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.
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.
https://thennt.com/nnt/psa-test-to-screen-for-prostate-cance...
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.
(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.)
I don't have a strong opinion about the tests either way, but I wasn't the one getting the biopsies.
For a good short overview: https://www.cancer.gov/types/prostate/psa-fact-sheet
And read “is the PSA test recommended…”
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.
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.
The harm is not the PSA test but in overtreatment too early on—a lot of prostate cancer is slow. Fighting it when it’s stage 4 is no fun, though.
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.
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.
surprised that it didn't escape prostate with that high load.
Despite all that, as you say, you won't be sued for saying that stuff.
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.
https://www.researchgate.net/publication/361217707_The_role_...
I've read very little about choosing radical prostatectomy very early after detection, but it's likely that it does little to improve survivability:
https://medicine.washu.edu/news/surgery-early-prostate-cance...
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.
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.
If there was a simple cure for it once detected, we could screen and test everyone all the time.