This triggers my frustration about a discussion I had two days ago with my third urologist, the first two having retired, about whether someone of my age should continue to have PSA screenings.
As background, contrary to the 1990s, when PSA screening was all in sweeping vogue, the prostate cancer medical community is now obsessively focused on what they call "over diagnosis" and "over treatment" of prostate cancer because of high PSA signals. In order to reduce these over diagnoses and treatments at the population level, the various American associations of urologists, cancer specialists, and preventive medicine specialists all have differing guidelines as to what age groups should receive PSA screening, as do their Canadian and European counterparts. It's a cacophonous mess.
In general, to avoid over diagnosis and over treatment of prostate cancer, these guidelines essentially specify that young men and old men shouldn't get screened. The age guidelines vary from association to association, along with some other factors, but a general idea is that men under 50 (or 45) or over 70 (or 75) just shouldn't bother getting PSA screened. The logic for old men seems to be that if no one sees a PSA signal of potential cancer in these men, no one will be tempted to over diagnose or over treat them for prostate cancer—and, besides, most of these old men will die of something else before their cancers fatally metastasize.
For myself, I don't care about POPULATION level guidelines or what may kill MOST old men. I only care about ME, my life. From my perspective, it is undeniable that some percentage of older men, albeit a minority, will develop an aggressive prostate cancer that can be detected by a PSA screen and that some of them could have their life prolonged by a swift and appropriate surgical or other medical treatment. For that reason, I argued to my urologist that I prefer to continue PSA screenings (and DREs) even though with my (knock on wood) low PSA history I'm likely to die of something other than prostate cancer.
He went along with my preference, although I could tell that he was annoyed that I knew so much about this issue, and about simple Aristotelian logic, and had the temerity to challenge his "vast experience."
