zlacker

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.

>>waynec+(OP)
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.

For a good short overview: https://www.cancer.gov/types/prostate/psa-fact-sheet

And read “is the PSA test recommended…”

>>waynec+(OP)
If you’re 58 and your dad died of prostate cancer, I’d insist on PSA tests in your checkups if I were you.

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.

>>waynec+(OP)
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.

>>waynec+(OP)
https://www.cancer.org/cancer/types/prostate-cancer/detectio...

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.

>>mindsl+TH
I would make sure you scope your advice to the health system of the person you're replying to, even if you can't be sued for wrong answers.

>>randcr+QO
> prostate was 80% cancerous

surprised that it didn't escape prostate with that high load.

>>robert+Nc1
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.

>>randcr+QO
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.

>>mindsl+OO1
"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.

>>waynec+(OP)
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.

>>robert+Fe2
"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.

>>waynec+e02
Yes, but I have no personal knowledge about radical prophylactic prostatectomy. You might start here:

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.