unicorn

I'm glad you had a good outcome. With modern technology, the advice regarding surgery vs radiation may have been out of date. Radiation now has better cure rates and fewer side-effects. The first surgeon may have had it right in that respect:

Wow. That story demonstrates another problem with screening. Obviously, it's not the test itself, but what one does with the results which determines the outcome. With a low PSA and a Gleason of 7, especially 3+4, the expected outcome is wildly different from a Gleason of 9. One has to wonder about the reason for the massive difference. Was the first pathologist just doing "CYA" (Cover Your Ass) because he wanted to force the patient into surgery? Did he genuinely lack the skill to interpret the biopsy? (pap smears are generally read by computers these days, so more reliable) More than likely, in this case active surveillance would have been a great option, as the outcome would probably have been fine in any case. The science is still out on genetic analysis. If the science proves robust, that may change outcomes (and subsequent changes in guideline recommendations), but that's speculation at this time. Most of the time, when men find out they have a cancer, the immediate reaction is "Get it out!", and the surgeon or radiation therapist is happy to oblige. Pathologists, as in this case, may push the scales further in the wrong direction, either through lack of skill or unscrupulous behavior.

While one cannot, of course, come to any conclusions from a single case, @lookin's post demonstrates one of the problems with PSA screening. Some of the more aggressive cancers won't produce PSA, while harmless ones will. Another problem is interpretation of the biopsy results. A Gleason score of 9 is highly alarming and would warrant aggressive treatment. A Gleason score of 7 indicates a possibly harmless cancer, for which active surveillance would be an option. Which was correct? Any pathologist would know that giving a score of 9 would prompt aggressive treatment, while a 7 might not. I'm happy there was a good end-result for the poster.

Well, all public health experts and professional organizations have guidelines which state that PSA screening in those 70+ is harmful, and should not be offered (see above), much less "generally recommended." Such behavior is, therefore, by definition unprofessional. While there's nothing wrong with a discussion, the fact that the writer states he "generally recommends" the test is de facto proof that these discussions contain misinformation. The vast majority of men over 70 have prostate cancer, few of which will ever affect the life of that person (and probably most of these cancers even regress). Checking PSA in one's 70s or 80s is like playing Russian Roulette with a bullet in all spots except one. You're going to get burned most of the time. Neither that speaker, nor, much less, the poster of this post, has any data to backup the (incorrect) contention that testing in the 70s (or beyond) is helpful for the man being tested. Just because you can name someone (such as the Secretary of Health and Human Services) who agrees with you does not entail a shred of evidence that your false beliefs are correct. This is all just more BS, without a shred of scientific fact. It's all a bunch of "someone agrees with me" rather than "Here's some data to support my belief." The only "support" you offer for your belief is testimonials, rather than fact. It's all rather childish. So RFK, Jr. thinks vaccines are harmful. Where's the evidence? And what's your excuse? Do you have a worm in your brain?

No surprise. No facts to backup your BS statement. Was anyone taking any bets?

A consensus statement (or professional guideline) is different from a scientific study. By definition (quite different, in fact). However, consensus statements are made by evaluating scientific studies--lots of studies. And if you've read extensively about this subject and know of even one (or, preferably, more than one) study which was somehow overlooked by the experts on the subject, why not share with everyone, instead of pretending to be such a smart-ass (with nothing but the opinions of his relatives to back him up)? Or will you fess up to lying about having read "extensively" on this subject? (And, no, polling your relatives doesn't constitute a valid scientific study)

No, you did not do the same: "...Adequate evidence from randomized clinical trials (RCTs) shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened. Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened. Current results from screening trials show no reductions in all-cause mortality from screening...". But what can one expect from the forum's resident liar? Not everyone on this forum is a brilliant mind, but you're unique in your propensity to lie (as opposed to just spouting dumb stuff). You are correct that I don't think that any of those consensus statements came out this year, and, since technology advances, there could be updates. If you know of any recent studies which contradict the current professional guidelines, please share with a link (though, knowing you, I will certainly go through any link you post, since you have a habit of stating that a source says one thing, when it actually says the opposite). So far, no one has posted any evidence which contradict these guidelines, unless you believe personal opinions constitute hard evidence (which apparently some people on this forum do in fact believe). I'm doubtful that such evidence exists, since it would be so ground-breaking that it would make international news everywhere. However, I'm all ears.

🤣

I'm glad I don't fly with the Star Alliance, which includes Lufthansa (my airline's with OneWorld). I often see the purser go in the pilots' cabin when one of the two pilots goes to the bathroom. Like 9/11, that German Wings tragedy should never happen again. Ever. There's no good reason to leave anyone in the pilots' cabin alone.

That post is so preposterous it boggles the mind. First of all, I didn't quote a study, I referenced a consensus statement written by experts who have gone through all of the many studies which examined the issue. They would never issue a statement based on one study. If you'd bothered to examine the link (which you didn't), you'd have found the 43 papers the group reviewed before coming up the recommendations. Secondly, it wasn't just their statement, but every single other organization (AAFP, AUA, Canadian Task Force, etc.) which agrees that screening those over 70 is harmful. Even organizations whose members stand to profit $$ from this screening (i.e. the American Cancer Society and American Urological Association) agree. As for the six doctors in your family who also believe they're more knowledgeable than the worlds' experts, that only provides support for the old adage: the apple doesn't fall far from the tree. As for the silly Japanese farmer argument, while I can't claim to have the world's experts behind me, I disproved every assertion made by those who thought the farmer was a hero rather than an idiot. If someone won't change his mind when new evidence gets presented, that only lends support to another adage: birds of a feather flock together.

Fortunately, science is not a popularity contest. Facts win out. 😉 That being said, if you haven't watched it, you might want to check out the movie Idiocracy. It looks as though we're heading that way. Under RFK Jr.'s direction, Florida just became the 2nd state to remove fluoride from its water. Let's celebrate science denial!

Obviously, if someone is having obstructive urinary symptoms, an exam and a (numerical) PSA test would be strongly recommended. This is not the same as screening. By definition, screening is testing someone with no symptoms. And free PSA is usually up to about 25%, not 30-35%. I cannot explain something to someone who refuses to educate himself on the subject.

Why don't you read the multiple references? Obviously, it's not the blood test itself, but rather acting on the information without understanding the consequences, like a lot of dumb-asses do. Even if only a biopsy is done, 1% of prostate biopsies involve complications which require hospitalization, and that's just for the biopsy. When prostates are removed for harmless cancers (and yes, most prostate cancers are harmless), morbidity and mortality increases. Not that difficult a concept to understand. First read up on the subject. Then you won't sound like an ignoramus when you try to discuss the subject. And maybe you'll actually learn something, instead of simply being a know-it-all who tries to pretend he's knowledgeable about something in which he's ignorant. You have no medical background, no public health background, yet have the arrogance to claim to know better that the world's best experts on the subject, who've actually read the data and know what they're talking about. Your extreme arrogance is only matched by your extreme ignorance of the subject.

A PSA test is not a "yes/no" test. It is a numerical value. The reference range depends on one's age, and even one's country of origin: https://pmc.ncbi.nlm.nih.gov/articles/PMC8099648/#:~:text=According to the findings of,9.01 ng%2FmL for the In general, a PSA between 4 and 10 should be followed up by a free PSA determination (higher levels of free PSA lower the concern for cancer), and levels over 10 should usually involve some further evaluation (ultrasound, MRI, or biopsy). Home tests have little role, and I can't think of who would want to have one done. If you don't have health care coverage, such as insurance, which will pay for a real, laboratory PSA test, you have far bigger things to worry about.

Well, what cannot be disputed is that no one needs a PSA test. However, professional guidelines dictate that the test not be offered without fully informing patients of the test's risks and.potential benefits. If the patient consents to the test, it should be an informed decision. When patients asked me about the test, I would inform them both verbally and in writing what the risks and potential benefits of the test were. Once informed, a majority declined, but some decided to go ahead. A more accurate statement would be that if the physician offers the test without fully informing you of both the risks and the potential benefits, change your doctor. As the professional guidelines state: "Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening."

Well, it's not arbitrary. It's what the data show. There is a difference between "I" recommendations (insufficient evidence), and "D" recommendations, which mean there IS adequate evidence, and the evidence shows that the action (i.e. screening) is harmful. This is different from the recommendations for Colon Cancer screening, which is more nuanced as we get older. The problem with prostate cancer screening is that ALL men will get prostate cancer if they get old enough, and only a small percentage of those who get prostate cancer will ever be affected by it. Autopsy studies on men who died for other reasons in the US show that essentially one's age pretty much equals the percent probability of finding prostate cancer on autopsy (in other words, most men 70+ have prostate cancer but won't be affected by it). While most prostate cancers regress spontaneously and/or do nothing, most colon cancers really do need to come out, and the data strongly suggest colon cancer screening is highly effective. When to stop colon cancer screening (unlike prostate cancer screening) depends more on the patient's health:

It's highly infantile, or insane, to believe that your personal (probably incorrect) feelings about the harms and benefits from screening in your individual case somehow invalidate decades of scientific study and known facts. The data are what they are, and not subject to "opinion": https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening#fullrecommendationstart "...Adequate evidence from randomized clinical trials (RCTs) shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened.3, 4 Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened.3 Current results from screening trials show no reductions in all-cause mortality from screening...". These facts don't change because of rhetoric. They are what they are. "Challenging" them can only be done with newer studies, perhaps reflecting newer technology (of course, these guidelines are reviewed every few years, or as new data come out). Saying they're invalid because of feelings from a personal experience makes about as much sense as statements from people who say "My niece received an MMR at 13 months, and was diagnosed with autism at 15 months. Therefore the MMR vaccine causes autism." It's ignorant and childish to make such statements, as well as hostile to science.

Well, there's really no lack of consensus, overall, as the data are very clear. (1) It is well-documented that there is NO overall survival benefit for prostate cancer screening. (2) There is a very small benefit in prostate cancer-specific death mortality for those screened (ages under 70), but this is completely offset by the increased mortality resulting from the screening. There is also significant morbidity associated with screening (not just "anxiety," but real morbidity such as incontinence). The only difference between the guidelines is whether it's EVER appropriate to discuss PSA screening. Some, such as the USPSTF and ACS, say it's OK to offer as long as the person being screened fully understands that the only benefit is prostate cancer-specific mortality, not all mortality, and also understands the serious morbidity risks (for those under 70). Others, such as the AAFP and Canadian Task Force, advise that any screening is inappropriate, since there is no overall mortality benefit, and substantial morbidity risks. This represents a very minor difference in opinion. Following the more permissive USPSTF and ACS guidelines, however, which are to fully inform patients of the risks and benefits, few men actually choose to go ahead, though some do. Not a single person who's actually reviewed the data thinks screening is appropriate for those 70+.

There is some epidemiological evidence that those who ejaculate at least 20 times a month have a lower risk for prostate cancer. However, the evidence is not based on randomized clinical trials, so must be viewed with some suspicion. Twice daily seems a bit overboard.... 😉 https://pubmed.ncbi.nlm.nih.gov/27033442/ "...During 480831 person-years, 3839 men were diagnosed with PCa. Ejaculation frequency at age 40-49 yr was positively associated with age-standardized body mass index, physical activity, divorce, history of sexually transmitted infections, and consumption of total calories and alcohol. Prostate-specific antigen (PSA) test utilization by 2008, number of PSA tests, and frequency of prostate biopsy were similar across frequency categories. In multivariable analyses, the hazard ratio for PCa incidence for ≥21 compared to 4-7 ejaculations per month was 0.81 (95% confidence interval [CI] 0.72-0.92; p<0.0001 for trend) for frequency at age 20-29 yr and 0.78 (95% CI 0.69-0.89; p<0.0001 for trend) for frequency at age 40-49 yr. Associations were driven by low-risk disease, were similar when restricted to a PSA-screened cohort, and were unlikely to be explained by competing causes of death...".

Yes, it did. You asked "How often did the White House doctors check his for this cancer?". Since he was in the 70+ age group during his entire time in the White House, the simple answer is that if his doctors knew what they were doing, never. (And I provided a link to the professional guidelines in order to substantiate the advice) In all likelihood, the former POTUS will do fine with hormonal treatment.

I'm sorry, but I'm not of the RFK, Jr. ilk who feel that any "opinion," regardless of its basis of known scientific facts, is "valid." This is not an issue in which the experts are "guessing." This issue has been studied extensively in almost countless studies around the globe, involving hundreds of thousands of men. Although there are plenty of different recommending bodies which have gone through the scientific studies and their data (unlike yourself), and there is some disagreement as to whether screening in the 50-69 group should be discussed and/or offered, every single organization composed of members who've looked at the data agree on one issue: screening those 70 and over is harmful. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening#fullrecommendationstart Recommendations of Others The American Academy of Family Physicians39 and the Canadian Task Force on Preventive Health Care40 recommend against PSA-based screening for prostate cancer. The American College of Physicians41 recommends that clinicians discuss the benefits and harms of screening with men aged 50 to 69 years and only recommends screening for men who prioritize screening and have a life expectancy of more than 10 to 15 years. The American Urological Association42 recommends that men aged 55 to 69 years with a life expectancy of more than 10 to 15 years be informed of the benefits and harms of screening and engage in shared decision making with their clinicians, taking into account each man’s values and preferences. It notes that to reduce the harms of screening, the screening interval should be 2 or more years. The American Urological Association also notes that decisions about screening, including potentially starting screening before age 55 years, should be individual ones for African American men and men with a family history of prostate cancer. The American Cancer Society43 adopted detailed screening recommendations in 2016 that highlight the importance of shared decision making and the need for informed discussion of the uncertainties, risks, and potential benefits of screening. It recommends conversations about screening beginning at age 50 years and earlier for African American men and men with a father or brother with a history of prostate cancer before age 65 years. To disagree with every recommending organization on the planet only shows both arrogance and ignorance. There are people whose job it is to review the data. They are not "guessing." And, no, the MMR vaccine doesn't cause autism, even though RFK Jr. may have a different opinion.

You may wish to inform yourself regarding subjects on which you pontificate. Prostate cancer screening is NOT recommended routinely for anyone. Official guidelines are that it's reasonable to discuss in men 55 to 69, and recommended against from age 70 onwards: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening Population Recommendation Grade Men aged 55 to 69 years For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening. C Men 70 years and older The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older. D I'm guessing that the discovery was made due to bone pain. Biden will be offered hormonal treatment (either physical or chemical castration), and probably will be fine. His other health problems, mainly his dementia, will get to him first.

Quite silly. Obviously, no one is above the law. Even the conservative majority of the SCOTUS stated such when they said Trump couldn't be prosecuted for his actions in his role of POTUS. Also obviously, misdirecting the authorities was not part of her judicial duties.

It looks like a grand jury indicted her yesterday. I wonder if she'll get a speedy trial?