5 ms·

I don’t understand why PSA levels aren’t included as part of the standard blood work done with check ups.

by aantix 1y ago

tombert 1y ago
Not a doctor, but I thought that part of the issue is that PSA tests aren't terribly accurate, and have a lot of false positives.
kgwxd 1y ago
Today, my local news station said they used to. My guess is, carriers decided to keep the money instead.
- nradov 1y ago
  Which carriers are you referring to? Commercial health plans are subject to a minimum medical loss ratio so they don't get to keep any more money by denying coverage for PSA tests. The general issue is that with only a few exceptions, most cancer screening tests haven't been proven to improve patient outcomes.
kelseyfrog 1y ago
Most people with prostates experience a rise in PSA levels as they age. There's no evidence that treatment, especially given how slow, growing prostate cancer usually is, results in a net positive benefit overall. The exception is younger people with aggressive cancer, but you can't exactly limit PSA screening only to young people with aggressive prostate cancer.
henrikschroder 1y ago
My understanding is that it's net negative to test too much. A lot of men die with prostate cancer, because only very few die from it. And if you belong to the former group, knowing about it or doing any kind of intervention means a massive loss in quality of life. So the best course of action overall is to close our eyes and stop looking. And hope you don't belong to the latter group.
- trebligdivad 1y ago
  It does depend a bit what the next step is; you can MRI as the 1st step, and that at least is harmless.
  - burnt-resistor 1y ago
    MRI machines need to be a) democratized so they're cheaper and everywhere and b) connected to trustworthy clinically-proven radiological AI to identify and watch growths. There's absolutely no rational reason any patients should end up with surprise terminal cancers or surprise coronary artery disease. (Yes, yes whole body scans exist but these are largely pseudo-medical scams that don't deliver what they promise. I'm saying deliver on it, within reason.)
    - trebligdivad 1y ago
      It would help if they weren't damn slow; taking up an expensive machine for an hour is not a way to be cheap!
    - CamperBob2 1y ago
      Why wouldn't whole-body scans satisfy your criterion in the first paragraph (for those who can afford them, anyway?)
    - robertlagrant 1y ago
      > MRI machines need to be a) democratized so they're cheaper What does this mean?
      - southernplaces7 1y ago
        I'd also like to know how one "democratizes" a multi-million dollar machine that's also extremely expensive to maintain.
- dmurray 1y ago
  It's an indication that something's wrong with the system. We'd get better overall health outcomes if we tested everyone and told a large cohort of people "you do have cancer, and there are these possible treatments for it, but we recommend you don't take any of those treatments and just hope for the best". But between doctors and patients and other healthcare participants, we collectively can't do this - a large minority of people will freak out and demand treatment and the healthcare providers will feel compelled to go along with it. Perhaps this plan just needs better marketing. Instead of dividing tumors into benign and malignant we could have a third category for malignant but slow-growing.
waynecochran 1y ago
My doctor tells me that PSA testing has now shown to not be effective so they don't do it anymore. I am 58 and my dad died of prostate cancer so I am concerned.
- Herodotus38 1y ago
  It should be patient dependent. Screening everyone is not currently thought to be useful but those with risk factors should be screened after a discussion of risks/benefits. Your father having prostate cancer (especially if he was diagnosed before age 65) is a risk and I would advocate for it, especially if it something you are worried about and you understand that sometimes a PSA can be falsely elevated in benign conditions, which may mean you get a biopsy that ultimately wasn’t necessary, and the potential risks that could have. For a good short overview: https://www.cancer.gov/types/prostate/psa-fact-sheet https://www.cancer.gov/types/prostate/psa-fact-sheet And read “is the PSA test recommended…”
- jonstewart 1y ago
  If you’re 58 and your dad died of prostate cancer, I’d insist on PSA tests in your checkups if I were you. The harm is not the PSA test but in overtreatment too early on—a lot of prostate cancer is slow. Fighting it when it’s stage 4 is no fun, though.
- mindslight 1y ago
  Think of how full of shit most software developers are. Now think of how much worse their advice would be if they could be sued for wrong answers, but were given all of ten minutes to look at a code base and come up with a recommendation. That's a doctor. I agree with the sibling advice to insist on PSA labs. You are your own advocate. The primary job of a doctor is actually to be a bureaucrat, the first line of offense for the health management companies whose whole function is to deny healthcare. They can easily rubber stamp a few labs once you change their risk calculus of not doing it, by explicitly laying out your risk factors.
  - robertlagrant 1y ago
    I would make sure you scope your advice to the health system of the person you're replying to, even if you can't be sued for wrong answers.
teuobk 1y ago
Current evidence is that PSA tests don't actually save lives: https://thennt.com/nnt/psa-test-to-screen-for-prostate-cancer-2/ https://thennt.com/nnt/psa-test-to-screen-for-prostate-cance... I wish they did, of course. I personally lost a close friend to prostate cancer last year. He was 41 and was, before the cancer, one of the healthiest and most athletic people I knew. The first inkling he had that anything was wrong was a backache that wouldn't go away; a stage 4 diagnosis ensued. He held on for 21 months from the onset of symptoms before the cancer took him.
RandallBrown 1y ago
My dad is in his late 70s and has tested at very high PSA levels a few times. So far none of the biopsies have found cancer, but they've caused a lot of stress and discomfort for him. I don't have a strong opinion about the tests either way, but I wasn't the one getting the biopsies.
- aantix 1y ago
  That does sounds stressful. Sorry he had to go through that. I have high psa levels. 17. Had a biopsy. Turns out I have a really large prostate. My doctor said that some just naturally have larger prostates and the larger ones produce more psa. The psa density function put my levels at normal when taking in to consideration the size. The biopsy came back negative.
- apwell23 1y ago
  i thought only cancerous cells dump out PSA into serum. is that not true?
  - tim333 1y ago
    Yeah, not true.
_--__--__ 1y ago
In addition to what other commenters have said, the growing market for telehealth finasteride means means that a decent portion of the male population are artificially below baseline PSA levels (and my understanding is that this has some degree of long term effect even if you stop taking the drug).

I don’t understand why PSA levels aren’t included as part of the standard blood work done with check ups.

by aantix 1y ago

I don’t understand why PSA levels aren’t included as part of the standard blood work done with check ups.

Not a doctor, but I thought that part of the issue is that PSA tests aren't terribly accurate, and have a lot of false positives.

kgwxd 1y ago

Today, my local news station said they used to. My guess is, carriers decided to keep the money instead.

nradov 1y ago
Which carriers are you referring to? Commercial health plans are subject to a minimum medical loss ratio so they don't get to keep any more money by denying coverage for PSA tests. The general issue is that with only a few exceptions, most cancer screening tests haven't been proven to improve patient outcomes.

kelseyfrog 1y ago

Most people with prostates experience a rise in PSA levels as they age. There's no evidence that treatment, especially given how slow, growing prostate cancer usually is, results in a net positive benefit overall. The exception is younger people with aggressive cancer, but you can't exactly limit PSA screening only to young people with aggressive prostate cancer.

henrikschroder 1y ago

My understanding is that it's net negative to test too much. A lot of men die with prostate cancer, because only very few die from it. And if you belong to the former group, knowing about it or doing any kind of intervention means a massive loss in quality of life. So the best course of action overall is to close our eyes and stop looking. And hope you don't belong to the latter group.

trebligdivad 1y ago
It does depend a bit what the next step is; you can MRI as the 1st step, and that at least is harmless.
- burnt-resistor 1y ago
  MRI machines need to be a) democratized so they're cheaper and everywhere and b) connected to trustworthy clinically-proven radiological AI to identify and watch growths. There's absolutely no rational reason any patients should end up with surprise terminal cancers or surprise coronary artery disease. (Yes, yes whole body scans exist but these are largely pseudo-medical scams that don't deliver what they promise. I'm saying deliver on it, within reason.)
  - trebligdivad 1y ago
    It would help if they weren't damn slow; taking up an expensive machine for an hour is not a way to be cheap!
  - CamperBob2 1y ago
    Why wouldn't whole-body scans satisfy your criterion in the first paragraph (for those who can afford them, anyway?)
  - robertlagrant 1y ago
    > MRI machines need to be a) democratized so they're cheaper What does this mean?
    - southernplaces7 1y ago
      I'd also like to know how one "democratizes" a multi-million dollar machine that's also extremely expensive to maintain.
dmurray 1y ago
It's an indication that something's wrong with the system. We'd get better overall health outcomes if we tested everyone and told a large cohort of people "you do have cancer, and there are these possible treatments for it, but we recommend you don't take any of those treatments and just hope for the best". But between doctors and patients and other healthcare participants, we collectively can't do this - a large minority of people will freak out and demand treatment and the healthcare providers will feel compelled to go along with it. Perhaps this plan just needs better marketing. Instead of dividing tumors into benign and malignant we could have a third category for malignant but slow-growing.

waynecochran 1y ago

My doctor tells me that PSA testing has now shown to not be effective so they don't do it anymore. I am 58 and my dad died of prostate cancer so I am concerned.

Herodotus38 1y ago
It should be patient dependent. Screening everyone is not currently thought to be useful but those with risk factors should be screened after a discussion of risks/benefits. Your father having prostate cancer (especially if he was diagnosed before age 65) is a risk and I would advocate for it, especially if it something you are worried about and you understand that sometimes a PSA can be falsely elevated in benign conditions, which may mean you get a biopsy that ultimately wasn’t necessary, and the potential risks that could have. For a good short overview: https://www.cancer.gov/types/prostate/psa-fact-sheet https://www.cancer.gov/types/prostate/psa-fact-sheet And read “is the PSA test recommended…”
jonstewart 1y ago
If you’re 58 and your dad died of prostate cancer, I’d insist on PSA tests in your checkups if I were you. The harm is not the PSA test but in overtreatment too early on—a lot of prostate cancer is slow. Fighting it when it’s stage 4 is no fun, though.
mindslight 1y ago
Think of how full of shit most software developers are. Now think of how much worse their advice would be if they could be sued for wrong answers, but were given all of ten minutes to look at a code base and come up with a recommendation. That's a doctor. I agree with the sibling advice to insist on PSA labs. You are your own advocate. The primary job of a doctor is actually to be a bureaucrat, the first line of offense for the health management companies whose whole function is to deny healthcare. They can easily rubber stamp a few labs once you change their risk calculus of not doing it, by explicitly laying out your risk factors.
- robertlagrant 1y ago
  I would make sure you scope your advice to the health system of the person you're replying to, even if you can't be sued for wrong answers.

teuobk 1y ago

Current evidence is that PSA tests don't actually save lives: https://thennt.com/nnt/psa-test-to-screen-for-prostate-cancer-2/ https://thennt.com/nnt/psa-test-to-screen-for-prostate-cance... I wish they did, of course. I personally lost a close friend to prostate cancer last year. He was 41 and was, before the cancer, one of the healthiest and most athletic people I knew. The first inkling he had that anything was wrong was a backache that wouldn't go away; a stage 4 diagnosis ensued. He held on for 21 months from the onset of symptoms before the cancer took him.

RandallBrown 1y ago

My dad is in his late 70s and has tested at very high PSA levels a few times. So far none of the biopsies have found cancer, but they've caused a lot of stress and discomfort for him. I don't have a strong opinion about the tests either way, but I wasn't the one getting the biopsies.

aantix 1y ago
That does sounds stressful. Sorry he had to go through that. I have high psa levels. 17. Had a biopsy. Turns out I have a really large prostate. My doctor said that some just naturally have larger prostates and the larger ones produce more psa. The psa density function put my levels at normal when taking in to consideration the size. The biopsy came back negative.
apwell23 1y ago
i thought only cancerous cells dump out PSA into serum. is that not true?
- tim333 1y ago
  Yeah, not true.

_--__--__ 1y ago

In addition to what other commenters have said, the growing market for telehealth finasteride means means that a decent portion of the male population are artificially below baseline PSA levels (and my understanding is that this has some degree of long term effect even if you stop taking the drug).