The physical experience before versus after removal of the prostate gland?

[+ Funguy]

I know I've mentioned professional guidelines here before, and a lot of you guys poo-poo them. As of this time, the randomized clinical trials, following men for over 15 years have been done, and it's a known fact, not an opinion that PSA screening does NOT save lives. National guidelines written by world-renown experts now give only one of two recommendations: (1) PSA screening should not be done (USPSTF, AAFP), or (2) PSA screening should be done only if the patient has been fully informed that the risks of the screening exceed the benefits, and the patient wishes to proceed anyways (AUA, ACS). From the AUA's own website:

https://www.auanet.org/advnews/press_releases/article.cfm?articleNo=290

The guideline makes the following specific statements:

 

PSA screening in men under age 40 years is not recommended.

Routine screening in men between ages 40 to 54 years at average risk is not recommended.

For men ages 55 to 69 years, the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, shared decision-making is recommended for men age 55 to 69 years that are considering PSA screening, and proceeding based on patients’ values and preferences.

To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.

Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.

 

In other words, if you have a prostate cancer discovered because of a "screening" PSA rather than because you have symptoms, the chance that this cancer would kill you before you have symptoms is 1 in a thousand. Feeling lucky? When my primary care physician asked me if I was interested in PSA screening, I said "You can take my prostate out of my body when it's cold and dead." Of course, there are always those who believe they know more than the leading experts in the field...

 

Well put, Unicorn.

[Diverdan]

I have a great respect for you, Unicorn and for the medical profession and medical research. I have worked in health care all of my life. However, I am living today because I participated in a research study on the benefits or lack thereof from routine PSA testing, which made me sensitive to the potential benefits, and the potential downsides of having routine PSA tests. However, when my PSA results started steadily increasing and then dramatically increasing, I chose to have a biopsy done. Half of the biopsies had cancer of the most aggressive kind. I had it removed, and discussed the pathology reports with my surgeon and internist. Based on the pathologists reports, they indicated that the cancer would likely have spread outside of the prostate in less than a year. Then radiation and or chemo would be the only alternative. I should also tell you that I had no other symptoms even though my prostate was huge. The surgeon hardly believed me after the surgery and quizzed me a lot about any other symptoms.

 

So, I must respectfully disagree, and urge guys over 45 to have an annual PSA test until some other better test comes along, which researchers are doing. While some insurance companies do not want to pay for routine PSA tests, but it is worth it in my book to pay for it yourself. You may be one of the exceptions to the studies which base finding on large cohorts, but don't take the individual exceptions into consideration.