Joe Ferguson forever

More is not always better but more intelligence is.

at least you're consistent(ly)....incorrect' looks like he stopped screening for prostate cancer after age 70 consistent with guidelines. BPH actually causes many false positive psa's. A history of this makes psa even less useful. TURP, the surgery most often done for BPH, has nothing to do with cancer and wouldn't be a factor in deciding whether to do further screening psa's

Africa is a continent. Do you mean S Africa and white farmers?

so he should move to Africa to have financial stability. awesome. way to completely miss the point.

bs. every one of my nieces and nephews of age have college degrees. one has a recent Chem Engineering degree from Berkley. He has only worked independent contractor jobs from big pharmaceutical so far. No benefits, both sides of social security, no 401k match etc. Big companies do this routinely now to save money (make more money). The days of working for a company with full benefits for your entire career are gone. If a president can tell Walmart to eat tariffs, he can also demand that companies treat their employees better.

now you know....what's your response?

The Medicare cuts were news to me. This except explains it: If enacted, the Republican bill would add trillions of dollars to the deficit over the next decade by delivering another round of tax cuts skewed to the rich, partially offset by huge cuts to Medicaid and other programs. According to the CBO, the bill's addition to the deficit would trigger a process known as sequestration under the Statutory Pay‑As‑You‑Go (PAYGO) Act of 2010, a law long reviled by progressives that requires spending cuts equal to legislation's average deficit impact. Unless lawmakers offset the deficit impact of the Republican bill or agree to waive the PAYGO requirements—which the GOP measure does not do—the Office of Management and Budget (OMB) "would be required to issue a sequestration order not more than 14 days after the end of the current session of Congress (excluding weekends and holidays) to reduce spending by $230 billion in fiscal year 2026," the CBO said. "The deficit will explode so badly it will trigger automatic cuts, including over half a trillion dollars from Medicare." Under PAYGO, automatic Medicare cuts are capped at 4%. The CBO estimates that the Republican legislation would trigger roughly $45 billion in Medicare cuts in 2026 and a total of $490 billion in cuts to the program between 2027 and 2034. "This Republican budget bill is one of the most expensive—and dangerous—bills Congress has seen in decades," said Boyle, the top Democrat on the House Budget Committee. "The nonpartisan CBO makes it clear: The deficit will explode so badly it will trigger automatic cuts, including over half a trillion dollars from Medicare." "This is what Republicans do—pay for massive tax breaks for billionaires by going after programs families rely on the most: Medicaid, food assistance, and now Medicare," Boyle added. "It's reckless, dishonest, and deeply harmful to the middle class." remember that trump specifically promised not to touch medicare. if both medicaid and medicare cuts occur, there will be even faster closures of hospitals and clinics nationwide but especially in poor areas. that will affect the commercially insured in these areas also due to less access to care.

blaming the victims. Cost of living is extremely high especially for essentials like housing and food. All of my nieces and nephews are working their asses off too and not hanging out at Starbucks or living an opulent lifestyle. The affluence is concentrated in a small fraction of the population and this bill greatly worsen this economic inequality.

excellent article https://www.latimes.com/politics/story/2025-05-20/6-doctors-on-bidens-cancer-diagnosis-how-it-may-have-arisen-and-his-treatment-options Dr. Mark Litwin, chair of UCLA Urology, said that description indicated Biden has a more advanced and aggressive form of prostate cancer than is diagnosed in most men, but that it was nonetheless “a very common scenario” — with about 10% of such cancers in men being metastatic at diagnosis. Dr. Howard Sandler, chair of the Department of Radiation Oncology at Cedars-Sinai, agreed. “It’s a little unusual for him to show up with prostate cancer that’s metastatic to bone at first diagnosis, but not extraordinary,” he said. “It happens every day to elderly men.” The doctors The Times spoke to had no special insight into Biden’s medical care, but said his diagnosis did not make them feel any less confident about the caliber of that care or suggest to them any nefarious intent to hide his condition. For starters, “it would be considered well within the standard of care” for Biden to have forgone testing in recent years, given his age, Sandler said. “Certainly after 80.” Litwin said he believes Biden probably was still tested, given his position, but that doesn’t mean he was necessarily hiding anything either. Some forms of aggressive prostate cancer don’t secrete antigens into the blood at levels that would be flagged in a PSA test, while others can grow and even metastasize rapidly — within a matter of months, and between routine annual screenings, he said. Patel said he has personally found “very aggressive disease” in patients who had relatively normal PSA levels. “I don’t think anyone can blame anyone in terms of was this caught too late or anything like that,” he said. “This happens not too infrequently.” Dr. Alicia Morgans, associate professor of medicine at Harvard Medical School, a genitourinary medical oncologist and the director of the Survivorship Program at the Dana-Farber Cancer Institute, agreed. Even if a patient is diligent about getting screened annually, “there will be some cancers that arise between screening tests,” she said.

if following the facts makes me a good guy, then I am. I was adequately compensated for that already. No head pat needed.

sounds like you approved of vance saying people were eating dogs and cats in Ohio, only to later admit he lied.

nope. you're dim if you pretend to know when or if a psa was done or that it was positive just because you want to. the test is not great. i've repeatedly shown that. not a loophole. a fact. it is absolutely possible that a psa was done a year ago and was negative. I posted a link that showed 15% of false neg psa's are in patients with aggressive cancers. not a loophole, a fact. and yes, by now we are all well aware of the hate maga's have for science.

stupid people should not do science or medicine. This is from The American cancer society site and is the currently used staging system IVA Any T, N1, M0 Any Grade Group Any PSA The tumor might or might not be growing into tissues near the prostate [any T]. The cancer has spread to nearby lymph nodes [N1] but has not spread elsewhere in the body [M0]. The Grade Group can be any value, and the PSA can be any value. IVB Any T, any N, M1 Any Grade Group Any PSA The cancer might or might not be growing into tissues near the prostate [any T] and might or might not have spread to nearby lymph nodes [any N]. It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs [M1]. The Grade Group can be any value, and the PSA can be any value. as you can see, stage 4 is primarily defined by mets and lymph nodes. tumor size (T) does not define stage 4. The tumor can be any size. additionally, a large tumor can still be felt on rectal exam as a nodule.

My doctor and I followed the guidelines and found cancer. It was the right thing to do. Now we are doing active surveillance which is also the right thing to do. Re the specificity and sensitivity of tests, here's yet another quote from a 2024 article in a Family Practice journal (primary care docs do the vast majority of testing and interpretation) Although PSA testing has been used to screen for prostate cancer since 1987, there is no consensus on which threshold should warrant a prostate biopsy. The most commonly used threshold of more than 4.0 ng per mL (4.0 μg per L) has an approximately 70% false-positive rate. Lowering the threshold to more than 2.5 ng per mL (2.5 μg per L) increases the false-positive rate to 80%.8 Using a biopsy threshold of more than 4.0 ng per mL, the PSA test has an overall sensitivity of 72%, specificity of 93%, and positive predictive value of 25%.9 As many as 15% of men with a PSA level less than 4.0 ng per mL will have prostate cancer on biopsy, and 15% of those cancers are high grade (which is a possibility in Biden's case).10 Benign prostatic processes, such as hypertrophy or infection, can also cause PSA elevations. Many strategies have been suggested to improve the diagnostic performance of the PSA test, such as free PSA, PSA velocity, and PSA density. However, none of these strategies has been evaluated in an RCT. It's a hugely flawed test but still valuable in the appropriate population. You're dim.

Maybe. Maybe not if the white house doc appropriately feels a psa in an 82yo has more risks than benefits.. Either way, there's a decent chance it wasn't picked up by the test if it was done. again, sensitivity is low.

I think it would be reasonable to raise the threshold for positive psa in the older population if they desired to be tested. The attending doc can also offer serial psa's No one will stop you from getting the test over 70 but your doc willl almost certainly rec against it.

I am an MD but not a urologist. I've educated myself on it recently when my psa came back high. MRI is the follow up test. Then a bx if mai is positive. This is the up to date protocol And screening (all psa tests are screening in patients without known cancer) is not recommended in men over 70 by any of the organizations that make recs. Because the very real risk of overtreatin g and especially over biopsying. same reason for the high threshold for psa positivity... Re catching it early, obviously that gives a better prognosis but at 82 with this extremely aggressive grade (not stage- there are 4 stages, the forth being distant metastasis), my feeling is his prognosis is poor. I read 5 year survival is about 40% (mine is over 99% to0 show you the difference in grade and gleason scores) There are 9 grades based on cellular microscopic exam of biopsy tissue by a pathologist.

they can lower the threshold for a "positive"{ test but that lowers the specificity (more false positives) which would lead to many unnecessary biopsies (I just had 13 donefor an extremely low grade cancer that5 will likely never be of any problem. but it's the trend of psa that is most useful. I'm ordered every 6 month psa's for the rest of my life.

a study of 1.! Sensitivity= true positives/true positives +false negative. for psa it's 20% at the widely used threshold on 4ng/ml so, even if a psa done, there's an 80% chance a cancer will be missed within a population, at least in the study I posted. It's a crappy test. Always has been.

there is EVERY chance. Read the most respected guidelines. there's are similar. from US preventative task force Men aged 55 to 69 yearsFor men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.C Men 70 years and olderThe USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older.D

What is not true? Specifically? I quoted experts from Dana Farber, Stanford and Johns Hopkins? And you know better because you have prostate issue? Here's another nice tidbit. Please support your contention and specify what I wrote that was incorrect. from arch Urology In this article we explain findings from the Prostate Cancer Prevention Trial (PCPT) concerning the operating characteristics of PSA for biopsy-detectable prostate cancer, with special emphasis on a subpopulation of men with PSA less than 4 ng/ml, what is often regarded as the "normal" level of PSA in healthy men. The PCPT enrolled 18,882 healthy men 55 years of age or older, with a PSA value less than 3 ng/mL and a normal digital rectal exam (DRE); 9,459 of these men were randomized to the placebo arm and 9,423 to the finasteride arm In this report we summarize the operating characteristics of PSA only for the placebo arm of the PCPT; operating characteristics of PSA on the finasteride arm are more complicated to assess since finasteride approximately halves the PSA value and will be reported only briefly. In our first analysis, we focused on a group of 2,950 men on the placebo arm who had had an end-of-study biopsy and a normal DRE and PSA < 4 ng/mL for all 7 years of the study. For prostate cancer, the standard PSA cut-off of 4 ng/mL has low sensitivity: with this cut-off only 20.5% of the prostate cancer cases test positive-nearly 80% of prostate cancer cases are missed. The specificity at this cut-off is high (93.6%) meaning only 6.2% of men who do not have prostate cancer falsely test positive. Lowering the PSA threshold for screening increases detection of aggressive cancer at an earlier stage, but has the unavoidable tradeoff of increased detection of the biologically irrelevant cancers.

No. He may not have had a psa since that is actually against guidelines act 82. Even if he did, psa is a notably poor test. There are signing numbers of false positives and negatives. It's part of the reason why screening is controversial. But the vast majority off of 80+yo that get prostate cancer will die of something else. Biden sadly probably will not. “One of the reasons that you don’t want to screen older men is they’re so likely to have prostate cancer, even though it’s that benign-ish prostate cancer that’s never going to kill them,” said Otis Brawley, a medical oncologist at Johns Hopkins University who treats patients with metastatic prostate cancer. “I’ve seen an awful lot of guys have a lot of mental torment and a lot of physical torment because they were diagnosed with a prostate cancer that all the doctors knew was a cancer that was never going to bother them if It was left alone,” Brawley said. President Trump had his PSA levels tested in April, according to the White House. They were normal. Speaking to reporters at the White House on Monday afternoon, Trump questioned whether Biden was tested, and why the cancer wasn’t caught sooner. Behfar Ehdaie, a urological surgeon at Memorial Sloan Kettering Cancer Center in New York, said while it’s difficult to provide an accurate assessment of Biden’s prognosis, men typically are not screened for prostate cancer after the age of 70, unless they show symptoms. The public summary of his visit listed several tests doctors performed, but not a prostate-specific antigen (PSA) test. That’s not surprising, said Geoffrey Sonn, an associate professor of urology at Stanford University School of Medicine. “Really, there’s not many people out there that will advocate for continuing aggressive PSA screening for men in their 80s,” he said. “In retrospect, I think that it’s likely that if he had continued screening against pretty much all guidelines, that they probably would have found this earlier.” Current cancer screening guidelines are complicated, and Biden’s case echoes a tension; it’s best if the cancer is caught early, but there needs to be a balance between early detection and overtreatment.

https://thehill.com/policy/healthcare/5308413-prostate-cancer-screening-biden/ Biden’s diagnosis is serious, and while treatable, it can’t be cured. Prostate cancer experts said it’s unclear how long Biden has had cancer. Even if he was screened regularly in recent years, they said it’s not uncommon for cancer to develop without notable symptoms. “Cancer doesn’t necessarily follow a rule book. It’s possible that this came out of the blue, because cancer can do that,” said Alicia Morgans, a prostate cancer specialist at the Dana-Farber Cancer Institute, and board member of the advocacy group ZERO Prostate Cancer. The public summary of his visit listed several tests doctors performed, but not a prostate-specific antigen (PSA) test. That’s not surprising, said Geoffrey Sonn, an associate professor of urology at Stanford University School of Medicine. “Really, there’s not many people out there that will advocate for continuing aggressive PSA screening for men in their 80s,” he said. “In retrospect, I think that it’s likely that if he had continued screening against pretty much all guidelines, that they probably would have found this earlier.” Current cancer screening guidelines are complicated, and Biden’s case echoes a tension; it’s best if the cancer is caught early, but there needs to be a balance between early detection and overtreatment. Doctors not involved in Biden’s care said they did not see any signs of a missed diagnosis. “Nothing about his story sounds to me as if there’s been a cover-up or a delay, or anything that is untoward,” said Morgans. “It really sounds like an unfortunate case of prostate cancer diagnosed just a hair too late to cure in a man who also happened to be the President of the United States very recently, and now has a very real-world problem that he and his family have to tackle.”

not seen that. even in blue areas. but many of those are college towns. What are they selling? VW beetles?

routine PSA screening isn't recommended after age 70, partly because it's so prevalent. Partly because per population health measures it doesn't change mortality significantly. If you did post mortem ex's on all 100 yo would see almost 100% positives. Over 80, they're much more likely to die from something else. Biden is an exception but screening would likely not change anything, even in his case. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening. USPTFS guideline are adopted by medicare for reimbursement, or at least they were. Other recs are similar: The American Academy of Family Physicians39 and the Canadian Task Force on Preventive Health Care40 recommend against PSA-based screening for prostate cancer. The American College of Physicians41 recommends that clinicians discuss the benefits and harms of screening with men aged 50 to 69 years and only recommends screening for men who prioritize screening and have a life expectancy of more than 10 to 15 years. The American Urological Association42 recommends that men aged 55 to 69 years with a life expectancy of more than 10 to 15 years be informed of the benefits and harms of screening and engage in shared decision making with their clinicians, taking into account each man’s values and preferences. It notes that to reduce the harms of screening, the screening interval should be 2 or more years. The American Urological Association also notes that decisions about screening, including potentially starting screening before age 55 years, should be individual ones for African American men and men with a family history of prostate cancer. The American Cancer Society43 adopted detailed screening recommendations in 2016 that highlight the importance of shared decision making and the need for informed discussion of the uncertainties, risks, and potential benefits of screening. It recommends conversations about screening beginning at age 50 years and earlier for African American men and men with a father or brother with a history of prostate cancer before age 65 years. there is no stage 9, but if there were bleach would surely cure it.