The primary care MDs associated with my insurance provider have been directed not to order PSAs for individuals over 70 unless the patient's father had prostate cancer. Reasons given: 1) There were too many false positives which subjected the men to unnecessary (and costly) biopsies and 2) Even if ca is confirmed upon biopsy, it is generally a slow grower and odds are that the patient will succumb to something else. I wonder if this directive prevails throughout the profession.
Here in Ohio, I had my PSA checked as a part of annual checkup by my PCP. It was high and I was referred to a urologist, who checked at least 2 more times, and the results were lower than the initial test. They wanted to do a biopsy, but I declined. I do have an older brother who has been dealing with prostate cancer for 10 years or so.
It may be nice to know what the deuce PSA stands for! I could look it up, but I'd rather have you explain it to me.
PSA => Prostate-Specific Antigen It is a test to screen for prostate cancer https://www.cancer.gov/types/prostate/psa-fact-sheet
Even if insurance declines to cover it, I'll pay for it if I can afford it. My PSA always been low, but when a local urologist felt lumps, he recommended I get a biopsy even though a CT scan showed the issue to likely be calcium deposits. The urologist that did the biopsy--after looking at the CT scan--wondered why anyone would have recommended the procedure in the first place. I mostly had it done because I was on the table for a bladder cancer screening and to have a bladder stone removed. I was already under anesthesia, so I told them to gimme the works. The same goes for a colonoscopy. I recently lost a friend at 86 years of age to colon cancer. I have no idea why she had not been screened, but I've had others tell me that they have been told by their doctors to not bother after they hit their 70s. They say to not bother if you have other health issues, but in her case she had heart issues that prevented them from treating the cancer (she would likely not survive the chemo.) Removal of the precancerous polyps would have saved her life. As long as I can afford it, I'll have it done. I really don't buy the whole "at your age, something else will get you before this does" crap. These are easily treatable cancers when caught early enough. @Boris Boddenov Are you not on Medicare? As long as your doctor takes "assignments" (your doctor takes Medicare and agrees to the limits they put on charges), you get a PSA test every year.
@John Brunner JB, Medicare A (hospital) but not B. What I have is I think better than Medicare B, Federal Blue Cross and Blue Shield. Wife and I worked 30 yrs. at SSA HQ, ironically in their SSDI programs. Not sure if this position on PSAs is the insurer's or the medical providers. I think that the latter has the same policies for all patients, regardless of coverage. Could stand corrected. Anyway, I could do PSAs out of pocket if necessary, but it has never reached 1.0 far below the 4.0 that was required before ordering biopsy. In fact, mine has usually been around 0.4.
@Boris Boddenov If this were the medical provider's policy, I'd just go somewhere else for the psa test...maybe one of those walk-in clinics. There's no reason to not get tested for something that's so deadly, yet so easily remedied if caught early. My psa is the same as yours...0.39 On the flip side, I was reading that if you get prostate cancer and it's accompanied by a low psa, it's a specially nasty bugger to get rid of.
@John Brunner I don't know my risk for the disease. No familial history of which I'm aware altho dad and his youngest brother had benign prostatic hypertrophy. No indication of that in me so far Because of musculoskeletal miseries with the upper extremities, I've ignored general health. Sometimes I pray for that lightning bolt. Colonoscopy later this year. Screw it. A nurse who lives across the road has been allowed to bring-in a limited no. of her elderly relatives for whatever covid vaccine is being administered at Carroll County Hospital. She has only her dad and two-in laws and graciously invited me. I turned her down. Call me crazy but it's so damn hard, especially at a moment's notice, to get ready and out and about.
@Boris Boddenov Man, I'm sorry for your health issues. It horribly sucks. I keep walking different lines. -My close male relatives have died in their 50s, so I've been glad to get tests because I have no idea what a male of my age in my family might be susceptible to. Each clean test gives me hope. -On the other hand, I, too, have a fatalistic streak, over things that are going on right now and over life in general. I bit the bullet and finally had a bladder stone removed, and thought that was gonna be the end of those issues. Nope. Just the beginning of other urological stuff and a daily procedure I'm supposed to do to myself that I just can't do. The Urologist made an appointment for me to go in next Tuesday so I can get beat up for not shoving a catheter inside myself every day. I'm not looking forward to it. The thing is, another urologist said "You just have one of those bladders" and "No action required." (Each of these guys spits on the ground when I mention the other's name.) I could get other opinions, but with these issues everyone needs to get up in there to "look for themselves." Each opinion involves another extremely intrusive procedure. I only got on this train in the first place when a kidney cyst and a bladder stone were discovered in a CT scan for an unrelated issue. Then it's "ultrasound/MRI/monitor" for the cyst, followed by "remove the stone," followed by "check for bladder cancer," followed by "prostate biopsy" followed by "self-catheterize." (This all started with digestive issues.) The cyst was benign, I've had the stone removed, I've been checked for the cancers (both negative, and we're likely unnecessary tests.) I'm at the point that whatever happens, happens. So back to the specific topic (although the above is in the realm "things below the belt")... The CT scan showed I have calcium deposits in my prostate. The current urologist (Charlottesville) gave me the finger and said "I feel lumps. You need a biopsy." Because of issues I have with 2 doctors there (I'm seeing an LPN now), I had a Richmond urologist do the biopsy/bladder exam/stone removal all when I was under general anesthesia. The Richmond guy saw the CT scan and shook his head in disbelief that anyone would recommend that a guy with a 0.39 PSA and calcium stones should get a biopsy based upon what was "felt." But once that seed of "might be something bad" gets planted...
Simple excision surgery is the way to go for cancer. It's too bad that The Big Cancer Machine usually succeeds in locking its victims into costly "therapies" that, eventually, kill them when their bank accounts have been drained. My great aunt had a radical mastectomy, in the 50's, for breast cancer. They wanted her to have follow up "treatments." She refused. She lived another thirty years!
Good for her, but that is not always the case. There are many, many types of breast cancer, and it is not a fatal disease unless it migrates to other organs. Many times, removing the tumor or the breast is sufficient treatment, though those procedures may also involve radiation to kill any stray cells left behind after surgery. Things are vastly different nowadays from "the 50's."
@John Brunner One like me who tends to feel sorry for himself doesn’t have to look too far to see someone with bigger problems. With you it starts with the knowledge that close male relatives died young, followed by the fact that you do have significant GU (and apparently GI) issues, and for the icing on the cake expert specialists who have polar opposite views with respect to diagnosis, treatment, and prognosis. It’s easy for an outsider to advise a tie-breaker. In your shoes I don’t know how I’d wrap my head around this problem, but when push-came-to-shove, I’d go to a 3rd, after trying to ascertain the best. Had to research the best GI surgeon for my wife’s Whipple, and fortunately his team did nothing but Whipples and were relatively close, Johns Hopkins.
The PSA test was not recommended for cancer but is used. Any injury to the prostate even slight can give you a high count. Like having sex the night before the test or riding a bike or even sitting down hard in a hard chair. I had a relative high reading with one blood test and I laugh because I rode my motorcycle over a rough road before the test.
Here is an online article from University of Chicago Medicine regarding PSA tests. In part, it says: “Every man who has a life expectancy estimated to be greater than 10 years should at least have the conversation with their physician about the pros and cons of checking their PSA levels,” Eggener said. “Not every man needs a PSA, not every man with an elevated PSA needs a biopsy, and not every man with cancer necessarily needs immediate treatment.” An internet search says that the cost of a PSA Test is about $40 as a stand-alone test. So all this crap about whether or not to get a test as part of early cancer detection is infuriating. Why would I "Have a conversation with my doctor" about whether or not to get this test when it only costs $40 retail? Hell, the guy's gonna charge me $50 just to discuss it. And you're drawing blood anyway for my annual physical, moron! If they wanted to sell this to us, we would be denigrated for not spending "Less than the price of a cup of coffee a month." Just because a man might not need a biopsy and/or treatment does not mean to forego the initial testing. This is stupid to repress data gathering because subsequent decision making might be flawed. The only "con" to the test is what might be done with the information. "I might go on an unhealthy diet, so I threw away my scale."