Get PJ Media on your Apple

PJM Lifestyle

Men: Need Another Excuse to Put Off That Prostate Exam?

All in all, the paper is not encouraging: except to me, of course, who wants desperately to have to do nothing for the sake of my health.

by
Theodore Dalrymple

Bio

August 27, 2013 - 1:00 pm
Page 1 of 2  Next ->   View as Single Page

shutterstock_1836800

Even non-hypochondriacs such as I sometimes worry fleetingly about their health when, having reached a certain age, some of their friends and acquaintances fall foul of a disease, namely (in this case) cancer of the prostate. But my anxiety does not last long and so far I have managed successfully to resist all attempts by my medical colleagues to measure my prostate specific antigen (PSA). I want to have as little to do with doctors as possible, other than socially of course, and there is nothing quite like a high PSA level to provoke doctors’ interference in a man’s life.

Would this interference, though, prolong my life if I allowed it to take place? A recent paper in the New England Journal of Medicine starts optimistically and ends pessimistically. It draws attention to the fact that mortality from prostate cancer has fallen drastically and attributes this to improvement both in early diagnosis of the cancer by means of screening and of treatment once diagnosed.

The body of the paper, however, is less sanguine. First 18,880 elderly men were divided into those who were given finasteride, a drug that was hoped would prevent cancer, and those given placebo. Some years later it was discovered that finasteride did indeed reduce the numbers of patients who developed cancer, in fact by nearly a third.

So far so good: but this is not the end of the story. Unfortunately, prostate cancer is a very variable disease such that, while some men die of it, many more men die with it than of it. And while finasteride seems to have prevented many low-grade cancers, those that would not have killed the men in any case, it seems also to have increased both the number and proportion of the more serious kind.

Comments are closed.

Top Rated Comments   
Get ready. I just had my 'yearly' and my GP asked if I wanted the PSA test. I asked why she was asking. She said that the data may be leading men to believe that they should act on info when no action is needed. I asked her why we would shy away from keeping track of PSA movement away from baseline. She agreed that info was not a harmful thing and was, in her estimation a good thing. So what gives? New 'guidelines'.

For how many years were women encouraged, cajoled, nagged and berated into having a mammogram? Then, miraculously, just as Obamacare was passed, we received new info. Don't need them under 50. Sorry and nevermind.
See a similarity? No, me either.
46 weeks ago
46 weeks ago Link To Comment
All Comments   (9)
All Comments   (9)
Sort: Newest Oldest Top Rated
In Terence57 you see how the welfare state works. No matter if a test does any good statistically, if the nanny state is taking it away then the suspicion is that it must be for cost reasons only.

If we paid for our own exams, each one of us would have to decide for ourselves whether it is worth it or not. Some would want it, and others would not. The folly is a centralized decision for everyone. Whether you'll want one or not depends on your philosophy of life and understanding of the medical efficacy.

I say "no" to finger exams. You know why? It is entirely unscientific. They don't keep any measurements of your prostate size, so how the Hell would your doctor know year to year whether your prostate is enlarging? A few years ago my doctor surprised me by saying "You're prostate is a bit enlarged". A was surprised because I have no family history even of enlargement. It worried me quite a bit. Then next year he says "You have no swelling whatever in your prostate." He didn't even remember he'd ever said otherwise. It's stupid. Never again is anyone checking my prostate.
45 weeks ago
45 weeks ago Link To Comment
Alex. if you think Jacob`s blurb is incredible, I just got a great Volkswagen Golf GTI from having made $8040 this - 4 weeks past and also ten grand this past month. this is actually the nicest work Ive ever done. I started this nine months/ago and almost straight away was bringin in more than $79 per-hr. web link http://www.wep6.com
Go to website and click Home tab for more details.
❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤❤
46 weeks ago
46 weeks ago Link To Comment
My father-in-law (a pathologist) feels PSA tests are nearly pointless because the antigen levels in blood are secondary and subject to many factors: PSA is found primarily in semen, of which it is a normal component. In men over 50, some 8% have PSA>4, yet when biopsied only 25% of them had prostate cancer of any type. That's a significant level of false-positives (75%).

Even worse, when men over 50 with PSA<4 were biopsied in a significant study some 15% of them *did* have cancer. That's a significant level of false-negatives (15%), yet if the biopsy threshold is set at >2.5 the false-negative problem remains significant and the false-positive problem becomes even worse.

Perhaps most misleading of all is that only about half of all prostate CAs are diagnosed by screening and even in those cases the percentage of diagnosed men whose cancers were likely to kill them if untreated hovered in the low single-digits.

The main reason for avoiding PSA screening is that the test is just plain lousy at achieving its intended purpose. If your DRE is fine and you can still write your name in the snow (as it were) the PSA is far more likely than not to be wrong, no matter where the threshold is placed.
46 weeks ago
46 weeks ago Link To Comment
there is nothing quite like a high PSA level to provoke doctors’ interference in a man’s life.
LOL! A partial solution is to hedge your bets: find an attractive 30-something female GP and ask her to make a low moaning sound as she 'performs the procedure'.
46 weeks ago
46 weeks ago Link To Comment
Get ready. I just had my 'yearly' and my GP asked if I wanted the PSA test. I asked why she was asking. She said that the data may be leading men to believe that they should act on info when no action is needed. I asked her why we would shy away from keeping track of PSA movement away from baseline. She agreed that info was not a harmful thing and was, in her estimation a good thing. So what gives? New 'guidelines'.

For how many years were women encouraged, cajoled, nagged and berated into having a mammogram? Then, miraculously, just as Obamacare was passed, we received new info. Don't need them under 50. Sorry and nevermind.
See a similarity? No, me either.
46 weeks ago
46 weeks ago Link To Comment
Where's the harm in having an annual PSA test?

No matter what the results, the patient still has the option of deciding what further, if any, tests to have done, and also what treatment, if any, is appropriate. No doctor can force you to have treatment you don't want.
46 weeks ago
46 weeks ago Link To Comment
Well overall I prefer the PSA test to that other bit.
46 weeks ago
46 weeks ago Link To Comment
Yeah, Doc, sit back and wait for symptoms. You shoulda
learned in med school that prostate cancer, in a lot of
cases, has no symptoms until it's all over the body. Yeah,
go ahead and wait until you have intense pain in your spine
and then whine when a doc says you're in real trouble.

Have a PSA test a couple of times a year, it won't kill you.

46 weeks ago
46 weeks ago Link To Comment
Finasteride, then, has three effect

1. reduce some tumors
2. shrink the prostate making urination easier
3. grow hair

2. and 3. are good things especially when you get to the point where you need both.

Downsides? I'll skip jumping into bed with Miley Cyrus.
46 weeks ago
46 weeks ago Link To Comment
View All