.
Feedback

Will You Get a PSA Test this Year?

Considering the latest U.S. Preventive Services Task Force recommendation will you Men over 50 request a PSA Test or roll the dice?

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. 

Paul Schwarz July 10, 2012 at 07:08 pm
I count myself as one who is here because of the existence of the PSA test. After unchanged results for ten years, my doctor, noting a sharp rise, sent me to a urologist, where a biopsy was positive, and a Gleason score (aggressiveness) was moderate to high. My prostatectomy was 11 years ago. Here I am. What do the people who downgrade the usefulness of the PSA test have to say to people like me?
Bob Rohr July 10, 2012 at 07:33 pm
Paul, that is a great story and I am truly happy for you. 11 years with no biochemical failure must be a very good feeling. I am sure you remember how it was to live you life in those chunks of time between tests.
Thanks for standing up and sharing. Men that have suffered from Prostate Cancer seem to hide out, like it is something shameful.
bruiser July 10, 2012 at 09:45 pm
Watchdog stop with all the rhetoric and lies,"Some of people’s concerns (about the health care legislation) have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost.(Ya know fox snooze) "The best example is the claim, made not just by radio and cable talk show hosts, but by prominent politicians,(Sarah i can see Russia from my house Palin) that Obama plans to set up such a panel is a lie, plain and simple.I would suggest before making a comment like yours do your homework.
Bob Rohr July 11, 2012 at 01:15 am
First of all Watchdog and Bruiser, this post is not meant to serve your political agenda, you two wanna fight take it outside. If you really believe in what you are saying use your names.
This post and others I have written about this topic are meant to give some information and maybe a bit of comfort to Men who will hear they have this Cancer tomorrow, or next week. Folks like us can be hurting and confused through this process. People like Paul with 11 years Cancer free, and my 2 1/2 years tell them that it can be OK, it really can be OK. If you move forward in a logical informed manner rather than rush into the something you will regret, you can put this all behind you.
bruiser July 11, 2012 at 02:01 am
Bob i agree with your comment and will take the time to say i am sorry,but when i see comments like these i feel the need to respond to what i deem to be lies and rhetoric,again i am sorry and know first hand what the tests mean.
Bob Rohr July 11, 2012 at 02:31 am
Fair enough Bruiser. If you know what the test mean would you share your story?
Yehbut July 11, 2012 at 01:06 pm
I recently had a general exam where my DRE was normal, but my PSA was slightly elevated. My physician referred me to a urologist, given another normal DRE and another slightly elevated PSA. Both times my PSA was taken, I was not informed it could be higher due to sex, which was the case in my situation each time. Men should be told about this when the appointment is being made for the test! Men should abastain from sex for 48-72 hours before the test. It can raise the PSA a point or two. My tests were elevated less than 1 point. The urologist recommended a biopsy if the test was elevated again. However, upon researching this, I learned that cancer can be present without an elevated PSA, and with a normal DRE. It can also be present after a normal biopsy, leading to additional followup biopsies. Forgive me, but it seems to me these biopsies are being routinely ordered and it seems its become a lucrative part of the urology profession. If I can have no peace of mind after going through as an invasive procedure as a prostate biopsy, why should I? I researched further and discovered there are more precise psa tests that can be ordered, and MRI targeted biopsies that can pinpoint suspicious areas in the prostate as well as check for cancer linked chemicals that may be present. If I'm going to have my rectum and prostate pierced, I want more precise information and peace of mind, God willing. Neither doctor told me about this other information. I had to research it myself.
Bob Rohr July 11, 2012 at 02:24 pm
You bring up some great points which a lot of Men have not been informed of. I wrote an entire piece on my process from diagnosis to treatment.
First, of all the Internet is a great resource, but it is also filled with a lot of crap. You really have to get very critical of what you read, and pick your sources, and use a date filter on searches.. You also bring up a good point about some Doctors. My Brother is a Doctor and I have several Doctors I know very well and they gave me advice. The best general advice I received was from a general Surgeon. He simply said “do not let anyone rush you, you have time.” Doctors are like anyone else. You can have a group of people that have had the same training, and read the same Journals. How they apply what they have been taught is variable, like any other group of people. There is a new test that has been approved which appears to be more specific than the PSA. Like all new things time will tell if it is valid or truly better than the PSA test. One goal of mine is to tell Men that you have to take control. You have to be able to say no to certain things. You have to sometimes strongly request certain tests which can give some insight as to where the Cancer is, which will dictate what treatment will have the best outcome. To add to the confusion, some of the most aggressive Cancers do not elevate the PSA much at all.
Watchdog July 11, 2012 at 05:25 pm
Post removed. I apologize. You are correct.
Bob Rohr July 12, 2012 at 01:37 am
"Forgive me, but it seems to me these biopsies are being routinely ordered and it seems its become a lucrative part of the urology profession. If I can have no peace of mind after going through as an invasive procedure as a prostate biopsy, why should I?"
I think that your observation may have been the prime mover for the Task Force recommendation. There has been a lot of reports if excessive biopsies and surgeries being done on flimsy evidence. While the Urologist that performed the Biopsy on me is not my current Urologist, I do respect his not rushing the process. He is a ethical practitioner.

Newsletter & Alerts

Get the best stories each day and important breaking news

Subscribe

Not from Yorktown-Somers Patch? Find your Local Patch »

Note Article
Just a short thought to get the word out quickly about anything in your neighborhood.
Share something with your neighbors. Write a new post... What's up? Make an announcement, speak your mind, or sell something
Jarid proudly displaying his graduation diploma and "Altruistic Act of the Year" Award
Carolyn DePaolo June 18, 2013 at 08:20 pm
Jarid is an exceptionally giving person. We are so very proud of him, today and every day. WeRead More certainly can all learn a life lesson from Jarid. Love you and we are so proud of you Jarid!
Lisa Buchman (Editor) June 17, 2013 at 01:45 pm
Thanks for sharing this photo. We'd love to hear more from these groups; if you'd like to startRead More blogs on Patch, which archive your posts all together and give you a great landing page on the site, please email me at LisaB@Patch.com.
Joey Cirone June 11, 2013 at 01:45 pm
Correction: The Yorktown Leo's Club raised and is giving away $12,600 this year!!
Lisa Buchman (Editor) June 13, 2013 at 09:13 am
That is fantastic! These are really nice photos - terrific young leaders at work. If you'd like toRead More set the Leo's up with a blog, they can document their service through brief write ups or photos throughout the year. Email me LisaB@Patch.com if you are interested.