I wish they did, of course. I personally lost a close friend to prostate cancer last year. He was 41 and was, before the cancer, one of the healthiest and most athletic people I knew.
The first inkling he had that anything was wrong was a backache that wouldn't go away; a stage 4 diagnosis ensued. He held on for 21 months from the onset of symptoms before the cancer took him.
My dad is in his late 70s and has tested at very high PSA levels a few times. So far none of the biopsies have found cancer, but they've caused a lot of stress and discomfort for him.
I don't have a strong opinion about the tests either way, but I wasn't the one getting the biopsies.
That does sounds stressful. Sorry he had to go through that.
I have high psa levels. 17.
Had a biopsy. Turns out I have a really large prostate. My doctor said that some just naturally have larger prostates and the larger ones produce more psa. The psa density function put my levels at normal when taking in to consideration the size. The biopsy came back negative.
My understanding is that it's net negative to test too much.
A lot of men die with prostate cancer, because only very few die from it. And if you belong to the former group, knowing about it or doing any kind of intervention means a massive loss in quality of life. So the best course of action overall is to close our eyes and stop looking. And hope you don't belong to the latter group.
It's an indication that something's wrong with the system. We'd get better overall health outcomes if we tested everyone and told a large cohort of people "you do have cancer, and there are these possible treatments for it, but we recommend you don't take any of those treatments and just hope for the best". But between doctors and patients and other healthcare participants, we collectively can't do this - a large minority of people will freak out and demand treatment and the healthcare providers will feel compelled to go along with it.
Perhaps this plan just needs better marketing. Instead of dividing tumors into benign and malignant we could have a third category for malignant but slow-growing.
MRI machines need to be a) democratized so they're cheaper and everywhere and b) connected to trustworthy clinically-proven radiological AI to identify and watch growths. There's absolutely no rational reason any patients should end up with surprise terminal cancers or surprise coronary artery disease.
(Yes, yes whole body scans exist but these are largely pseudo-medical scams that don't deliver what they promise. I'm saying deliver on it, within reason.)
edit: Ah ok. Risk of over-treatment by broad scanning?
"Active surveillance aims to avoid unnecessary treatment of harmless cancers while still providing timely treatment for those who need it." according to NHS.
No, you don't recover. Many men will get prostate cancer when they're old, but they'll most likely die from something else before that one becomes an issue.
But if we do scan and test and screen, a lot of men will find out they have it, become anxious about it and will want to do something about it, which leads to a lot of unnecessary treatments that decreases people's quality of life and wouldn't extend their lifespan anyway.
My doctor tells me that PSA testing has now shown to not be effective so they don't do it anymore. I am 58 and my dad died of prostate cancer so I am concerned.
You have a direct genetic history of prostate cancer, thus you are at higher risk than most men. At age 57 I had no family history and no symptoms, yet my primary care doc suggested I be tested anyway. My PSA was in fact elevated. I got a biopsy and found my prostate was 80% cancerous. I got it surgically removed just in time. 10 years later I'm still cancer free.
Every day I five thanks that my doctor did NOT follow the standard medical advice back then NOT to test. Forewarned is forearmed.
This may sound like a silly question, but are there men who just have the prostate removed as a preventative measure? Some women have their breasts removed who have a high risk of breast cancer.
That said, if nerve-sparing surgery were done early instead of doing NON-nerve-sparing surgery later (a standard radical prostatectomy), perhaps that might diminish some of the typical side-effects of the standard surgery like impotence or incontinence. But I'm only speculating.
It should be patient dependent. Screening everyone is not currently thought to be useful but those with risk factors should be screened after a discussion of risks/benefits. Your father having prostate cancer (especially if he was diagnosed before age 65) is a risk and I would advocate for it, especially if it something you are worried about and you understand that sometimes a PSA can be falsely elevated in benign conditions, which may mean you get a biopsy that ultimately wasn’t necessary, and the potential risks that could have.
Think of how full of shit most software developers are. Now think of how much worse their advice would be if they could be sued for wrong answers, but were given all of ten minutes to look at a code base and come up with a recommendation. That's a doctor.
I agree with the sibling advice to insist on PSA labs. You are your own advocate. The primary job of a doctor is actually to be a bureaucrat, the first line of offense for the health management companies whose whole function is to deny healthcare. They can easily rubber stamp a few labs once you change their risk calculus of not doing it, by explicitly laying out your risk factors.
Sure, "in the US". Obviously you don't want to be as ham-fisted as to directly reference the liability dynamic, or to pop the doctor's ego by reminding them that most of their job is pushing paperwork. The point is to take the medical system off the pedestal in your own mind, such that there is one less thing holding you back as you have to repeatedly advocate for yourself. And I would think the need to advocate for yourself applies everywhere (Sturgeon's law), regardless of whether the system is as antagonistic as the one in the US or not. The US system just drastically increases the possible damage from failing to do so.
"the need to advocate for yourself" isn't the only thing you said. I was referring to "the first line of offense for the health management companies whose whole function is to deny healthcare" doesn't apply everywhere. I also don't think it particularly applies in the US, although I'm happy to see evidence of that.
Despite all that, as you say, you won't be sued for saying that stuff.
"Evidence" is a pretty high bar to clear, especially considering one of the reasons the healthcare industry was able to get so callous is exactly by focusing on top-down whole-cohort metrics while ignoring individual patients. I'm sure everything looks great from inside the system.
Anecdotally, healthcare management companies insist on individuals getting referrals from "primary care providers", who take several weeks to provide an appointment, a few weeks more to issue a referral, and will only do one referral at a time even for unknown problems despite it taking several months to get an appointment with a specialist. And finding an available new primary doctor is most certainly not easy, either. This has been my experience for myself and a handful of other people I've advocated for, across several different "insurance" companies. Obviously none of those requirements are necessary, except for expanding the bureaucracy to meet the needs of the ever expanding bureaucracy, but it has the net effect of constructively denying healthcare.
Might there be some regional healthcare system in the US where patients are seen promptly and where the bureaucratic procedures create efficiency rather than functioning as mechanisms to stonewall and run down the clock? Sure, of course. But given the terrible dynamics that are allowed to fester, it feels like a working system is the exception rather than the norm.
Sample size of 2 from my family but PSA tests led to biopsy and treatment with full recovery so far (knocks wood). It seems like low hanging fruit in the case where PSA levels spike.
In addition to what other commenters have said, the growing market for telehealth finasteride means means that a decent portion of the male population are artificially below baseline PSA levels (and my understanding is that this has some degree of long term effect even if you stop taking the drug).
Most people with prostates experience a rise in PSA levels as they age. There's no evidence that treatment, especially given how slow, growing prostate cancer usually is, results in a net positive benefit overall. The exception is younger people with aggressive cancer, but you can't exactly limit PSA screening only to young people with aggressive prostate cancer.
Which carriers are you referring to? Commercial health plans are subject to a minimum medical loss ratio so they don't get to keep any more money by denying coverage for PSA tests. The general issue is that with only a few exceptions, most cancer screening tests haven't been proven to improve patient outcomes.
