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News & ArtsTuesday, October 11, 2011
Health What You Don't Know Can't Hurt You
Posted by Goldy on Tue, Oct 11, 2011 at 2:44 PM
When the United States Preventive Services Task Force officially recommended last week that doctors no longer screen healthy men for prostate cancer using the currently routine P.S.A. test, many observers predicted a public backlash along the lines of that which erupted last year when the task force similarly recommended that healthy women wait until age 50 to start routine mammograms. Well... not so much.
So why did women and women's health advocates create such an uproar over the revised breast cancer screening recommendations, while we men seem to be collectively shrugging our shoulders? Well, I've got a theory, and it mostly has to do with the fact that, as a man, I'm pretty much looking for absolutely any excuse not to go to a doctor. I don't need a routine P.S.A. screening? Great! That's one less reason for routine anything. And while you're at it, could you please tell doctors to stop sticking their goddamn fingers up my butt?
There is no evidence that a digital rectal exam or ultrasound are effective, either. “There are no reliable signs or symptoms of prostate cancer,” said Dr. Timothy J. Wilt, a member of the task force and a professor of medicine at the University of Minnesota.
Gee, thanks, United States Preventive Services Task Force! Now I, and millions of American men like me, can go back to blissfully ignoring our health concerns until it is too late.
3
There also isn't a prostate cancer ribbon and cadres of professional fund-raisers worrying about their gravy train.
5
Oh, and unless you actually have a familial risk factor of breast or prostate cancer, you are pretty much wasting your time.
Screening for breast cancer has some benefits between 50 and 70. Self-screening is actually more important.
Same for prostate.
Exercise (moderate), diet (varied, more veg fruits less red meat) more important.
Screening for breast cancer has some benefits between 50 and 70. Self-screening is actually more important.
Same for prostate.
Exercise (moderate), diet (varied, more veg fruits less red meat) more important.
6
I was always under the impression that the digital exam was more for englargement of the prostate, a much more common and more easily recognizable problem. Not so much for cancer. Am I wrong?
7
@6 - That's what I thought too.
I was also under the impression that all men will get prostate cancer if we live long enough, the only thing to check for is our levels of something-rather to make sure it's not the kind that's going to metastasize.
I was also under the impression that all men will get prostate cancer if we live long enough, the only thing to check for is our levels of something-rather to make sure it's not the kind that's going to metastasize.
8
@3:
Please, for the love of all that's sacred, NEVER, EVER, EVER - use the term "gravy train" again in the same sentence when conversing on the subject of prostrate cancer and/or digital rectal exams.
(Unless of course, you also happen to be talking about Rick Santorum's health status.)
Please, for the love of all that's sacred, NEVER, EVER, EVER - use the term "gravy train" again in the same sentence when conversing on the subject of prostrate cancer and/or digital rectal exams.
(Unless of course, you also happen to be talking about Rick Santorum's health status.)
9
http://www.nytimes.com/2011/10/09/books/…
The most interesting thing I've read on prostate cancer today.
The most interesting thing I've read on prostate cancer today.
10
"But let’s look at the numbers more closely. Prostate cancer is slow-moving; more people die with it than from it. According to one 2004 study, for every 48 prostate surgeries performed, only one patient benefits — the other 47 patients would have lived just as long without surgery. ... Moreover, the 47 who didn’t need the surgery are often left with an array of unpleasant and irreversible side effects, including incontinence, impotence and loss of sexual desire. The likelihood of one of these side effects is over 50 percent — 24 of our 47 will have at least one. This means a patient is 24 times more likely to experience the side effect than the cure."
12
As someone who works with a large cancer non profit, @3 has nailed it. There is so much emotion and such little business sense. Keeps me employed at least, I just get tired of cleaning up the messes every single day.
13
Reason for recommendation: “This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does.”
So will Obama-care cover screening if it's elected by the patient but not recommended by the United States Preventive Services Task Force? Or is death from Prostate Cancer "natural" and therefore not to be treated under Obama-care?
Personally, if I have a cancer that "may or may not affect me during my "natural" lifetime”, I want to know, and I'm sure as shit going to treat it like it will affect me during my "natural" lifetime.
And... for what it's worth, I intend to live longer than what may be considered "natural" by the United States Preventive Services Task Force (which seems to think that death other than maiming or homicide is “natural”).
Fuck... This is exactly the sort of shit we get when the Fed's start deciding what medical services we do and do not get to have. In this case, quite literally, cancer screening.
So will Obama-care cover screening if it's elected by the patient but not recommended by the United States Preventive Services Task Force? Or is death from Prostate Cancer "natural" and therefore not to be treated under Obama-care?
Personally, if I have a cancer that "may or may not affect me during my "natural" lifetime”, I want to know, and I'm sure as shit going to treat it like it will affect me during my "natural" lifetime.
And... for what it's worth, I intend to live longer than what may be considered "natural" by the United States Preventive Services Task Force (which seems to think that death other than maiming or homicide is “natural”).
Fuck... This is exactly the sort of shit we get when the Fed's start deciding what medical services we do and do not get to have. In this case, quite literally, cancer screening.
16
I wouldn't.
The article makes a more salient point in this way: "Much of this decision making revolves around your own willingness to take risks and your threshold for putting up with inconvenience, side effects or pain. Returning to prostate surgery, consider that six weeks is the advised recovery period. Coincidentally, the operation will, on average, add six weeks to your life. (This averages across the 47 people who had no benefit from the operation and the one person who did.) To my way of thinking, the decision then becomes this: When do you want to “spend” those six weeks? When you’re relatively young and feeling well, or at the end of your life, when you’re old and only dimly aware of your surroundings?"
The article makes a more salient point in this way: "Much of this decision making revolves around your own willingness to take risks and your threshold for putting up with inconvenience, side effects or pain. Returning to prostate surgery, consider that six weeks is the advised recovery period. Coincidentally, the operation will, on average, add six weeks to your life. (This averages across the 47 people who had no benefit from the operation and the one person who did.) To my way of thinking, the decision then becomes this: When do you want to “spend” those six weeks? When you’re relatively young and feeling well, or at the end of your life, when you’re old and only dimly aware of your surroundings?"
17
@13-- This has nothing to do with the health care bill passed last year. These are medical professionals looking at massive amounts of epidemiological data and making reasonable conclusions.
That is a huge fucking amount of data. And it shows very clear results.
Now, there will always be individual anecdotal examples here or there that, on their own, counteract that data. But the studies are clear. Not to mention that, if this is like the breast cancer recommendation, testing will still be recommended at a younger age for those with genetic predisposition.
And, ultimately, do you think your private, for-profit insurance company is going to pay for anything that isn't recommended? Right. So then, how is the health care bill related, again?
Honestly, if you want to knee-jerk "Obamacare" into any discussion even remotely related to health, there's a place for that and it's called The Seattle Times comment threads.
"The European trial had 182,000 men from seven countries who either got P.S.A. testing or did not. When measured across all of the men in the study, P.S.A. testing did not cut death rates in nine years of follow-up. But in men ages 55 to 69, there was a very slight improvement in mortality. The American trial, with 76,693 men, found that P.S.A. testing did not cut death rates after 10 years."
That is a huge fucking amount of data. And it shows very clear results.
Now, there will always be individual anecdotal examples here or there that, on their own, counteract that data. But the studies are clear. Not to mention that, if this is like the breast cancer recommendation, testing will still be recommended at a younger age for those with genetic predisposition.
And, ultimately, do you think your private, for-profit insurance company is going to pay for anything that isn't recommended? Right. So then, how is the health care bill related, again?
Honestly, if you want to knee-jerk "Obamacare" into any discussion even remotely related to health, there's a place for that and it's called The Seattle Times comment threads.
18
Want to reduce prostate cancer?
Have sex with the same partner frequently.
Get a little more exercise, eat a varied diet with more veggies and fruits and less red meat.
But age related diseases do occur.
EXCEPTION: If you have a family history of problems with this risk.
Same basic advice for women re breast cancer, quite frankly.
Take Home Message: Stop panicking. If female, do self-exams. Problem is breast tissue behaves differently at different ages and for different physiology.
Second Take Home Message: There are not 2 choices - there are multiple choices - diet, exercise, hormones (important impacts both pro/con), and you can frequently do small changes that have major impacts. Life is not On Off but shades of probabilities.
Have sex with the same partner frequently.
Get a little more exercise, eat a varied diet with more veggies and fruits and less red meat.
But age related diseases do occur.
EXCEPTION: If you have a family history of problems with this risk.
Same basic advice for women re breast cancer, quite frankly.
Take Home Message: Stop panicking. If female, do self-exams. Problem is breast tissue behaves differently at different ages and for different physiology.
Second Take Home Message: There are not 2 choices - there are multiple choices - diet, exercise, hormones (important impacts both pro/con), and you can frequently do small changes that have major impacts. Life is not On Off but shades of probabilities.
20
@17 et al.
So the voluminous data shows a slight benefit between 55 and 69. which I think leads to an obvious recommendation.
get tested in your 50s to early 60s and skip it after that.
as was mentioned eventually essentially all men get Prostate cancer if they live long enough. the late life prostate cancer is rarely the cause of death. the early in life (before 65) prostate cancer is actually more likely to be an aggressive cancer and more likely to be a cause of death. so again testing would seem to make some sense between 50 and 65. I have no idea why that wasn't the recommendation.
I must admit I am not unbiased. Anecdotal evidence definitely sways me here. My partner was diagnosed at 50, had the surgery, the after surgery biopsy confirmed a very aggressive tumor that would have very likely led to bone cancer by now (3 years later). instead he is cancer free. I completely understand the difference between 1 experience and statistical evidence. But his result actually matches the data. The post 70 prostate cancers likely (almost half of the surgeries) on the other hand don't appear to be beneficial.
So why this recommendation is 50 to 65 too confusing for people? I don't get it.
oh and this clearly has nothing to do with the health care act as 17 said.
So the voluminous data shows a slight benefit between 55 and 69. which I think leads to an obvious recommendation.
get tested in your 50s to early 60s and skip it after that.
as was mentioned eventually essentially all men get Prostate cancer if they live long enough. the late life prostate cancer is rarely the cause of death. the early in life (before 65) prostate cancer is actually more likely to be an aggressive cancer and more likely to be a cause of death. so again testing would seem to make some sense between 50 and 65. I have no idea why that wasn't the recommendation.
I must admit I am not unbiased. Anecdotal evidence definitely sways me here. My partner was diagnosed at 50, had the surgery, the after surgery biopsy confirmed a very aggressive tumor that would have very likely led to bone cancer by now (3 years later). instead he is cancer free. I completely understand the difference between 1 experience and statistical evidence. But his result actually matches the data. The post 70 prostate cancers likely (almost half of the surgeries) on the other hand don't appear to be beneficial.
So why this recommendation is 50 to 65 too confusing for people? I don't get it.
oh and this clearly has nothing to do with the health care act as 17 said.
21
For those without insurance and reasons for concern (like genetic predisposition), you can get testing at low cost without seeing a doctor (though discussion is certainly advised), for example (I have no ax to grind here; it's just the service I use):
https://www.mymedlab.com/prostate/psa
Better yet, get a whole bunch of tests done for not a whole lot more money, for example:
https://www.mymedlab.com/get-started-pan…
Go to the homepage for more info. Basically, you select the tests you want online, pay and get rubber-stamp approval by a staff physician, print out lab order, find a nearby LabCorp location with the search tool (usually close by, though I have to drive 150-200 miles) to have specimens taken, get your results on line, freak out in ignorance or go see your doctor.
https://www.mymedlab.com/prostate/psa
Better yet, get a whole bunch of tests done for not a whole lot more money, for example:
https://www.mymedlab.com/get-started-pan…
Go to the homepage for more info. Basically, you select the tests you want online, pay and get rubber-stamp approval by a staff physician, print out lab order, find a nearby LabCorp location with the search tool (usually close by, though I have to drive 150-200 miles) to have specimens taken, get your results on line, freak out in ignorance or go see your doctor.
22
Re: 21, FWIW, my local public hospital is allowed to charge me as an uninsured person $375-400 (and they won't provide a firm price up-front) for CBC, lipid profile, metabolic profile, and PSA. So it's totally worth spending $60 on gas on a day off to go the on-line route.
23
Do you know what a mammogram is? It's your breasts, smashed flat so that a clear image could be taken. The equivalent for a man would involve flattening the nut sack.
It's a finger up your butt for a few seconds. Men really need to grow up and get over their precious selves.
It's a finger up your butt for a few seconds. Men really need to grow up and get over their precious selves.
25
@23 Breasts and testicles ain't even close to the same thing. I have no doubt that mammography is extremely unpleasant, but doing the same thing to a man's testicles wouldn't only hurt, it would completely destroy them.
26
@13,
Aren't you rich enough to pay for it yourself? Why should the rest of the people in your insurance group subsidize YOUR hypochondria? Isn't the proper conservative position that, if you can't afford it, you should just fucking die already? That's what you want to happen to anyone who can't afford health insurance.
Aren't you rich enough to pay for it yourself? Why should the rest of the people in your insurance group subsidize YOUR hypochondria? Isn't the proper conservative position that, if you can't afford it, you should just fucking die already? That's what you want to happen to anyone who can't afford health insurance.
28
@27,
Thanks for proving that you're yet another hypocritical, moronic Republican who can't defend his stance on any single, little thing. It makes me feel all warm and fuzzy inside.
Thanks for proving that you're yet another hypocritical, moronic Republican who can't defend his stance on any single, little thing. It makes me feel all warm and fuzzy inside.
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