I have been seeing the seemingly new recommendations that we are being too aggressive with the current PSA testing for men over 50. The logic behind the new recommendation is that we are testing too soon and too often in men that are healthy. Most prostate cancers are very slow movers and most doctors say that something else is more likely to kill the patient than the prostate cancer itself.
Most of the time elevated PSA means that there is a benign enlargement or that there is an infection in the prostate giving artificially high numbers. I am of the mind that if a patient is having urinary hesitancy, I will test the PSA level. If it's elevated, the first thing I do is a round of Cipro for 2 weeks and recheck the level. If it moves downward, it's not prostate cancer. If it continues to climb, I make a referral to urology and let them make the final call.
Most of the prior thought process is based on the age expectancy of around 70-75. Well...I have another issue. Men are living until their late 90's now. If I find an elevated PSA at 50 and I ignore it for a long time and it breaks into their bladder or bowel and kills them before their time, I would feel rather neglectful. I certainly don't want to have a painful cancer that could have been prevented. Would you?
I have also seen the reports that the treatments are bad for men's sex life. Sorry to tell you but so is death! I think that being healthy without sex is more important. I understand that most men find their sex drive to be all important but at the age of 70 plus, who really is worried? Certainly not their wives who have already been past menopause and have lost the urge a LONG time ago. I think that they would much rather have their husbands to spend quality time with in other areas.
What say you?
Most of the time elevated PSA means that there is a benign enlargement or that there is an infection in the prostate giving artificially high numbers. I am of the mind that if a patient is having urinary hesitancy, I will test the PSA level. If it's elevated, the first thing I do is a round of Cipro for 2 weeks and recheck the level. If it moves downward, it's not prostate cancer. If it continues to climb, I make a referral to urology and let them make the final call.
Most of the prior thought process is based on the age expectancy of around 70-75. Well...I have another issue. Men are living until their late 90's now. If I find an elevated PSA at 50 and I ignore it for a long time and it breaks into their bladder or bowel and kills them before their time, I would feel rather neglectful. I certainly don't want to have a painful cancer that could have been prevented. Would you?
I have also seen the reports that the treatments are bad for men's sex life. Sorry to tell you but so is death! I think that being healthy without sex is more important. I understand that most men find their sex drive to be all important but at the age of 70 plus, who really is worried? Certainly not their wives who have already been past menopause and have lost the urge a LONG time ago. I think that they would much rather have their husbands to spend quality time with in other areas.
In the UK we sometimes feel that Americans overtreat prostate problems and this is seen (rightly or wrongly) as a moneymaking venture for the urologists. Do the surgery - get paid.
ReplyDeleteI have been advised by colleagues who work in urology that the PSA gives too many false positives and, unless there are symptoms, to leave well enough alone.
As for sex into the 70's, I am looking forward to annoying my wife into our 80's.
GrumpyRN
I say, look at the data.
ReplyDeleteFor all of us, our first impulse is to defend the way we do things now.
After all, if what we are doing now is wrong, then, logically, we have been hurting people we should have been helping! And that's an ugly thought.
I say look at the data. I say this not having dug into it myself yet, but if I were a betting man, I have to say that after the mammogram shitstorm, I really, really doubt the USPSTF brought out this recommendation without slam-dunk evidence. Reportedly they held onto it for two more years, just to get yet more data to strengthen their case.
And it's not just impotence and incontinence we are talking about. It's hospitalization and surgery, with all the complications of medication errors, surgical mistakes and hospital acquired infections. When you are talking about a minimum of twenty or thirty TURPs to extend one life, those other factors become important to whether there is any actual mortality benefit.