Now, let's not be to hard on the author.  They have to make a living by
filling space.  And then YOU come along and expect that they also include
accuracy and sense. Geeez......

Just kidding. It's one of my pet peeves too.  Sometimes I think people who's
writing (or speaking) effects the health and well being of people should
require a license to publish.   I know the First Amendment crowd will scream
but we DO require licensing of doctors, pharmacists, etc.

hi smith - the bottom line on the psa test is that some people want to
treat it as THE final word.  it is simply a tool that can used in
conjunction with the DRE,  free psa II test, and biopsy.  

they are right when they say that the psa can give false positives, but
the psa test is doing it's job.  now, what did i mean by that?

you may have a prostate infection and get a psa testing and it may come
back in the 30's.  boy, wouldn't that make you run to the uro.  but
after treating the infection, your psa would go back into the normal
range.  did they make the psa wrong?  no, it tested what it was suppose
to.  

another case in point.   you can have an ejaculation and it will drive
up the psa reading.  again, is the psa test at fault?

or how about getting a STD?   certainly that might drive up the psa.

but to make a blanket statement that the number of the psa test will
clearly indicate that you do or do not have prostate cancer is totally
off base.

now, with that said, i will give some facts about my case.  i hadn't had
a psa test for 5 years.  my psa came back at  5.79 with a negative DRE.
they decided to treat me with a 2 week round of antibiotics.  it dropped
a little bit, but not much.  they weren't happy with the psa number and
sent me to the uro dept, which took another psa test with the
understanding that if it was 3.99999 we would NOT do the biopsy, but if
it was 4.0000 we WOULD do a biopsy.  psa test came by at 6.25.  biopsy
confirmed cancer in both lobes.  at time of surgery psa was already at
6.35 and i had a DRE done within a few hours of surgery and they still
could not "feel" any lumps or signs that i had cancer knowing all the
tests confirmed it.  

would i put my faith into the psa test - you betcha.  it was the ONLY
test that sounded the alarm.  but one has to remember, figures don't
lie, but liars did figure.  keep that in mind when you read about
somebody taking a stance for or against a concept and read inbetween the
lines.  you might be surprised what the true meaning is.

just my .02 cents

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."

I agree. A PSA test alone does not lead to unnecessary treatments. It may
signal a desire to test further. Only after a biopsy and a conclusive
finding that cancer is present will men be treated for PCa. How does someone
so incompetent get published in Business Week???

Larry

My primary care doc did not do the PSA test because of the false
positives, and then a biopsy would be required to know for sure.  He
explained in detail how it worked, and then left the final decision up
to me.  I trusted his opinion and just went with the DRE.  When mine
was diagnosed it was T1C, PSA 5.0, PSA Free 6%, Gleason 6, and only 6%
in two cores on biopsy, so it was caught early.  Having the PSA at all
was just a fluke, insurance nurse physical, so I was lucky.  I could
have gone ten more years and ended up with who knows what?  

Yes, I agree, the article is lacking in fundamental logic here.  The
author missed something for sure.

Thank you.
David S.

Is there any reason to believe that Businessweek or its reporters have
any special expertise which qualifies them to make recomendations
concerning medical issues?  I doubt it.

There is a big debate still ongoing in the medical community about the
advantages of PSA testing.   But this refers mainly to how useful it is
as a public health measure when applied to the population as a whole.
Urologists by and large think it is good idea, but other groups
including some epideimiologists don't.   The scientific debate invovles
considerable subtleties, but when they get out into the general media,
these subtleties are glossed over and you see idiotic statements like
that you refer to.

PSA testing, by iteself, is not dangerous.   The dangers, if any, are
relatively remote consequences of testing.   The critics of testing
argue that general testing will detect many cancers which in fact need
not be treated.  If those cancers are treated, a certain number of the
men involved will suffer significant negative side effects.   So the
problem from a public health perspective is whether the net gain in
reducing prostate cancer mortality and improving the lives of men whose
cancers are treated is greater or less than the net negative
consequences of treating men whose cancers don't need treatment.
Talking about this is made more complicated by the fact that no one
knows how many cancers which are currently being treated need not be
treated, and there are no really hard figures on how much better off men
who are treated by radiation and surgery for early prostate cancer than
are men who are not so treated and later develop metastatic cancer which
has to be treated by HT.

Unfortunately the critics have gone to the general public, as have the
proponents to a much lesser degree.   In so doing they make exaggerate
claims about the innocuousness of prostate cancer and/or the futility of
treating it.  This is often picked up by the media.

In this particular case, the reporter has even got the critics argument
wrong.  The PSA test is indeed "too sensitive" in that it produces a lot
of false positives.  That by itself would not be all that serious since
many other medical screening tests do the same thing.   But as you point
out, the consequence of such a false positive is an unnecessary biopsy.
 biopsy does have some minor risks but by and far it is a simple, safe
procedure.   The issue is really what happens when the biopsy is
positive (so the PSA test was not a false positive).   It is in that
case that the question arises as to whether the cancer should be treated
aggressively.  As noted above, we don't really know how many such cases
there are and, more important, which such cases really need to be treated.

But it should be noted that in many respects the two sides of the debate
are not really that far apart.   The critics mostly would agree that
certain men who are at high risk for prostate cancer should have regular
PSA tests, and those in favor of PSA testing usually don't think it is
necessary for men past a certain age who are unlikely to benefit from
aggressive treatment if a cancer is detected.