PSA Testing of Asymptomatic Men

PSA testing of asymptomatic men is very complicated. The results of a new clinical study of over 75, 000 men show that PSA testing may be more result in more harm than good. The clinical trial showed that PSA screening didn’t reduce deaths from prostate cancer. Despite this remarkable evidence, testing continues, as if these data never existed.

PSA was always known to be a lousy test. Three out of four men with elevated PSA levels do not have prostate cancer! If this isn’t bad enough, one out of 3 men with normal PSA levels have been found to have prostate cancer! Obviously, an elevated PSA is not diagnostic of prostate cancer. To make that diagnosis, the prostate must be biopsied. So, why do PSA testing at all? In my opinion it’s done because no one would consent to an annual biospy.  If you told men over 50 they needed to have a needle stuck up their butt and into their prostates, not once but up to 12 times, it is unlikely that they would consent to do so. Screening men is big business, and PSA testing is non invasive. So PSA testing it is! Prostate cancer, after all, is a $7 billion a year industry.

This week the American Cancer Society finally wade in on the debate and recommended that before drawing blood for PSA testing of asymptomatic men, there should be a discussion between the patient and doctor about its benefits and risks. In my experience with PSA testing, most of it is performed in the primary care setting during routine annual exams. No discussion takes place. A box on the lab request form is checked along with all the other routinely ordered tests. So, it will be up to you, the patient, to be informed about the risks and benefits of PSA testing and initiate these discussions with your doctor.

Many men who have been diagnosed with prostate cancer using PSA are upset with the American Cancer Society’s recommendations that treating the disease is risky. Men with cancer say that the risk of biopsy is worth the benefit; their cancer was caught early and they were cured. The thing is, in the great majority of men, if nothing was done they would be cured of their cance.r The real risk is the positive biopsy proceding  to surgery that is most likely unnecessary. With the surgery (or radiation) there is a risk of death, infection, incontinence, impotence and, some men tell me, that the length of their penises are shortened by an inch. Remember, most prostate cancers (80%) are not lethal; if you do nothing at all, it won’t kill you. That’s why you need to have that discussion with your doctor; so you can make an informed decision-do what’s best for you. For other options to treat prostate cancer see my other posts on prostate cancer.

All of this is very complicated. That’s why the American Cancer Society recommends that you discuss testing with your doctor. The blood test for PSA is easy, it’s what to do after the blood test that’s so difficult.

Disclaimer: Please recognize that I am not a Medical Doctor. I have been a Scientist researching and studying prostate cancer for over 15 years. The comments or recommendations I make are not intended to be the procedure for you to now follow; rather, they are to be reviewed along with comments or recommendations of others for your own further study and discussion with the physician providing your prostate cancer care to come to your own conclusion.

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