Well done in general. I know of no urologist, and I know many, who follow the recommendation of the PSA not being done as per the guidelines. They ALL recommend that a PSA be done. There are 2 kinds of PSA available here: High-sensitivity PSA & total/free PSA. I am ordering PSA on ethnic patients over the age of 40 and all men over the age of 50. From alternative medicine, ice cream is the #1 determinant of cancer of the prostate (& what was the common picture we often saw of Biden?) followed by dairy products as a whole, and then the animal protein oriented Western diet. An 85% (ideally organic and unprocessed: grains-vegetables-beans-fruit-nuts-seeds) plant-based diet decreases both cancer of the breast and cancer of the prostate and slows the progress of both. HRS, MD, FACC
One possible factor not discussed here is the extent to which genetic loading plays a part in decision-making. My brother had an aggressive prostate cancer when he was about 68 and chose surgery. Our father had the more typical slow growing prostate cancer and died of congestive heart failure at age 97. Did the fact that Dad had prostate cancer impact my brother's chances of an aggressive prostate cancer?
Thanks for the summary. PSA screening is not a one time event. My yearly tests over the past decade have created a time line or a curve. I would think a sudden “spike” would be a concern. First, physical exam of prostate is normal, and no change in other symptoms. Next, seeing a urologist for their suggestions. Continuing research is needed to guide decisions about follow up, scanning and biopsies in men over 70. As in all science there are differing opinions. For me, that would mean having a conversation.
Thanks John. It is really great to hear from you and I agree with your perspectives. I believe most people can understand these issues and my goal is just to give them more information so they can participate in the discussion meaningfully. The goal is to get treatment if it will help and avoid it if it won't.
Another sage piece from Dr Bestermann. In the case of former Pres. Biden, wouldn't a rectal digital exam over the past 10 - 12 years likely have detected irregular (firm) texture to the prostate gland? I don't see that mentioned as a key element of the annual screening for this disease. Thank you Bill.
Thanks for pointing that out Dr. Schutzer. Sorry for that omission. Yes, a digital rectal exam is another important way to detect prostate cancer and if there is a nodule, that tells you exactly where the cancer is. I am not a urologist, but it seems that information would make a biopsy more accurate.
However, the biggest flaw in the USPSTF recommendation is that it relies on average life expectancy, which doesn't account for individual variation. Many men live well into their 80s and beyond, so it's misguided to assume that a 70-year-old today is unlikely to live another decade. This limitation is starkly illustrated by the former president himself—now 82—who had his last PSA test in 2014 at age 72 and is now battling an aggressive, metastatic cancer.
Well done in general. I know of no urologist, and I know many, who follow the recommendation of the PSA not being done as per the guidelines. They ALL recommend that a PSA be done. There are 2 kinds of PSA available here: High-sensitivity PSA & total/free PSA. I am ordering PSA on ethnic patients over the age of 40 and all men over the age of 50. From alternative medicine, ice cream is the #1 determinant of cancer of the prostate (& what was the common picture we often saw of Biden?) followed by dairy products as a whole, and then the animal protein oriented Western diet. An 85% (ideally organic and unprocessed: grains-vegetables-beans-fruit-nuts-seeds) plant-based diet decreases both cancer of the breast and cancer of the prostate and slows the progress of both. HRS, MD, FACC
Thanks for that comment on urologists. That really helps put the recommendations into perspective.
One possible factor not discussed here is the extent to which genetic loading plays a part in decision-making. My brother had an aggressive prostate cancer when he was about 68 and chose surgery. Our father had the more typical slow growing prostate cancer and died of congestive heart failure at age 97. Did the fact that Dad had prostate cancer impact my brother's chances of an aggressive prostate cancer?
It is pretty clear that if a father has prostate cancer it is more likely to occur in the son. I can't comment beyond that.
That Biden didn’t have a psa for many years stuns me. Personally I would prefer a psa->discussion than a discussion->psa
Thanks for the summary. PSA screening is not a one time event. My yearly tests over the past decade have created a time line or a curve. I would think a sudden “spike” would be a concern. First, physical exam of prostate is normal, and no change in other symptoms. Next, seeing a urologist for their suggestions. Continuing research is needed to guide decisions about follow up, scanning and biopsies in men over 70. As in all science there are differing opinions. For me, that would mean having a conversation.
Thanks John. It is really great to hear from you and I agree with your perspectives. I believe most people can understand these issues and my goal is just to give them more information so they can participate in the discussion meaningfully. The goal is to get treatment if it will help and avoid it if it won't.
Another sage piece from Dr Bestermann. In the case of former Pres. Biden, wouldn't a rectal digital exam over the past 10 - 12 years likely have detected irregular (firm) texture to the prostate gland? I don't see that mentioned as a key element of the annual screening for this disease. Thank you Bill.
Thanks for pointing that out Dr. Schutzer. Sorry for that omission. Yes, a digital rectal exam is another important way to detect prostate cancer and if there is a nodule, that tells you exactly where the cancer is. I am not a urologist, but it seems that information would make a biopsy more accurate.
Completely agree, Dr. Bestermann!
I had written about this as well:
https://ramkrishnan.substack.com/p/the-missed-signal-what-president
From my post:
However, the biggest flaw in the USPSTF recommendation is that it relies on average life expectancy, which doesn't account for individual variation. Many men live well into their 80s and beyond, so it's misguided to assume that a 70-year-old today is unlikely to live another decade. This limitation is starkly illustrated by the former president himself—now 82—who had his last PSA test in 2014 at age 72 and is now battling an aggressive, metastatic cancer.