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Harvard Health Blog
Another study shows PSA testing doesn’t save lives
- By: Marc Garnick, M.D., Editor in Chief, HarvardProstateKnowledge.org
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I was one of the fortunate males to have had a prostate biopsy and found (2012 at 72 y/o) that I had cancer of the prostate. I lived one year with “watch and wait”; the next year another biopsy found that the cancer had attached itself to one of the nerve bundles and I felt it required immediate attention. I found through a lot of research that MDAnderson, out of Texas, has an IMRT program that fitted my needs. After the IMRT program of 42 sessions, my PSA went from 9.5 to 1.4 in one year. Without the PSA tests, I could have been overcome with prostate cancer in less that 5 years.
This doesn’t mean that I’m home w/o prostate cancer, it just means that I’m still here and viable albeit not in the same way I was before the treatments.
This is the problem with American medicine. In Britain, the PSA test is disregarded. There is considerable criticism now in treating diseases based upon markers. The result is needless treatment. Testing for PSA at all ages would just increase the rate of overtreatment, not prolong survival. Too many men, out of fear, demand treatment that will not save their lives. Patients and their loved ones are deceived by the calendar effect, that earlier detection equates with longer survival. Yes, true, from the date of detection, but the patients are dying on the same calendar day. Any prolongation in survival is imagined. The treatments are largely ineffective and alternatives need to be sought immediately upon confirmed diagnosis rather than after treatments have failed. Some of the most promising are molecular medicine approaches to prostate cancer, which includes natural molecules such as lycopene (tomatoes), resveratrol and quercetin(grapes, red wine), vitamin D (sunlight), vitamin E (tocopherols and tocotrienols), and the trace mineral selenium. There is growing evidence that these molecular approaches also enhance existing treatment, helping overcome treatment resistance and reducing treatment side effects. The prevailing problem is that patients and their loved ones demand something be done and will protest loudly if nothing is done. They will demand insurance pay for treatment regardless of efficacy. The same occurred for bone marrow transplants for breast cancer. Family members would run to the local newspaper to protest that insurance companies were rationing care and not living up to their agreement to pay for treatment. It was all for naught. Doctors share some blame for giving in to patient demands. I know some men who for years have lived with chronic prostatitis and elevated PSA. To biopsy, surgically excise and toxicate is to only provoke localized precancerous tissue into a spreading form of cancer. Hippocrates noted that it was better to leave tumors alone rather than treat. The first goal should be to keep tumors from spreading (metastasizing). Surgical invasion triggers the growth of new blood vessels (angiogenesis) in the wound healing process that can grow tumors. These new blood vessels then create a pathway for tumor cells to travel elsewhere. Surgical removal will still leave a few million tumor cells. Efforts to elevate activity of white blood cells to mop up roaming cancer cells and to inhibit adhesion of tumor cells to the walls of blood vessels would be strategies to prevent metastasis, which is the mortal form of the disease.
I think both doctors and men find PSA generally confusing.
My neighbour who is 65 and has a PSA level of 7has been told he needs to have a biopsy by one doctor but another doctor is telling him level is normal for his age. Both doctors work in the same hospital. Who is right???
PSA levels appear to depend partly on age. A PSA of 5 ng/ml might be considered normal for a 73-year-old man, whereas a PSA of 3.9 ng/ml in a 50-year-old man might be a red flag. For that reason, some doctors and researchers advocate adjusting “normal” levels for different age groups. On the other hand, some doctors recommend that the threshold to biopsy be lowered to 2.5 ng/ml for men of any age. (Tradiationally, a biopsy has been recommended for men with PSA levels of 4 ng/ml and higher, though can can change if a man has a family history of prostate cancer.)
One strategy pursued by some men in this situation who are reluctant to have an immediate biopsy is to wait several weeks and then have their PSA checked again. PSA levels can be elevated for reasons that have nothing to do with cancer. The results of the second test may help in making a decision about whether to have a biopsy.
To care passionately for another human creature brings always more sorrow than joy.
Good point. I hadn’t touhhgt about it quite that way. 🙂
I have read many negative reviews about PSA testing however I am always wondering why still it is the most common method the health providers are using today. Though I agree with you about its unreliability however I don’t think it doesn’t mean that it doesn’t save lives. I think it had also lives but not everytime it is used. Without PSA test, what could be the other way in diagnosing prostate problem that is most reliable then? http://www.sexualhealthcare.net/
PSA is always confusing for patients and even more for doctors, specially the last years.
I believe a doctor has a responsibility to avoid making blanket statements that could cost lives. By advocating that PSA testing doesn’t save lives, he is generating a false sense of security for thousands of men who may never know enough to ask for a PSA test after experiencing erectile and urinary symptoms – especially at a young age. If people in responsible positions tell you “you don’t need it” and “that doesn’t happen to men under 50” – you just might believe it…
I am disgusted with this article! I just lost my husband at age 40 to prostate cancer. Yes, that is correct, age 40. He was diagnosed at age 35. After he was diagnosed we later came to find out that he did have a PSA test at age 33 . It was a 2.5 . Yes I understand that it is within “normal” range for a 50 year old but Not a 33 year old!!!! The doctor failed to do a follow up test. 2 years later he was diagnosed with stage 4 prostate cancer. I don’t understand what the big deal is to do a simple blood test!! If he had a follow up PSA maybe he would still be here today and they would have caught it sooner. This disease is attacking men younger and younger everyday. This is not an “old mans disease” anymore!! If a man complains of any symptom related to a prostate issue they should have a PSA done!!!! Oh, and by the way, we sued the doctor who failed to follow up and we WON!!!!!!
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