unicorn

We're halfway through a 2-week cruise, on a voyage where most of the guests are in their 70s and 80s (neither of us is). The evening entertainment consists mainly of shows containing music of the 70s and 80s, when most of the guests would have been in their youths. There doesn't seem to be any music from the last 30 years. Well, I'm in my early 60s, yet I usually listen to more contemporary music. Yes, sometimes I listen to music from my youth, but less often. I don't necessarily listen to every latest song, but I prefer listening to more current singers. Obviously, the cruise line tries to cater to its target passenger, but is it really the case that older people aren't interested in what's currently playing? Am I unusual in having interests in recent hits, in addition to older music? I have an old (well, very old) friend who was born in 1919 (as of last December, at least, she was still alive). She lives on the opposite coast, and when we got together we would enjoy going to jazz clubs together. It wasn't until my husband and I met her that we mused "Well, I guess that's the music which was popular in her youth!". Do you older men mostly enjoy the music from when you were young, or do you more often listen to the latest hits?

I couldn't agree with you more! 😃

People believing what they want to believe instead of actual facts? Believing some doofus or doofuses instead of examining actual facts and listening to the experts? Where have I heard that before? Oh my goodness!

That statement is so incredibly both stupid and factually wrong, it hardly deserves comment, but here I go. As you know, I wasn't quoting my opinion, but rather consensus statements and professional guidelines which were put together by groups of health care experts (which you are definitely not) who read, digested, and spent large amounts discussing among themselves (none of which you did). It is you (and your family members, apparently) who have the arrogance and foolishness to believe you know better.

Well, since these data followed the patients for over 10 years, and new radiation techniques which protect the bladder and rectum have only been around 7-8 years, the data would tend to over-estimate the complication rates of radiation therapy. However, given the identical 5 and 10-year overall survival rates (i.e. those who survived regardless of cause of death), one has to ask whether the outcomes are any better or worse for those who chose surveillance (in other words, neither surgery nor radiation). Those studies tend to show surveillance as a wiser choice: https://jamanetwork.com/journals/jamaoncology/article-abstract/2826069 (The abbreviation PCA means prostate cancer) "...3946 participants had PCA, among whom 655 were treated with prostatectomy and 1056 with radiotherapy. The 12-year hazard risk of urinary or sexual complications was 7.23 times greater for those with prostatectomy (95% CI, 5.96-8.78; P < .001) and 2.76 times greater for radiotherapy... The incidence per 1000 person-years of any 1 of the 10 treatment-related complications was 124.26 for prostatectomy, 62.15 for radiotherapy, and 23.61 for untreated participants... This cohort study found that, even after accounting for age-related symptoms and disease, PCA treatment was associated with higher rates of complications in the 12 years after treatment. Given the uncertain benefit of PCA treatment for most patients, these findings highlight the importance of patient counseling before PCA screening and treatment and provide a rationale for pursuing opportunities for cancer prevention...". Unfortunately, as this discussion clearly shows, adequate patient counseling and eduction both prior to obtaining consent for PSA screening, and after results are given, are more the exception than the rule. You earlier asked "How can a blood test lead to bad results?". Well, this is the answer.

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...".