The U.S. Preventive Services Task Force has made a recommendation that there is no benefit for men over 50 to have PSA testing.
As a prostate cancer survivor I and others have very mixed feelings about this recommendation. In discussion groups with other survivors this recommendation does not sit well.
The PSA test is not a very good test; there are factors other than cancer that elevate a PSA level. These factors include: Infections, sexual intercourse, and even riding a bicycle.
The doctor that developed the PSA test wrote and piece in The New York Times denouncing the way the test is being applied, or more exactly, misapplied.
Here is the problem, prostate cancer can be very slow growing and considering your age, it may never be an issue. It can also be very aggressive and move from the Prostate into the bones and elsewhere in the body.
While the cancer is contained in the gland, surgery and radiation have a good chance of eliminating it. Chemotherapy is very ineffective against prostate cancer.
The drugs used to slow down the growth of the Cancer cells works by eliminating the body’s ability to produce testosterone. It is aptly called chemical castration, and the side effects are very unpleasant.
This therapy only slows down the cancer, and it can become ineffective in time. Nothing developed yet eliminates cancer cells that have metastasized into the bone or other parts of the body.
I used the word misapplied in conjunction with the PSA test, and that was part of the problem the task force was addressing.
In my case, it was a routine exam that included the dreaded DRE. The Doctor felt something and suggested I see a Urologist for a second opinion. My PSA at this point was within normal limits. The Urologist did a quick DRE and said I was fine, and to come back in six months. In six months my PSA had risen and I had a Biopsy which was positive.
I was told by urologists that in my case many urologists would have gone right to the biopsy, since defensive medicine dictates they act when another physician suspects cancer.
There are other urologists that routinely dobiopsies based solely on a PSA test. This is how the PSA test is misapplied. There are a lot of unnecessary procedures being performed, putting a large number of people at serious risk.
Considering my experience with prostate cancer, I am not sure that a blanket proclamation is in the best interest of the male population. I feel that a set of guidelines concerning the use of the biopsy is more in order than a blanket proclamation. One in six men will be diagnosed with prostate cancer at some point in their life.
Earlier, I mentioned a few of the things that can raise the PSA level, and good medical practice should dictate that those other causes be ruled out before performing the risky biopsy procedure.
The patient can also contribute to this overtreatment. Hearing you may have cancer can rock your world in ways you cannot imagine. People panic when they should become analytical. It is important to step back and not demand immediate aggressive testing and treatment.
Studies show that almost 50% of the biopsies are negative. To complicate matters, depending on how many samples are taken and how carefully they are spaced, the cancer can be missed. In this case you have a negative biopsy, and you have cancer. If it is a slow grower, you may never know that. If it is a fast grower, you are delaying treatment.
If you find this confusing, it is. Now imagine you have been told you may have cancer and all of this seemingly contradictory information is rolling around in your head. In my experience going though this process I have learned some steps you can take to help eliminate some of this confusion.
I will explain those steps in further posts, if people are interested.