PSA Is A Bad Test For Prostate Cancer
It is crystal clear to me that PSA is not a good test to screen asymptomatic men for prostate cancer. Although it has been used as a screening tool in the US for more than 2 decades, it wasn’t until 2009 that the results of a clinical trial, called the PLCO trial, revealed that it does not save lives from prostate cancer.
Some symptoms of prostate cancer include:
- Trouble urinating
- Decreased force in the stream of urine
- Blood in your urine
- Blood in your semen
- Swelling in your legs
- Discomfort in the pelvic area
- Bone pain
We in the medial community waited decades for this study and what did the urology community recommend based on it? They now recommend dropping the age to begin screening from 50 to 40! They ignored their own study and pointed to a european study that showed a small statistically significant increase in survival with PSA screening. It was so small, that the European medical community did not recommend screening!
Screening men without symptoms with PSA has always been and continues to be controversial in the medical community, with the prestigious American Cancer Society withholding its recommendation of this test
Remember, an elevated PSA is not diagnostic of prostate cancer! An elevated PSA just starts a cascade of tests and procedures to determine whether cancer is present. If 100 men had their PSA measured, 15 will found to have elevated levels. Further testing of those 15 men would reveal that only 3 have cancer. Men have an overall 16% chance of being diagnosed with prostate cancer in their lifetime, but only a 4% chance of dying from the disease.
PSA was originally intended to be used as a tool to detect prostate cancer recurrence. Following prostatectomy after cancer diagnosis, men would be followed with periodic PSA screening. When the prostate is surgically removed (prostatectomy) PSA would be zero (because PSA is a protein that is primarily found in the prostate), but if PSA was detected it meant that the cancer had returned.
Urologists turned it into a screening test for men with no symptoms of prostate cancer.
The best thing tom do is to follow the recommendations by the USPSTF that PSA testing on asymptomatic should be done only after you have all the information you need from your doctor to make an informed decision. Namely, 1. Understand that PSA is not diagnostic of prostate cancer. 2. If you have an elevated PSA you will need a biopsy which has it’s own complications. 3. If you are diagnosed with cancer you will have to choose a treatment option which could have serious side effects for a cancer that probably wouldn’t have resulted in your death. Such side effects include, among other things, erectile dysfunction and incontinence.
You will probably have to initiate a conversation about PSA screening with your doctor because its the family care physician who usually orders the test without even telling the patient. He just draws your blood and checks off PSA on the list of lab tests without thinking twice about it. Speak up! Once the test is drawn you’re on the PSA train and there’s no going back.
If you do go ahead with PSA screening and are subsequently diagnosed with prostate cancer, get a second opinion. If the pathologist doesn’t see enough prostate cancers where it has become routine in his practice, he may not have the experience to make an accurate diagnosis. Also, if the diagnosis is confirmed and you decide to go ahead with treatment be sure your doctor has done the procedure hundreds of times. For example, that it takes at least 250 prostatectomies for a urologist to be an expert.
Get involved with your care so you don’t have any regrets later on!
[Photo By Horia Varlan]