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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2006How Men Select PCa Tx, per ACS
Public release date: 27-Mar-2006 Contact: Amy Molnar <mailto:amolnar@wiley.com> amolnar@wiley.com <http://www.interscience.wiley.com/> John Wiley & Sons, Inc. Prostate treatment decisions based on perception more than fact Men with prostate cancer generally make treatment decisions based on differences in the information they receive rather than their own preferences, according to a new review. Published in the May 1, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the review of studies in prostate cancer decision making suggests that a lack of medical evidence and consistent, comprehensive messages about therapeutic options compel men to turn to a wide variety of popular and biased sources, which influence their decision. This approach often results in treatments that do not generally reflect patients' goals. Despite new treatment options for prostate cancer, there is little evidence-based consensus in the oncology community about the most efficacious treatment. Newly diagnosed patients must still balance existing information about risks and benefits of available therapies with their own treatment objectives. Studies have shown that prostate cancer treatment varies not only among men in general but also by race and ethnicity, suggesting that the guidance patients receive is variable and confusing, and plays a part in their decision-making. Steven B. Zeliadt, Ph.D., M.P.H., of the Fred Hutchinson Cancer Center in Seattle and colleagues synthesized data from other studies to examine how and why men with prostate cancer make treatment decisions. The review of current literature shows that cancer eradication or control was the foremost objective of treatment for men. Minimizing side effects ultimately played a minor role in decision making. However, studies report a gap between patient treatment objectives and the evidence supporting the efficacy of the treatment chosen. Men's concerns about controlling "the cancer" correlated directly with the aggressiveness of the treatment they chose, regardless of actual disease severity. Yet, in choosing treatment, patients did not consistently rely on scientific evidence of a therapy's efficacy to control disease or prolong life. As few as one in four patients in one study relied on evidence of a treatment efficacy for their decision. Physicians and family, as well as race and culture may affect patients' decisions, but the degree of their respective influence varies in the literature and is often poorly measured, according to the review. Notably, physicians tended to present therapies in ways that were both confusing and dismissive of patient concerns about risks. This either biased patients' decisions or turned patients to other sources of information. Finally, studies fail to show how and if patients actually critically analyze the quality of information they receive. It is very likely, the authors add, that patients "have significant limitations in their ability to identify biased information, as well as their ability to weigh complex information about the outcomes that are important to them." "The perceptions of treatment efficacy related to cancer control far outweigh available supporting evidence, and most patients appear to select a prostate cancer treatment primarily based on its perceived ability to control the tumor," conclude the authors. > Prostate treatment decisions based on perception more than fact > "The perceptions of treatment efficacy related to cancer control far > outweigh available supporting evidence, and most patients appear to > select a prostate cancer treatment primarily based on its perceived > ability to control the tumor," conclude the authors. Well, as far as I can tell, for the great majority of PCa men, the local txs all have about the same efficacy. So I don't know what these authors think men are missing. As far as systemic, there's basically one option--ADT. Maybe chemo, for the experimental. I just don't think this article *says* anything. >> Prostate treatment decisions based on perception more than fact >> "The perceptions of treatment efficacy related to cancer control far [quoted text clipped - 3 lines] > > I just don't think this article *says* anything. When I read that report point by point to see if there is anything profound or interesting in it, I quickly began thinking in circles. Juniper's bottom line is a pretty good assessment, as I think most of us realize by now. Perhaps its most astute and critical observation is "Notably, physicians tended to present therapies in ways that were both confusing and dismissive of patient concerns about risks. This either biased patients' decisions or turned patients to other sources of information." The question then becomes, "Will more than about three uros or oncs change a thing in how they advise pts?" I.P. There is an overall 'ring of truth' to the report though nothing specific. The 'ring' is... many folks say that 'PC is so easy to treat these days' that it's no big thing. Docs who remove the prostate and proclaim the patient 'cured'. Guys not wanting aggressive treatments due to fear of impotence or incontinence. I actually think that this is the prevailing opinion and that WE...who look deeper...some MUCH deeper...consider that way of thinking to be really stupid...and it IS. Some folks, depending upon their insurance, their familiarity with docs and medical things...are quite content to have a doc say...'I'll cure you, not to worry.' We know it's dumb...but we also know that it DOES go on. Ron B. Chicago My reading of the abstract posted by Steve is that patients want the most aggressive treatment with the best chance of a cure, but only one in four do any research to find out what that treatment is. I presume that means that 3 out of 4 are simply asking their doctor, What's the best treatment for a cure? And then perhaps they do what he says with no further research. Maybe that's it. If so, it would mean that patients don't realize how much controversy there is about all this. It is a tradition in the U.S. to find a doctor you trust and just do what he says. I have a relative who was just diagnosed with lymphoma. He's a very intelligent and well educated guy. I sent him links to websites and support groups for lymphoma but he wasn't interested. He was sure he was in good hands and didn't need to do any research on his own. Alan > My reading of the abstract posted by Steve is that patients want the > most aggressive treatment with the best chance of a cure, but only [quoted text clipped - 3 lines] > he says with no further research. > I thought that the article was interesting and provocative, which is why I posted it. I suspect that all of us have seen men who simply will not take action to improve their chances for an optimal outcome. And of course there are those like a friend in Spokane who is of the right age for PCa, smokes, eats incorrectly, is generally a prime candidate. He refuses to have a PSA test because his medic says that there are "too many false positives." We all know (me from experience) what that means if he has the misfortune to develop PCa. IIRC, the position of the ACS is the same as my friend's medic. Frustration reigns. Regards, Steve J Here's (much) more information on the article based on WebMD's interview with its author [plus my comments in brackets]: Prostate Cancer Choice a Coin Toss? Uncertainty, Faulty Info Confuse Men Facing Prostate Cancer Treatment By Daniel DeNoon WebMD Medical News Reviewed By Louise Chang, MD on Monday, March 27, 2006 More From WebMD March 27, 2006 -- It may be the most important decision of their lives, yet most men base their choice of prostate cancer treatments on incomplete information. The finding comes from a review of studies looking at how men decided what to do when they learned they had early-stage prostate cancer. One huge complicating factor underlies the decision how -- and whether -- to treat prostate cancer: There's no clear evidence that any one treatment is more effective, or has fewer side effects, than another has. [Isn't he completely blowing off large bodies of work, especially including Strum & the PCRI plus many similarly authoritative findings? How can he say ADT SEs are comparable to those of RP or RT, especially considering that a) ADT does not cure and b) many RT and RP pts have zero SEs once their initial hassles dissipate? SURELY he's including only RP and RT!] At least for some men, there's not even good evidence that treatment is better than watchful waiting, says Steven Zeliadt, MD, PhD, research scientist at the Fred Hutchinson Cancer Research Center in Seattle, who worked on the study. "As a culture, we just don't like not knowing. So we tend to ignore that there is no information, and we find some way of being encouraging about treatment," Zeliadt tells WebMD. "Over and over and over again in these studies, men would bring up the issue of treatment side effects. But when it came down to it, among the factors that made them decide, side effects played a very small role. Ironically, that is the only area of treatment we have a lot of information about." It's an important study, says Robert A. Smith, PhD, director of cancer screening for the American Cancer Society. "What this particular article is addressing is very, very important," Smith tells WebMD. "People bring different preferences to bear in prostate cancer treatment decisions. But it is not clear these preferences are matched with the broad amount of information on what to do. It is hard." The Zeliadt study appears in the May 1 issue of the journal Cancer. How Men Pick a Prostate Cancer Treatment Once a man hears the words, "you've got prostate canceryou've got prostate cancer," he's faced with a choice. Because prostate cancer usually grows very slowly, he may choose watchful waiting. That means doing nothing more than having frequent checkups to make sure the cancer isn't spreading. Most men, after all, die with prostate cancer, not from it. Men who want to do more -- and most do -- face very different prostate cancer treatment options. For most men, these choices boil down to surgery or radiation therapy. {Now he's making some sense.] Most men, Zeliadt and colleagues found, want to pick the treatment that is most effective at curing their cancer. And this is where the system breaks down. Urologists who do surgery are most likely to say that surgery is the best treatment. Radiation oncologists are more likely to say that one or another radiation therapy is best. Yet there's no reliable proof that any of these relatively effective treatments is better than another, says prostate cancer researcher Timothy J. Wilt, MD, MPH, professor of medicine at the Minneapolis VA Center for Chronic Disease Outcomes Research. "Making a prostate cancer treatment decision is quite difficult," Wilt tells WebMD. "It is made more difficult because it involves many different medical specialties with competing, well-intentioned beliefs of effectiveness, what doctors practice, and what they might get reimbursed for." While the effectiveness of most treatments is roughly the same, the treatments do differ in important ways. These differences lie in their side effects. [Now we're back to self-contradiction.] "There just are a lot of side effects, period," Zeliadt says. "And that is downplayed in the discussion about prostate cancer treatment." "In general, doctors are more optimistic about treatment benefits and -- at that minute they tell a man he has prostate cancer -- they devote less attention to the risks and side effects," Smith says. Zeliadt found that men worried a lot about side effects. But they tended to choose a treatment not because of how well they think they can tolerate the side effect but because of how well they think it would work. And the factor that sways their decision doesn't always come from a reliable, unbiased source. "Men hear all this different information, and they tend to latch onto something," Zeliadt says. "It may be something the doctor said, the fact that their uncle died of prostate cancer, or something a neighbor said. It seems sort of random. In one study we reviewed, they came up with list of 93 questions men had about prostate cancer. And no two questions were on the top of any one guy's list. They just have so many different information needs. It is all over the place." [I'm starting to like this guy.] Every expert who spoke to WebMD said the same thing. Eventually, a man facing prostate cancer will ask his doctor, "Doc, what would you do?" "It is my personal belief that a doctor should not say what he or she personally would do," Wilt says. "Unless they come back with a treatment choice that I think is out on the far end, I just would not know what I would do, or what I would tell my father to do -- because my father and I are not you." Wilt, Smith, and Zeliadt say it's essential for a man to consider each of the possible side effects of treating, or not treating, early prostate cancer. They also agree it's essential for every man to make his own choice. [Oh, yez. He keeps getting better. ;-) ] "My job is to give you the information in the most balanced way and to understand what is most important to you," Wilt says. "That allows me to support you in that choice no matter what happens." Zeliadt suggests that men focus on their own situation and on their particular needs. "I would encourage men to forget all the information they have heard from other men. It probably does not apply to their scenario," Zeliadt says. "They should really think about how they would adjust to the different side effects of treatment and have that be an important consideration. There is probably not a wrong decision about survival you can make. All the different treatment options are pretty close to being excellent. And that includes watchful waiting." When a man does make his decision on prostate cancer treatment, Smith says, he tends not to regret it -- even if the outcome isn't as good as he'd hoped. [Hey, how do I vote for this guy in '08?] "The real issue for the doctor is how do you prepare and present authoritative information so that whatever decision the patient makes, he feels he made the right one at the time and knew what to expect afterwards," Smith says. Unfortunately, there's still a long way to go before doctors can offer men more help with these questions. "We may have been placing a lot of emphasis on questions about testing, and we need to place more emphasis on questions about treatment," Smith says. "Because men have to feel confident later that they had made the right decision." SOURCES: Zeliadt, S.B. Cancer, May 1, 2006; vol 106: advance online edition. Steven Zeliadt, MD, PhD, research scientist, public health sciences division, Fred Hutchinson Cancer Research Center, Seattle. Timothy J. Wilt, MD, MPH, professor of medicine, Minneapolis VA Center for Chronic Disease Outcomes Research. Robert A. Smith, PhD, director of cancer screening, American Cancer Society. > ... > While the effectiveness of most treatments is roughly the same, the > treatments do differ in important ways. These differences lie in their > side effects. > > [Now we're back to self-contradiction.] I know many people disagree with the view that the various forms of surgery and radiation are not equally effective, but I don't see any self-contradiction here. All he's saying is that the cure rates of the treatments are the same, but the side effects are different. Or did you mean this contradicts something earlier in the article? > ... > Every expert who spoke to WebMD said the same thing. Eventually, a man [quoted text clipped - 6 lines] > I are not you." > ... This is a fascinating question. We can presumably rule out the case where a doctor has a considered belief that one treatment really is better than another. If a doctor truly believes that surgery is more likely to lead to a cure than radiation, or vice versa, it be irresponsible not to tell that to the patient. But in the other case, where a doctor thinks two treatments are equal, what should he do when a patient presses for the doctor's choice? It seems to me that there are good ways to answer that. For example, a doctor might say "I think that I personally would choose surgery because, for me, I'd want a very clear indication whether the treatment worked or not." Or perhaps, "I think that I personally would choose radiation because I think the danger of incontinence is less and that is very important to me." But even when he does this, he should explain why someone would choose the opposite treatment. I consulted a radiation oncologist who told me that he thought pure external beam and external beam plus seeds were equally effective for my case. He resisted telling me which he would choose. But when I pressed him on it, he said he treated his father-in-law with EBRT + seeds. I appreciated his telling me that. Alan >> ... >> While the effectiveness of most treatments is roughly the same, the [quoted text clipped - 11 lines] > Or did you mean this contradicts something earlier in the > article? Exackle. He had just finished stating, "There's no clear evidence that any one treatment ... has fewer side effects than another" > But in the other case, where a doctor thinks two treatments are > equal, what should he do when a patient presses for the doctor's > choice? Certainly not give a short answer, IMO, because it will be misleading unless doc and pt have spent hours comparing priorities. For example, > "I think that I personally would > choose surgery because [insert any one or two criteria here]." would imply that's an overriding reason, even for the pt, whose main criterion might be any of the OTHER dozen considerations. I suspect the only way in which a doc should answer that question would be something like "Here are 10-15 significant factors, and you've read two of my recommended PC books. In what order would you prioritize your decision factors, and are any of them deal-breakers? ... discuss discuss discuss ... Well, Treatment A favors your criteria, but ..." > I consulted a radiation oncologist who told me that he thought > pure external beam and external beam plus seeds were equally [quoted text clipped - 3 lines] > > I appreciated his telling me that. But did he also admit that there's no advantage to dual radiation, or was that information not available yet? And did he tell you that his FIL was terrified of surgery, was a hemophiliac, and was allergic to scalpels ... or that your case was very different from his FIL's? I'm just a civilian, but even I try not to mention WHAT my adjuvant tx decision was without providing extensive rationale, lest anyone think my choice means squat to them. A doctor should be even more hesitant to say what he'd do, because his opinion MEANS something. I.P. > PSA test because his medic says that there are "too many false > positives." We all know (me from experience) what that means if he has I never understood what they mean by "false positives". A PCA test is not a diagnosis of cancer. I know, they think too many people get tx based on a PCA. But that is not the test's fault. The problem is that people don't do annuals, assess DT, etc. And I doubt anyone gets RP or RT on the basis of a PSA. That would be from a biopsy. And if someone makes a decision to have tx based on an iffy biopsy, that is still not the fault of the PSA test. It's not a false positive for anything, because it doesn't diagnose anything. Drives me nuts. As bad as our situation is, surely it would be worse if the PSA had risen to 260 before a test. Nuts. > IIRC, the position of the ACS is the same as my friend's medic. This is why I replied. Steve, what is "IIRC"? > This is why I replied. Steve, what is "IIRC"? If I Remember Correctly ... which I don't always do. Alan Quoting me: >> PSA test because his medic says that there are "too many false >> positives." We all know (me from experience) what that means if he has >> > > I never understood what they mean by "false positives". A PCA test is > not a diagnosis of cancer. That's why I put the phrase in quotes. Essentially, it's meaningless except to those, such as my friend's medic, who are clueless and need a convenient label (never mind that it is wrong). The PSA test is not PCa-specific, as we know. But it *is* prostate gland-specific. And a high test result gives patient and medic a heads-up that further investigation is necessary. AIUI (As I Understand It) most high-PSA results are not a result of PCa. (snip) >> IIRC, the position of the ACS is the same as my friend's medic. >> > This is why I replied. Steve, what is "IIRC"? > It's one of many Usenet abbreviations such as AIUI. IIRC = If I Recall Correctly. They're used as time-savers for commonly-used phrases. Regards, Steve J "The thing is to expect nothing in particular, but be aware of the lack of enforceable guarantees or enforceable contracts with nature/god/entropy as to the condition or durability of our bodies." -- Brian Brunner, PCa survivor, December 12, 2005 on The Prostate Problems Mailing List Thank you, Brian. Probably more than most would want to know... If your PSA "cutpoint" is say 4.0, then wouldn't a false positive (FP) be when someone has a PSA >= 4.0, but doesn't have PCa. The number of FP results is one of the factors used in the formulas for specificity and positive predictive value. These terms, along with sensitivity, negative predictive value and test efficiency are important to both the test developer and the patient...Ron Test Positive Test Negative Disease Present True Positive (TP) False Negative (FN) Disease Absent False Positive (FP) True Negative (TN) Sensitivity of a test is the percentage of all patients with disease present who have a positive test. __TP___ X 100 = Sensitivity (%) TP + FN Specificity of a test is the percentage of all patients without disease who have a negative test. __TN___ X 100 = Specificity (%) FP + TN The predictive value of a test is a measure (%) of the times that the value (positive or negative) is the true value, i.e. the percent of all positive tests that are true positives is the Positive Predictive Value. __TP___ X 100 = Positive Predictive Value (%) TP + FP __TN___ X 100 = Negative Predictive Value (%) FN + TN The efficiency of a test is the percentage of the times that the test give the correct answer compared to the total number of tests. ____TP + TN______ X 100 = Efficiency of a Test (%) TP + TN + FP + FN Prostate. 1999 Mar 1;38(4):296-302. Efficiency of prostate-specific antigen and digital rectal examination in screening, using 4.0 ng/ml and age-specific reference range as a cutoff for abnormal values. Crawford ED, Leewansangtong S, Goktas S, Holthaus K, Baier M. Division of Urology, University of Colorado Health Sciences Center, Denver 80262, USA. David.Crawford@UCHSC.edu BACKGROUND: The purpose of this study was to examine the diagnostic efficiency of prostate-specific antigen (PSA) and digital rectal examination (DRE) testing when using either 4.0 ng/ml or an age-specific reference range (ASRR) as an abnormal cutoff PSA value. METHODS: Between 1992-1995, 116,073 men, aged 40-79 years, were screened during Prostate Cancer Awareness Week. When using a 4.0-ng/ml cutoff PSA value, 22,014 had either an abnormal PSA, an abnormal DRE, or both. When using an ASRR cutoff PSA value, 17,561 had either an abnormal PSA, an abnormal DRE, or both. The positive predictive value (PPV), sensitivity, and specificity of PSA, DRE, and combined PSA and DRE tests were evaluated. RESULTS: When using a 4.0-ng/ml cutoff PSA value, the PPVs of abnormal PSA alone, abnormal DRE alone, and combined abnormal PSA and DRE tests were 27.7%, 17.7%, and 56.0%, respectively. Sensitivities were 34.9%, 27.1%, and 38.0%, respectively. Specificities were 63.1%, 49.0%, and 87.9%, respectively. When using an ASRR cutoff PSA value, the PPVs of each category were 31.8%, 20.8%, and 63.7%, respectively. Sensitivities were 27.1%, 41.0%, and 31.8%, respectively. Specificities were 75.0%, 32.8%, and 92.2%, respectively. The PPVs of the PSA test were higher than those of the DRE. The PPVs of combined tests were highest when using either a 4.0-ng/ml cutoff PSA value or an ASRR cutoff PSA value (all P < 0.001). When using an ASRR, the PPVs of PSA, DRE, and combined tests were higher than those when using a 4.0-ng/ml without statistical significance (all P > 0.05). Sensitivity of PSA when using an ASRR was lower than when using 4.0 ng/ml. CONCLUSIONS: Significantly higher PPVs indicated that utilizing both a PSA test and a DRE is most effective in screening for the early detection of prostate cancer. Although higher PPVs when using an ASRR cutoff PSA value suggested fewer unnecessary biopsies, lower sensitivities resulted in fewer cancers detected. Thus, we recommend that the combination of a PSA test with a cutoff value of 4.0 ng/ml and a DRE should continue to be utilized in the screening programs. PMID: 10075009 > Probably more than most would want to know... > If your PSA "cutpoint" is say 4.0, then wouldn't a false positive (FP) > be when someone has a PSA >= 4.0, but doesn't have PCa. The number of No, because PSA is NOT diagnostic for prostate cancer. PSA is an indicator of prostate function. A PSA above 4 doesn't tell you a thing about whether or not you have PCa. (Neither does a PCA <4.) If you had a blood test and found a low hemoglobin, you would have anemia. You wouldn't know why, just from the test. Anemia could be caused by a nutritional deficiency (iron, folic acid), a virus, a congenital condition (sickle cell anemia), blood loss, exposure to toxins, cancer..... So, a CBC will tell you that you have low hemoglobin, but it is not diagnostic for the cause. PSA will tell you something unusual is going on with your prostate, but it won't tell you what. Of course the PSA test is diagnostic for PSA, just not very accurate as the sensitivity, specificity and test efficiencies indicate. As Crawford (a PCa researcher of some note) points out in the abstract I included, the sensitivtiy, specificity, etc. for PSA are cutpoint dependent. Many others have said the same thing. Raise the cutpoint and you'll have fewer false positives, but many more false negatives. Lower the cutpoint and the reverse will occur. Bottom line, there are false positives and negatives with the PSA (or any) test...Ron > Of course the PSA test is diagnostic for PSA, just not very accurate as > the sensitivity, specificity and test efficiencies indicate. I do not know of anyone who knows anything about PCa who believes that the PSA test is diagnostic for PCa (which I think is what Ron referred to). I'd be pleased to see evidence to the contrary. As I wrote upthread, the PSA test is *not* PCa-specific; it is prostate-gland specific. To repeat: a high result tells the pt and his medic that something is not right and requires investigation. That is all. Regarding a low PSA where there is in fact PCa existent in the gland, it is a slippery concept. But low PSAs are known to be expressed by certain high-risk cancers such as those >Gleason 8; and epithelial and neuroendocrine tumors, as well as others of like nature. There are tests other than PSA than can help to alert the pt and medic to these. Arbitrary cutpoints are irrelevant where the test is irrelevant to what is being investigated. Regards, Steve J Perhaps this is just semantics. What is meant by "diagnose" or "diagnostic", how do these terms differ from "assess the likelihood"? This part of the thread began when Laurel questioned whether false positives and false negatives occur with the PSA test. My answer to that question remains "yes". Many papers have analyzed the PSA test in terms of positives, negatives, false positives and false negatives (see the abstract I included above). A single PSA value can be used to assess the likelihood of PCa being present. There are any number of papers where stratified PSA readings have been correlated to the likelihood that PCa is present...Ron > This part of the thread began when Laurel questioned whether false > positives and false negatives occur with the PSA test. My answer to Me? Then I misspoke. Because I have never thought PSA was a cancer test, I have never considered PSA results in light of false positives and false negatives, nor have I wondered if it had such, because PSA is not diagnostic for cancer. It shouldn't drive me crazy, but when I read or hear of someone who doesn't want a PSA test because they might get a 'false positive' whatever that means, I feel bad. I want to grab them by the throat and shake them and ask them if they were always an idiot, or if it was a skill they had to practice. So when doctors repeat that crap, I can't believe it. Well, I believe it. But I don't imagine such a benign consequence as shaking them silly. Pinning them to an anthill covered in syrup is more like the proper level of response. I would much rather we had begun on this road with a PSA of 4 or 8 than 26.7. And if we had had a 3rd PSA test, that went from 1.8 to 2.3 then to 3.5 (or whatever), AND IF we had a physician who could assess that progression, we probably would not be facing the problems we have today. And I wish for others that they will get regular PSA tests and that someone will watch the progression. A doctor saying PSA is a false positive is a cop-out. PSADT could be taught in a one page, highly graphic, readable format for every physician. They should have to be able to explain this before they are licensed. They should be required to post the graphic in their waiting rooms. If people keep thinking that PSA is a cancer test, then lots and lots of men are going to die in pain because they have cancer and their PSA is below 4. Ridiculous. And if people keep thinking that PSA is a cancer test, and they overtreat an elevated PSA, that again is not the fault of the test. It is ignorant or careless doctors. Jeesh. This group of doctors is the opposite of the group that says not to test PSA. The "don't test because of false positives" (positive what?) are the ostrich type. The ones that take a PSA of 5.5 and have you headed for surgery are the chicken-little type. What we need is more of the professional physician type of doctor. Avoiding PSA tests is just stupid. Not using the data from PSA tests is negligent. And I will never subscribe to a theory that PSA is a cancer test, so I will never shut up when I hear that phrase "false positive" applied to PSA and cancer. They are apples and oranges, both fruit, but that's about all you know from one to the other. I hope I have clarified my position a little better. laurel ;o) On March 30, juniper wrote, in pertinent part: (ka-snip) > It shouldn't drive me crazy, but when I read or hear of someone who > doesn't want a PSA test because they might get a 'false positive' [quoted text clipped - 5 lines] > in syrup is more like the proper level of response. > (su-nip) > I hope I have clarified my position a little better. Doggone it, I do wish Laurel would quit being evasive and tell us what she *really* thinks. Hee hee. ;-) Regards, Steve J > Arbitrary cutpoints are irrelevant where the test is irrelevant to what > is being investigated. LOL Would you say that the PSA test is not a diagnostic tool for PCa?..Ron > Would you say that the PSA test is not a diagnostic tool for PCa? > Yes. I already have. Several times. Regards, Steve J So your position places you in the Stamey camp. Many others call the PSA test a diagnostic tool. Google "PSA test, diagnostic tool" on the web...Ron You're arguing semantics without defining the terms. Only if one considers PSA a CANCER test could it provide false indications for CANCER. Most informed people, especially doctors, consider PSA a flag for prostate problems in general, maybe an indication that a biopsy is warranted. Thus a "positive" (high) PSA reading could be construed as a false indication of prostate problems if none existed, but a negative biopsy triggered by a high PSA would not mean the PSA test was a false negative, because the biopsy was in deed warranted. IOW, a PSA reading is a fact, a data point; unless the lab erred it's not false or positive. It just means something's abnormal and the prostate needs to be observed more closely to warrant any medical conclusions. Is a new mole on your cheek a false positive of skin cancer, or just a mole that needs to be checked out? I.P. > You're arguing semantics without defining the terms. Only if one > considers PSA a CANCER test could it provide false indications for > CANCER. Most informed people, especially doctors, consider PSA a flag RIGHT ON! This is the point. Alan commented: "It is a tradition in the U.S. to find a doctor you trust and just do what he says. I have a relative who was just diagnosed with lymphoma. He's a very intelligent and well educated guy. I sent him links to websites and support groups for lymphoma but he wasn't interested. He was sure he was in good hands and didn't need to do any research on his own." and Steve added: "I suspect that all of us have seen men who simply will not take action to improve their chances for an optimal outcome. And of course there are those like a friend in Spokane who is of the right age for PCa, smokes, eats incorrectly, is generally a prime candidate. He refuses to have a PSA test because his medic says that there are "too many false positives." We all know (me from experience) what that means if he has the misfortune to develop PCa. " Both exactly true.
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