Tag Archive for: U.S. Preventive Services Task Force

PSA: Sharing the Decision

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PSA screening is controversial because it may or may not indicate prostate cancer without additional testing and it may or may not indicate mortality from prostate cancer. As I said, many elderly men will die with prostate cancer but not of it. How do you know what to do? A recent study may provide some guidance.

Regular PSA Testing and Mortality

The Veterans Administration can be a challenging bureaucracy, but it’s one entity that can provide medical information on millions of subjects. Researchers wanted the answer to a simple question: Do higher rates of PSA testing yield a reduction in metastatic cases of prostate cancer?

The survey population included male patients getting a PSA test at 128 U.S. Veterans Health Administration facilities across the system from 2005 to 2019. The reason those years were chosen is that the U.S. Preventive Services Task Force (USPTF) had modified guidelines for PSA screening to recommend less frequent use of the test for men over 70. Over those years, there was a decrease in annual testing by 10% to 15% in non-VA healthcare facilities, and that was matched in the VA system. The USPTF recommended against screening all men, and PSA testing again fell in all age groups.

The data showed that as PSA testing decreased, the rates of metastatic prostate cancer increased. Drilling down into the data, those VHA facilities with higher rates of PSA screening had lower rates of metastatic prostate cancer.

Shared Decision-Making

The researchers were diplomatic in their conclusions. They simply presented the findings and suggested that the physician and patient should jointly decide on the course of action. Should we test? When do we proceed with a biopsy? What do we do if it’s benign? If it’s malignant? And a whole bunch more.

The Bottom Line

The researchers easily could have recommended that everyone gets tested and everyone gets a biopsy if the PSA is too high, but PSA testing is not precise enough. Some men have prostate cancer with PSA less than 4.0 and some do not have it with PSA over 10. The best course is having a discussion with your urologist and coming to a joint decision that satisfies you both. It’s also not a bad idea to get a second opinion, of whether you agree with the plan or not.

One thing for sure: always do the screening test again, regardless of whether it’s PSA, cholesterol, or HbA1c. For the most part, tests are accurate and reliable, but there’s always the possibility of a mistake; one test does not a diagnosis make. Retest, discuss, and plan a course of action with your healthcare professional.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Oncol. doi:10.1001/jamaoncol.2022.4319

Supplements: Helpful or Harmful?

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About a week ago when a press release about a study published in the Journal of American Academy of Cardiology stated that vitamins and minerals don’t seem to help the health of those people who use them; they should stick to getting nutrients from the food they eat. As you can imagine, I got questions from many readers.

For those of us who use dietary supplements, have we been wasting our money? Or maybe as part of the study showed, we’re doing ourselves harm? Don’t throw out your supplements just yet.

The study was a meta-analysis that examined randomized controlled trials (RCT) since the U.S. Preventive Services Task Force (USPSTF) Recommendations for Dietary Supplements was published in 2012. They examined RCTs that used multivitamins, vitamins and minerals, and antioxidants to determine their affect on health variables related to cardiovascular disease and overall mortality.

Was the study done well? Yes and no. They included RCTs that examined the use of specific supplements and health outcomes. The problem is that they didn’t examine the quality of the supplements used in those studies. That’s a significant problem but not the only one. More on this Saturday. Until then, regardless of the headlines, take your supplements if you know why you’re taking them.

What are you prepared to do today?

Dr. Chet

 

References: Jenkins, D.J.A. et al. J Am Coll Cardiol. 2018;71(22):2570–84.

 

Tracking Your Rate of Change

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The U.S. Preventive Services Task Force (USPSTF) just published new recommendations for prostate specific antigen (PSA) testing for men 55 and over. In effect, they don’t recommend PSA testing on a regular basis. I think that’s a mistake. I’ll cover the specifics for PSA testing during the Prostate Health webinar, but I think regular testing is important regardless of age for this reason: monitoring the rate of change.

Monitoring changes in medical tests does not just apply to PSA, it applies to just about every test: cholesterol levels, triglycerides, blood sugar, HbA1c, body weight, vitamin D. Even non-medical tests such as food intake. By monitoring changes, we can identify how each component of our health is changing, especially the rate at which they’re changing. It also tells us how well our lifestyle modifications are working. Those are valuable pieces of information.

No single number is important; it’s how that number fits in relation to other results of the same test that may be important. If it increases at a higher rate or at a faster rate, that may indicate a problem that needs to be addressed. Let’s say your PSA goes from 0.5 to 1.0 in a year. That’s a whole different story than if it went from 0.5 to 3.5 in a year; in that case, closer monitoring would be necessary. Same for your weight; if it went up two pounds in a year, your doctor probably wouldn’t be concerned. But if it went up 20 pounds in a year, something serious is happening and needs attention now.

I understand why the USPSTF took the position they did with PSA in those age groups: they want to prevent unnecessary tests and treatment. What they didn’t consider is that monitoring the rate of change could identify who needed to be treated now versus those who did not.

For those factors you can track for yourself, such as blood sugar if you’re prediabetic or a type 2 diabetic, fat intake, blood pressure, weight, and many others, you should make the effort. Those measurements can provide a lot of information for your health over time—information you can use to improve your health.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2018;319(18):1901-1913. doi:10.1001/jama.2018.3710.

 

Breast Cancer: A Professional’s Story

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Since I began this series on Tuesday, many more readers have shared their stories. Please keep them coming; I will share more of them at some point. Paula asks that I thank the many people who have told their stories and wished her well; they all help maintain the positive attitude that aids healing.

I chose this response because it’s from a healthcare professional who is a survivor; she raises some important issues that you should know more about. Please read this final story from a breast cancer survivor because it’s really designed for you from someone who . . .

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