The Big Four: Prostate Cancer

[@rfinky1]

Thank you for this presentation. I am a 71 year old man, my PSA level is 9.7 at this time, it has increased from low 7 to this 9.7 over the last 3 years. My first appointment with a urologist was with an older doctor who was honest regarding the PSA test, he told me that since the test started there was a large increase in people identified with prostrate cancer and a lot of people had been treated for those cancers but at the end of the day there wasn't a huge difference in mortality. There is a video here on KZbin where the fellow who developed the PSA test said it was being greatly misused by doctors who aggressively treat those who are found to have prostrate cancer. This presentation is balanced I think. I've avoided doing anything beyond the PSA test although another doctor was chomping at the bit to do a needle biopsy. I don't have any symptoms so at this point if I do have cancer I hope I am one who dies with instead of dies from prostrate cancer. Thoughts?

[@robwells230]

WTF is the harm of getting a PSA test??? None, and a great benefit to establish the PSA baseline and to detect abnormally high results. Any harm is a result of medical ignorance and incompetence in interpretation of results.

[@Alex-ik8pr]

Physically undertaking a PSA test might not be harmful but it's the implications which can cause harm - False -ve: Falsly reassuring that no cancer is present False +ve: undertaking unecessary investigations (MRI +/- Biopsy), unecessary stress Unecessary treatment (BPH / slow-growing) PSA is also elevated by ejaculation or exercise (e.g. cycling) Not sure how helpful a baseline would be, thresholds are based on age - any fluctuations below the threshold may be irrelevant? It's not necessarily the interpretation of the results which causes the harm, it's inappropriately running the test in the first place. PSA is more useful when given in context of presentation.