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This article isn't very good IMHO because it focuses on emotional considerations rather than the underlying math. The core problems with the PSA test is that it
by AlanYx 5y ago
This article isn't very good IMHO because it focuses on emotional considerations rather than the underlying math. The core problems with the PSA test is that it has relatively low statistical specificity and it hasn't been shown to have any statistically significant effect on mortality in aggregate, and the resulting treatment options do have statistically significant morbidity. Hence all the debate about when, how often, and for whom. All the arguments about increased anxiety are pretty unhelpful and obscure the underlying statistical challenges.
- zwieback 5y agoMy understanding was that the article was specifically meant to be about the emotional considerations, which are a result of the statistical challenges. BTW: one flipside of the high sensitivity is that if you have your prostate removed the PSA becomes a fantastic test. I get it once a year and if it's anything other than zero I know I have a problem
- NikolaNovak 5y ago>> if it's anything other than zero I know I have a problem Is that actually factually always true? At least two of the men I know have had prostate removed and show occasional PSA spikes, that have stumped their doctor for a decade but has never led to any specific issues concerns problems or actions (other than, yes, anxiety...)
- zwieback 5y agoThat is concerning. I've heard that PSA can be produced in other parts of your body but at very low level, not enough to pass the threshold of concern. If the spikes are high and the test is reliable then there could be something lurking in the body somewhere. The other answer also suggests it's difficult to diagnose where the cancer (or tumor, etc.) is located.
- drocer88 5y agoHere's an authoritative source on Protein Specific Antigen ( aka KLK3, Kallikrein related peptidase 3 ): https://www.proteinatlas.org/ENSG00000142515-KLK3/tissue https://www.proteinatlas.org/ENSG00000142515-KLK3/tissue
- mklepaczewski 5y agoIndeed. My father had prostate removed (due to a tumor) and does PSA screening regularly. A while after the surgery his PSA showed up again and started raising - slowly. Unfortunately, it took _years_ before doctors were able to locate source of it and remove it. I suspect you can imagine the impact it had on his mental well-being. Each test was bringing him closer to potentially grim diagnosis. He knew he had it, but he didn't know where and how serious it was going to be. I was shocked by it. So many times I've heard that people get diagnosed too late, and here was my father with as early as possible confirmation of spread of his cancer and he was told to wait. Edit: clarification on the cause of prostate removal.
- toomuchtodo 5y agoIf you don’t mind me asking, how did they find it and remove it years later?
- mklepaczewski 5y agoPET scan, the tumors where in lymph nodes. They got rid of them with surgery.