You may have heard that there's a bit of controversy lately swirling around the PSA test for prostate cancer.
A group of medical professionals called the US Preventive Services Task Force came out
with a recommendation in 2012 to do away with the test. Their reasoning? Widespread use
of the test is responsible for incredibly high levels of overtreatment. That means that
hundreds of thousands of men each year undergo unnecessary radical cancer procedures with
really serious side effects. The PSA test if the initial spark that starts the forest
fire. So, is the Task Force correct? Well, they're right about the overtreatment part.
It's estimated that 500,000 men have unneeded biopsies every year and 50,000 men undergo
radical prostatectomies that they don't need. And if any surgery deserves to be called radical,
it's that one, but that's another topic for another day.
So given these facts, if you're a man over 40 you should not bother having your PSA test,
right? Yeah, no. Not right. We still need it. The test measures a substance in the blood
called prostate specific antigen that the prostate gives off all the time, but at higher
levels when it's aggravated. It can be aggravated by sexual activity, inflammation, certain
types of heavy exercise, even riding a bike and, of course, prostate cancer. One smart
guy compared the PSA test to the check engine light in your car. That light could be on
because your gas cap is loose or it could be that your oil pump is failing and your
engine is about to seize up. Either way, you've got to look into it. You've got to find out
why that light is on.
The overtreatment problem isn't with the PSA test. It's with its current diagnostic partner
and with the mindset that all cancers are alike and that all cancers are life-threatening
all the time.
Okay, first the diagnostic partner. For most men, the next step after a high PSA test result
is the random needle biopsy which involves using a large needle to remove samples, called
"cores," from different areas of the prostate. The cores are examined under a microscope
and judgments are made about whether cancer is present or not. As a diagnostic partner
to the PSA, the needle biopsy has big problems. First, it's invasive. Men may suffer temporary
erectile dysfunction as a result of the biopsy and 3% of the men undergoing these biopsies
get infections serious enough to require hospitalization. More imporatanly though is the fact that the
random needle biopsy is not very accurate. It can miss serious cancer or it can pick
up low-level non-aggressive cancers that really don't require treatment. We need a new diagnostic
partner and thankfully, we have one. recent advances in MRI imaging have changed everything.
The latest generation of MRI machines called 3 Tesla or 3T machines scan at a much higher
resolution than the earlier machines. They enable radiologists to see all but the tiniest
tumors. This means that biopsies, when they are needed, can be targeted right to the suspicious
area in the prostate.
Now let's tackle the mindset. Get ready for some statistics. A lot of men die from prostate
cancer in the U.S. each year, nearly 28,000. It's a serious disease. From a raw numbers
standpoint, it's comparable to another serious disease, colon cancer from which about 26,000
people die each year. The difference lies in the number of new diagnoses. There are
241,000 new cases of prostate cancer diagnosed versus 73,000 for colon cancer. That means
that colon cancer has a mortality rate three and a half times greater than prostate cancer.
There's another relevant statistic that shows how differently even the bad type of prostate
cancer behaves. That is that the survival of a relapsed colon cancer patient averages
13 months while survival with relapsed prostate cancer averages 13 years. So even the deadly
form of prostate cancer progresses very slowly. But we've been focusing on the minority of
men with the bad type of prostate cancer. The truth is that most men have a form that
is so slow-growing, so non-life-threatening that it probably shouldn't even be called cancer.
So with all that said, let's get back to the PSA test. Should we get rid of our check engine
light? No, we shouldn't. If you are older than 40, you should have a PSA test as part
of your yearly checkup. Remember, there are 28,000 guys dying from prostate cancer each
year, but (and this is a big but) you shouldn't freak out if your PSA number comes back high.
Just like you wouldn't rush out to replace your car's engine without checking to see
if the gas cap is loose, you should not be rushed into ay decision about treatment, including
a random needle biopsy. Don't panic, slow down. Take a deep breath. Do your research.
A good place to start is PCRI.org. Another great resource detailing the steps you should
take after receiving a high number on your PSA test is this blog post reprinted from
The Prostate Snatchers Blog by Ralph Blum and Dr. Mark Scholz. Read it. Take control
of your own healthcare. Don't ignore warning signs, but don't be a victim of overtreatment.
It's worth it!