#2 Prostate Cancer Screening is defined as such: DRE (digital rectal exam) in other words the ol' finger in the rectum routine. Routine screening can be with or without the PSA (prostate specific antigen) serum level (blood test).

#3. A biopsy is NOT a screening. Biopsy is a diagnostic tool. This is invasive, expensive and sounds painful, which carries risks of its own.
Screening, such as the DRE, is an exam that distinguishes between normal and abnormal findings. Which if abnormal would then likely encourage you to escalate the level of care, i.e., PSA, biopsy, etc.

#4. USPTF made a recommendation around June of 2011 which made a recommendation AGAINST routine annual screening  (Means DRE and PSA) for MEN < 75 that are not in surveillance ( surveillance means you've been previously successfully treated for prostate cancer and are being watched for a recurrence of it) and are not currently in treatment for prostate cancer (you have prostate cancer and are either receiving chemo, radiation therapy, surgery, etc.).

So again, if any of what's in parenthesis applies to you, the recommendation does NOT apply to you.

Why wound the USPTF say that?

Because after review of many large randomized studies (meta analysis), the benefits of routine screening did not have a significant impact on prevention.

For one, many prostate cancers can and do occur even in the normal range of a PSA (<4 ng/mL).

Number two, as I stated before, DRE misses half of all cancers. This means that those who did have prostate cancer, DRE was not sensitive enough to detect it.

Number three, PSA levels are also not very sensitive, nor specific.
And just to clarify:
PSA tests have not changed.
What has changed is how that data is interpreted. Meaning, a good clinician doesn't just look for what that number is, but it looks at what it was before. The rate at which those two levels have changed is called velocity. This has implications of it's own. And I won't go into that.

QuoteHow many biopsies do you subject yourself to before they find what they want to find? No money in not performing procedures.

Your point is well made.
But I think you have me mistaken as being an advocate for screening indiscriminately.

The point you make is why urologist all over the U.S. threw their hands up in the air and screamed bloody murder when the USPTF made public the recommendation.
Who do you think performs all those biopsies and surgeries?

QuoteUndergo the biopsy and get back to me with your thoughts about it.

I hope I never have to. But given the strong family history, I'll make that decision together with my provider.
Just like everyone else should too.  

I agree with everything you said...

except the fact that the test has indeed changed. Both patients and providers had to recalibrate their thinking regarding results. I believe at the same time the 'normal' PSA level changed.

This occurred about 10 or 11 years ago.

Quote from: ducpainter on November 24, 2012, 02:11:32 PM
I agree with everything you said...
<SNIP>

Really?! Gee thanks. 

And here I was not agreeing with lick of what you said.   

But in all seriousness, one thing I know we can both agree on is cancer does in fact suck the big one. 

Quote from: Pedro-bot on November 24, 2012, 03:02:08 PM
Really?! Gee thanks. 

And here I was not agreeing with lick of what you said.   

But in all seriousness, one thing I know we can both agree on is cancer does in fact suck the big one. 

Certainly does.

It touches everyone, and never in a good way.

Well shit. 

Uncle's pancreatic cancer..I mentioned in Nov..took its course.  He rec'd news of 3 months to live <4 weeks ago.  Tonight, it's doubtful he'll make it through the week.  At least he's at home with all of the family. 

Dad's surgery for prostate cancer happened 2 weeks ago. The results, 1 week later, showed the cancer is worse than they thought. 

Well shit again.

sorry to hear Iz.

Oh no IZ!   I'm so sorry to see this! 

Wishing you as much peace as conceivably possible....     

Quote from: Stella on March 04, 2013, 09:25:26 PM
Oh no IZ!   I'm so sorry to see this! 

Wishing you as much peace as conceivably possible....     

+1

My thoughts are with you and yours IZ.

Argh..thanks all.  Wasn't expecting either of these outcomes.  Uncle is now unresponsive and not eating or drinking.  Last rights given.

This cancer thing though is sucking!  Aunt passed away on Thanksgiving from it and my uncle..her husband..just died two weeks ago from it.  Didn't tell family he had it so that was a shock.  Another aunt just diagnosed with it a week ago. 

Nothing I can do but days like this, it does suck being 1000 miles away from family.

Sorry dude. 

A chick I know (37) recently found out she has ovarian cancer and just had a hysterectomy to get rid of it. She's devastated.