Ralph and others,
Let me try to explain why I started this thread. I understand the concern that many have about overtreatment. Nobody wants to see a man go through prostate cancer treatment unnecessarily. That's a given. However, as I said many times, I don't think that the PSA test is a "causative" factor in overtreatment. The decision to treat or not treat should always be based on much more evidence than an elevated PSA, or even two or three elevated PSA tests. Even the decision to biopsy should be made carefully, but again, it's not the PSA test that is a causative factor in the decision to biopsy. It's the PSA number, plus (usually) other symptoms that leads to the decision to biopsy.
Let me offer my personal history as an example.
My primary care physician started including a PSA test with my other blood work during my annual physicals when I turned 50. The numbers were OK at first, but eventually rose into the "2" range, then the "3" range, then the "4" range, then the "5" range, and finally above 6. Only then did this hardheaded individual (me) consent to visit a urologist for his opinion. That led to a DRE, which detected a "bump," and then to a biopsy, which revealed 6 of 12 cores positive, all Gleason 7.
The uro suggested treatment but thoroughly briefed me on options ranging from brachy to surgery to AS, though he didn't recommend it. Thorough physical exams showed that I have a reasonable likelihood (God willing) of living for quite a few more years, so surgery made sense (I was 65 at the time).
And that's why I feel that it's wrong to undercut the importance of PSA testing, and wrong to talk about eliminating the PSA test. Let me explain further.
It never occurred to me that I could develop prostate cancer. I was incredibly naïve and stubborn. Cancer, I felt, was something that would never happen to me. Only after about five years of rising PSA tests was I finally convinced to seek an opinion from a urologist. It was the PSA numbers that caused my internal medicine primary care physician to suspect something might be wrong; it was the PSA test and the continuing rise that finally got it through my thick skull that I just might actually have cancer. Sure, I had significant urinary urgency, but then so did my older brother, and Flomax solved his problem. He had 3 biopsies and no cancer was ever found, and with Flomax he seems to be doing fine. I thought I was going down that same path and would be fine.
I assure you, there's no doubt about it: if I hadn't had the PSA tests, I would have gone blissfully down the road to advanced prostate cancer. Instead, I was a very lucky man, had the surgery, found the cancer to be still organ contained, and have had "undetectable" PSA tests in the nearly 3 years since.
So, do we really have men's best interest at heart when we talk about the failures of the PSA test? I know a lot of guys here on the forum feel that way, but I thank God and Dr. Ablin for inventing the test, even though he apparently has himself disparaged it since then. (though I'll bet Einstein wasn't too happy about the atomic bomb, either).
It seems we either focus on the guys who were treated perhaps unnecessarily; some of us, however, find ourselves more inclined to focus other than on the success stories, the men who will live to see their grandchildren graduate and marry. And I guess neither way of looking at things is wrong.
We need to be very careful not to take a very "grey" area of discussion and turn it into a black and white argument.