PSA test false positive rate 70%?

[chassis]

For the guys, but ladies chime in if you like.

The linked article (no sources, but hosted on a medical group's website) suggests 70% false positivity rate for the PSA test. Really? How can a test be offered with such a high false positive rate. If the article is true.

I googled a bit and found many examples talking about whether doing a PSA test is, or isn't, the best choice for the patient. I haven't found an NIH or FDA document that quantifies the false positivity rate.

What is everyone's view on the high false positivity rate claimed for the PSA test? Thanks.

https://www.ncfmg.com/wp-content/upl...-screening.pdf

[Humdizzle]

i see it sometimes with my patients. high psa on labs, i send them to urology, they come back saying everything was normal. there are other things that raise psa like prostatis (this is usually found in people who sit all day like truck drivers, or cyclists since the seat presses on the area). some people just live at a high level and nothing is wrong

we used to do psa screenings for everyone over 45-50. But now they've relaxed the rules and to only order it when someone has a high suspicion of prostate problems. probably due to the high false positivity rates and subsequent complications like the article mentions.

in short the test is a bit of a crapshoot. but if there is strong suspicion or risk of prostate cancer in the individual it can be helpful

another thing some urologists will tell you is that the number isn't as important as the trend or PSA velocity. a sudden uptick in your PSA number could mean cancer.

[JJ 911SC]

Key words...

Originally Posted by chassis

... The linked article (no sources, but hosted on a medical group's website)...

I also heard that the Covid Vaccine has a chip in it to modify your DNA

All jokes asside, here is the best recommendation from https://www.hopkinsmedicine.org/heal...ing-guidelines


An Abnormal PSA Test: What Comes Next?

If your PSA score is in the abnormal range, your doctor may recommend you repeat the PSA test. If your levels are still high, your doctor might recommend one of the newer prostate cancer screening tests available today.

These tests can help better assess your risk for prostate cancer and determine whether a biopsy is necessary. Only a prostate biopsy can definitively diagnose prostate cancer.

[Glen e]

I’ve been getting a PSA for the last eight years, I’m 70. My Doc is always looking for one thing and that is a radical change in the number that I usually generate. So far it has been smooth sailing with a PSA registering always about 1.5 to 1.7.

[M_Six]

Originally Posted by Humdizzle

another thing some urologists will tell you is that the number isn't as important as the trend or PSA velocity. a sudden uptick in your PSA number could mean cancer.

Exactly what my doctor has been telling me. Establish a baseline, then see if it changes. My results have been virtually identical (and very low) for years, so I'm ok with that. And I cycle 100 miles/week. Seems to have no effect in that regard for me.

[UPSROD]

Everyone is correct, it is a tool to predict the chance of prostate cancer not to say that you have it, a biopsy is required to do that.

[chassis]

Thanks for the comments. It found it surprising that a commonly recommended test (the PSA test) has such a high incidence of false positive results. Something to consider when weighing the decision whether or not to get the test.

[erawamai]

My dad (who is 73) just got a higher than usual PSA result.

He typically sits at 4.5 and has been for many years and over the last year it increased to 7.4, which is a bit alarming especially regarding the change. Hopefully its one of those 'false positives' the article talks about.

Hopefully its just prostatitis and nothing insidious. My grandfather had prostatitis so it runs in the family.

He goes back for another blood test in a few weeks. If it's still high I suspect he will be sent to a urologist for further tests.

[JJ 911SC]

Oh Oh...

[cooolone2]

PSA used alone is not a good predictor of Prostate Cancer. As noted there are many causations that can lend to elevated PSA results such as an infection, sexual activity, exercise (bike riding), etc... and age as well! A PSA reading in the 7's might not necessarily be too alarming depending upon personal history.

PSA is a gateway indicator to a possible need for further investigation, testing to determine the underlying cause of elevation. There are non-invasive liquid biopsies today that lend accurate diagnosis. And baseline imaging with MRI's that would and could better reveal if there is an issue. Usually there will be some symptoms present if in fact and elevated PSA might be associated with PCa off the bat. The DRE (digital rectal exam) might expose any abnormalities (lumps) during a physical exam, BPH, urinary, sexual and other dysfunction that would cause suspicion.

But elevated PSA alone... Means nothing!

Good luck and best regards!

[upstatedoc]

I still check a yearly PSA on my pts over 50. Personally, Ive caught more cancers than pts have had adverse reactions to further testing. Of course this is anecdotal. Maybe other providers have have seen more bad outcomes to further testing?

[zx10guy]

This is all too familiar with a tumor marker test I have been going through for the past almost 8 years. CEA. I hate this blasted test as it creates so much anxiety in cancer patients. I get why it's used and the results from this test solely isn't a prognosticator for cancer. But there are so many things that affect this test and even if you have a low CEA number doesn't mean you're cancer free. I've been dealing with 4 years of extremely elevated CEA numbers and no one can tell me what is going on. My oncologist says I'm case study worthy as I've gone through all manners of testing: MRI, PET/CT, CT w/contrast, upper GI endoscopy, small bowel capsule endoscopy, and colonoscopy. All clear.

Seems I have to look forward to another potential paper chase with PSA testing whenever I get ordered to start getting tested.

[zx10guy]

Something else I wanted to add. There has been other blood tests that have been created to get around the older tumor marker testing methodologies. The two companies that have created the newer tests are Signatera and Natera. They're both DNA based tests that look for tumor DNA floating in your blood. From what I've been told, they're much more accurate than the old tumor marker tests particularly CEA.

I wonder if something similar could be done for PSA.

[chassis]

Found this while browsing:

FYI from the British National Health system:

There's currently no screening programme for prostate cancer in the UK. This is because it has not been proved that the benefits would outweigh the risks.

https://www.nhs.uk/conditions/prosta...r/psa-testing/

It seems like the U.S. medical community is modifying the guidance on prostate screening, moving toward the UK example. Lots to read online about this if you search for it.

I view the UK, Germany and Japan as good benchmark countries for overall health management. They have similar, and in many cases better, health outcomes as the U.S., and with far lower cost expended in the entire system.

[cooolone2]

Originally Posted by chassis

Found this while browsing:

FYI from the British National Health system:

There's currently no screening programme for prostate cancer in the UK. This is because it has not been proved that the benefits would outweigh the risks.

https://www.nhs.uk/conditions/prosta...r/psa-testing/

It seems like the U.S. medical community is modifying the guidance on prostate screening, moving toward the UK example. Lots to read online about this if you search for it.

I view the UK, Germany and Japan as good benchmark countries for overall health management. They have similar, and in many cases better, health outcomes as the U.S., and with far lower cost expended in the entire system.

Well, when the UK suspended PSA screening completely, it experienced in increase of patients being diagnosed with more advanced stages when they were tested due to symptoms. So PSA screening in itself is not the problem.

The problem is noted on that page, in regard to over diagnosis, and over treatment of patients who would fair just as well with AS, rather than action. Much of the culpability could be assigned to the medical industry, but the patient also needs to accept their part as well.

Every person should understand that nobody will advocate for their care better than themselves. With the Advent of the Internet, these days, there's no excuse to not have at least an introductory understanding of what's going on. There are plenty of websites out there to walk you through the issue, here with Prostate Cancer, like the NCCN website and others. They have a patient Guideline that will walk you through Prostate Cancer from symptoms to diagnosis and treatment.

But back to PSA testing, it is an invaluable tool, when used properly! But individual health and other biometrics play in to it huge! Family history as well... Like for instance if you dad or uncle have had it, you're 75% more likely to as well. So many tests are available today to accompany an elevated PSA that would lend to providing a more accurate diagnosis, as noted, the blood biopsy, genetic screening, sensitive imaging such as PSMA-PET scans, etc. And if an invasive test is needed for tissue samples, the 3D multi-parametric MRI is most accurate (biopsy). This tissue should then be gentic tested and immunohistochemistry tested as well... And once you have some of these tests in hand, there's no reason NOT to have them receive a 2nd opinion, especially from doctors not invested in the treatment plan!

These tests will all paint an absolute picture (combined) providing an accurate Staging and Prognosis for the patient that would provide the best basis for decisions on treatments!

I won't post my situation here in regard to how I'm so familiar with this all, just know I'm in the deep end of the pool and have been swimming here for some time!

So... If you have family history #1, then yes, you should incorporate PSA testing into your physical exams. DRE tests too. If any suspicion exists, then go cautiously! Know that PCa is one of, if not the, slowest moving cancers there is. So this affords time to not only educate yourself before making a decision, but to find the very best care accessible to you. This typically is found at Major Cancer Center's and those rated in Excellence! Travel if you must! They actually performed a study some years back that supports the fact that the best results for patients was obtained from care by Oncologist's with the most experience! So if you hear those words "Cancer" and you have it, forget local facilities or doctors, they can't compete! And run to the experts!

Good Luck!

[BMWCCA1]

My GP for the past dozen-years has always asked if I wanted a PSA test while telling me of the false-positive data. He always asks if I'm still okay with not doing the test. My closest friend is a urological surgeon who is appalled that I'm not getting tested. He's 30-years younger than I am. One day, while visiting him at his hospital to do lunch, he tested me, returning with a hang-dog look on his face with the results . . . only because mine was lower than his. I've not been tested since. I'm 68-years-old.

[MarcoZandrini]

I've been getting the PSA test for years. My doctor and I agree it's not so much the number but the change in the number. My uncle had a PSA of over 9 for years. He passed away at 99 of natural causes.