My brother was diagnosed with stage 4 metastatic prostate cancer, with tumors at 10 bony sites, one year after a normal PSA. So yes, it’s possible and it happens.
Gleason 9/10 tumors are more likely to have low PSA levels and are generally not held in check with hormone therapy as long as Gleason 6-8 tumors.
The problem with PSA testing is what you do with it. With noninvasive MRI monitoring and the new radiation techniques, I don’t believe that a blanket approach to stop all screening at 70 is correct. But this is a nuanced and extensive topic of discussion.
The best argument for regular PSA screening is establishing a baseline, a trend, and then using deviations from same as a nudge to probe more deeply.
Long term, I believe blood tests that screen for a variety of cancer markers will become a cheaper and more effective means of catching cancers much earlier, allowing less invasive and more effective treatments.
Trouble is, even if one does such tests, there is no guarantee that the test will be administered often enough to catch all cancers, especially the very aggressive kinds that merit the most attention when it comes to saving folk.
So even if these new tests prove successful re screening, the tradeoff continues between $$$, convenience, etc. vs. being able to reach a ripe old age.
We’ve been regaled over the course of the pandemic with numerous stories of how healthy people can suddenly be diagnosed out of the blue with advanced cancer, despite not having been unwell.
This was stupidly labelled as “turbo cancer”, and was hailed by MAGATs and antivaxers everywhere as proof that Covid vaccines cause cancer.
Now, when someone has been diagnosed with advanced disease, the MAGATs are asserting this must have been present for several years (but was covered up).
Can’t these idiots find a conspiracy and stick to it for a change?
Thank you so this important information and clarification. I worked for 20 years in an oncology practice as a clinical lab scientist. I witnessed heartbreaking situations. Tumor marker values ca be unpredictable, even with rigorous testing. I encourage people to insist on testing when a PCP balks.
As a physician who turned 70 today, I am completely incredulous of the USPSTF's ridiculous recommendation to stop PSA testing in men 70 years of age or older, when the American Cancer Society reports that fully 51% of all new prostate cancer diagnoses in the United States are in men 69 years of age or older. While they are currently "revising" their 2018 standards, how many clinicians have relied on this outdated, unjustified standard that could only have needlessly resulted in countless cases of prostate cancer without a single urologist or urological oncologist on their "expert" board of advisors? I will not forget the discussion I had a number of years ago with my then primary care doctor about the fact that the VA system, relying on the recommendation of the USPSTF, was considering amending their policy to "spare" veterans the discomfort and the VA's burden of cost in resolving what they believed were unnecessary false-positives in PSA testing. One can only guess as to how many US service veterans actually were burdened with prostate cancers diagnosed at a later stage because of this choice. My doctor, however, held her ground, telling me that she was more than willing to risk a few false positive PSA's rather than compromise the safety of her senior male patients, and the American Cancer Society data appears to have proven her decision to be correct. Now is the time to bring into question their outdated, unjustified recommendations for mammography, and their fundamental lack of similar expert advisors that only stands to promote a similar disaster for women.
Sure, I understand—on a macro level—the recommendation against a PSA for men in certain demographics. But aside from the public health efficiency and similar concerns, I’ve only got this one life of mine. So when my doctor said a PSA was not recommended, but my insurance (and later medicare) would cover it if I wanted one, of course, I said, “Let’s do it.” In fact, I would’ve paid for it myself since I spend more than that on valet parking and similar frivolities.
The statement that PSAs return false negative for a small percentage of men who do have prostate cancer seems totally irrelevant to my decision, since if I do have prostate cancer, the PSAs I don’t get will—in effect—return false negatives 100% of the time.
I’ll give you 10 to 1 odds that the reason Biden wasn’t diagnosed sooner was because he hadn’t gotten a recent PSA. Don’t you reckon Biden and his family wish he’d gotten a PSA even if he had to pay for it out of pocket?
As a Stage 4 colon cancer survivor, I also believe a CEA should be part of a standard annual checkup. It’s a cheap lab test, and although it will have some false negatives, the true positives will prevent a lot of deaths and misery. By the time I was diagnosed, my CEA was over 400, and although I’m cancer-free now, the chemo, bowel surgery, and surgery for liver mets was severely life-altering.
Will it help stop the unhelpful, unhinged and inhumane attacks on Joe Biden and his cancer diagnosis. Nope. They don’t let truth get in the way, ever. This guy gave his life to public service, and the flood of vitriol and LIES about him and his family the past few years would have taken their toll, emotionally and physically. The truth about his achievements whilst president were not spoken about by main stream media who were focussed on the gaudy and evil persona of arch villain trump. MSM have blood on their hands for their obsessive coverage of trump, not holding him accountable, and for normalising his hateful attacks on anybody he didn’t like, feared and thought he’d score points from. You had an obligation to fact check his lies about Biden, the ‘worst economy’ and everything else. Time will place Biden as one of the great presidents who quietly got on with rescuing the economy which trump tanked in his first term, and introducing multiple bills that helped his country and people. Stop normalising trump’s lies, you could start by telling the unvarnished truth… Biden left trump with a healthy economy, not ‘the worst one in history. FFS MSM, start earning an honest day’s pay by calling out every lie the traitorous megalomaniac spouts. YOU are RESPONSIBLE for the stench in the WH, start cleaning your mess.
Sorry for the rant and going off track… just one of those days. 🤷🏻♀️
I have no interests in US politics, so I write from a total neutral viewpoint. My curiosity is just about medicine, and about the standards of health care in the US. I was assuming that a President should get a much higher and specific level of care than a common citizen. Not necessarily as a privilege, but to protect the continuity of his crucial service to the nation. I found this article is pretty long-winded and tries avoiding the core question by the classical technique of listing a bunch of information, more or less related to the question, without really answering. The question is simple: how likely is for a person under attentive medical monitoring, with money a non-issue, to suddenly find out this condition ? I want a number, p=xx% - not a chat. I was surprised about the whole discussion on PSA, age, and insurance: PSA is a very cheap test, and assume a President will be monitored by monthly blood tests anyway, so no reason not to do a PSA as well. The discussion about the standards of care for a large population is off-topic, here we are talking about a single person. There are rules against giving PSA to millions of healthy people just because there are not enough resources to do the follow-up exams to all those false positives that would surely be found. But, good practices for large populations simply do not apply to single, special individuals. Money not being an issue, I assume that not only the trivial PSA, but also regular MRI scans, and many other tests are done anyway as well, to this all-important individual - just to check for anything suspicious. So I was disappointed by the vague answer, from which I did not learn what I hoped to learn.
The biggest flaw in the USPSTF recommendation is that it relies on average life expectancy, which doesn't account for individual variation. Many men live well into their 80s and beyond, so it's misguided to assume that a 70-year-old today is unlikely to live another decade. This limitation is starkly illustrated by the former president himself—now 82—who had his last PSA test in 2014 at age 72 and is now battling an aggressive, metastatic cancer.
I was diagnosed with breast metastatic disease in 2023 and have been on an educational crash course ever since. Metastatic cancer is tricky despite all of the advances we have made in screening and treatment. It is very very sad that Biden has this diagnosis but not at all surprising. Praying for our president as he gets care.
My father was diagnosed with prostate cancer in 1993 and received radiation treatment. The following years he had regular check-ups, but became ill early in 1997. Despite great effort by Norwegian healthcare, the cancer developed into Hogdkins and he died in September 1997. Cancer can absolutely work unnoticed and fast.
All good points by this doctor but the timing of this cancer announcement comes right after the release of the tapes showing clearly Bidens mental deterioration and that is what makes this so suspect!! There are many questions regarding this announcement and there should be!! It’s the old trick Hey Look over here!! Forget about what’s over there!! Bottom line They knew Biden was incapable to hold office of president before he even ran and then they lied to the American people about his deteriorating mental health for 4 years and the media was involved in the cover up! Who was running our country?? Who was using the auto pen??
The American people have the right to know what happened in the White House snd just because this cancer diagnosis came out in the news literally 2 days after the tapes were released does not make it right to not question this diagnosis It’s very clear they are using this to make people not talk about the tapes that prove Biden was completely incapable of holding office of President!!!!
My brother was diagnosed with stage 4 metastatic prostate cancer, with tumors at 10 bony sites, one year after a normal PSA. So yes, it’s possible and it happens.
Medical oncology here and I agree.
Gleason 9/10 tumors are more likely to have low PSA levels and are generally not held in check with hormone therapy as long as Gleason 6-8 tumors.
The problem with PSA testing is what you do with it. With noninvasive MRI monitoring and the new radiation techniques, I don’t believe that a blanket approach to stop all screening at 70 is correct. But this is a nuanced and extensive topic of discussion.
The best argument for regular PSA screening is establishing a baseline, a trend, and then using deviations from same as a nudge to probe more deeply.
Long term, I believe blood tests that screen for a variety of cancer markers will become a cheaper and more effective means of catching cancers much earlier, allowing less invasive and more effective treatments.
Trouble is, even if one does such tests, there is no guarantee that the test will be administered often enough to catch all cancers, especially the very aggressive kinds that merit the most attention when it comes to saving folk.
So even if these new tests prove successful re screening, the tradeoff continues between $$$, convenience, etc. vs. being able to reach a ripe old age.
Yupp, it comes pretty suddenly! Happened to my dad out of the blue.. and he was one of the healthiest guys I knew!
No one should be asking “how did they not see it coming?”
No one sees it coming.
We’ve been regaled over the course of the pandemic with numerous stories of how healthy people can suddenly be diagnosed out of the blue with advanced cancer, despite not having been unwell.
This was stupidly labelled as “turbo cancer”, and was hailed by MAGATs and antivaxers everywhere as proof that Covid vaccines cause cancer.
Now, when someone has been diagnosed with advanced disease, the MAGATs are asserting this must have been present for several years (but was covered up).
Can’t these idiots find a conspiracy and stick to it for a change?
Thank you so this important information and clarification. I worked for 20 years in an oncology practice as a clinical lab scientist. I witnessed heartbreaking situations. Tumor marker values ca be unpredictable, even with rigorous testing. I encourage people to insist on testing when a PCP balks.
As a physician who turned 70 today, I am completely incredulous of the USPSTF's ridiculous recommendation to stop PSA testing in men 70 years of age or older, when the American Cancer Society reports that fully 51% of all new prostate cancer diagnoses in the United States are in men 69 years of age or older. While they are currently "revising" their 2018 standards, how many clinicians have relied on this outdated, unjustified standard that could only have needlessly resulted in countless cases of prostate cancer without a single urologist or urological oncologist on their "expert" board of advisors? I will not forget the discussion I had a number of years ago with my then primary care doctor about the fact that the VA system, relying on the recommendation of the USPSTF, was considering amending their policy to "spare" veterans the discomfort and the VA's burden of cost in resolving what they believed were unnecessary false-positives in PSA testing. One can only guess as to how many US service veterans actually were burdened with prostate cancers diagnosed at a later stage because of this choice. My doctor, however, held her ground, telling me that she was more than willing to risk a few false positive PSA's rather than compromise the safety of her senior male patients, and the American Cancer Society data appears to have proven her decision to be correct. Now is the time to bring into question their outdated, unjustified recommendations for mammography, and their fundamental lack of similar expert advisors that only stands to promote a similar disaster for women.
Sure, I understand—on a macro level—the recommendation against a PSA for men in certain demographics. But aside from the public health efficiency and similar concerns, I’ve only got this one life of mine. So when my doctor said a PSA was not recommended, but my insurance (and later medicare) would cover it if I wanted one, of course, I said, “Let’s do it.” In fact, I would’ve paid for it myself since I spend more than that on valet parking and similar frivolities.
The statement that PSAs return false negative for a small percentage of men who do have prostate cancer seems totally irrelevant to my decision, since if I do have prostate cancer, the PSAs I don’t get will—in effect—return false negatives 100% of the time.
I’ll give you 10 to 1 odds that the reason Biden wasn’t diagnosed sooner was because he hadn’t gotten a recent PSA. Don’t you reckon Biden and his family wish he’d gotten a PSA even if he had to pay for it out of pocket?
As a Stage 4 colon cancer survivor, I also believe a CEA should be part of a standard annual checkup. It’s a cheap lab test, and although it will have some false negatives, the true positives will prevent a lot of deaths and misery. By the time I was diagnosed, my CEA was over 400, and although I’m cancer-free now, the chemo, bowel surgery, and surgery for liver mets was severely life-altering.
Thank you for clarifying the situation.
Will it help stop the unhelpful, unhinged and inhumane attacks on Joe Biden and his cancer diagnosis. Nope. They don’t let truth get in the way, ever. This guy gave his life to public service, and the flood of vitriol and LIES about him and his family the past few years would have taken their toll, emotionally and physically. The truth about his achievements whilst president were not spoken about by main stream media who were focussed on the gaudy and evil persona of arch villain trump. MSM have blood on their hands for their obsessive coverage of trump, not holding him accountable, and for normalising his hateful attacks on anybody he didn’t like, feared and thought he’d score points from. You had an obligation to fact check his lies about Biden, the ‘worst economy’ and everything else. Time will place Biden as one of the great presidents who quietly got on with rescuing the economy which trump tanked in his first term, and introducing multiple bills that helped his country and people. Stop normalising trump’s lies, you could start by telling the unvarnished truth… Biden left trump with a healthy economy, not ‘the worst one in history. FFS MSM, start earning an honest day’s pay by calling out every lie the traitorous megalomaniac spouts. YOU are RESPONSIBLE for the stench in the WH, start cleaning your mess.
Sorry for the rant and going off track… just one of those days. 🤷🏻♀️
I have no interests in US politics, so I write from a total neutral viewpoint. My curiosity is just about medicine, and about the standards of health care in the US. I was assuming that a President should get a much higher and specific level of care than a common citizen. Not necessarily as a privilege, but to protect the continuity of his crucial service to the nation. I found this article is pretty long-winded and tries avoiding the core question by the classical technique of listing a bunch of information, more or less related to the question, without really answering. The question is simple: how likely is for a person under attentive medical monitoring, with money a non-issue, to suddenly find out this condition ? I want a number, p=xx% - not a chat. I was surprised about the whole discussion on PSA, age, and insurance: PSA is a very cheap test, and assume a President will be monitored by monthly blood tests anyway, so no reason not to do a PSA as well. The discussion about the standards of care for a large population is off-topic, here we are talking about a single person. There are rules against giving PSA to millions of healthy people just because there are not enough resources to do the follow-up exams to all those false positives that would surely be found. But, good practices for large populations simply do not apply to single, special individuals. Money not being an issue, I assume that not only the trivial PSA, but also regular MRI scans, and many other tests are done anyway as well, to this all-important individual - just to check for anything suspicious. So I was disappointed by the vague answer, from which I did not learn what I hoped to learn.
I have written about this as well on my Substack:
https://ramkrishnan.substack.com/p/the-missed-signal-what-president
The biggest flaw in the USPSTF recommendation is that it relies on average life expectancy, which doesn't account for individual variation. Many men live well into their 80s and beyond, so it's misguided to assume that a 70-year-old today is unlikely to live another decade. This limitation is starkly illustrated by the former president himself—now 82—who had his last PSA test in 2014 at age 72 and is now battling an aggressive, metastatic cancer.
I was diagnosed with breast metastatic disease in 2023 and have been on an educational crash course ever since. Metastatic cancer is tricky despite all of the advances we have made in screening and treatment. It is very very sad that Biden has this diagnosis but not at all surprising. Praying for our president as he gets care.
My father was diagnosed with prostate cancer in 1993 and received radiation treatment. The following years he had regular check-ups, but became ill early in 1997. Despite great effort by Norwegian healthcare, the cancer developed into Hogdkins and he died in September 1997. Cancer can absolutely work unnoticed and fast.
Good information
Saw on tonight’s news that his last PSA was in 2014.
.yes, INVESTMENT in RESEARCH - are you hearing this, POTUS and (your) friends?
All good points by this doctor but the timing of this cancer announcement comes right after the release of the tapes showing clearly Bidens mental deterioration and that is what makes this so suspect!! There are many questions regarding this announcement and there should be!! It’s the old trick Hey Look over here!! Forget about what’s over there!! Bottom line They knew Biden was incapable to hold office of president before he even ran and then they lied to the American people about his deteriorating mental health for 4 years and the media was involved in the cover up! Who was running our country?? Who was using the auto pen??
The American people have the right to know what happened in the White House snd just because this cancer diagnosis came out in the news literally 2 days after the tapes were released does not make it right to not question this diagnosis It’s very clear they are using this to make people not talk about the tapes that prove Biden was completely incapable of holding office of President!!!!