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. 

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

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.


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