PSA Testing: What’s a Guy To Do?

Updated From original article published in Bartlett’s Health on November 29, 2011 by Jeff Ward, CPCC

I sat at my kitchen table in total disbelief. I just received the news from my doctor that I had tested positive for prostate cancer. Here I was, young (late 40s), very healthy and fit for my age, with absolutely no symptoms. I really didn’t believe this was possible. Although I had been on pins and needles for a week waiting for the doctor to call me with the results of my prostate biopsy, I never really thought I would hear the dreaded “C” word. But there I was, sitting at the table with my wife—one minute thinking I was fine, and the next shocked to my core by the news.

With that diagnosis, I joined the ranks of the hundreds of thousands of American men who are diagnosed with prostate cancer every year. The numbers are staggering. The American Cancer Society estimates that 233,000 new cases of prostate cancer will be diagnosed in 2014, and about 29,480 men will die of it. Prostate cancer is the second leading cause of cancer death in American men—second only to lung cancer. Even though I was stunned that I had been diagnosed with cancer, in time, I was happy that I had been tested and caught the disease early. If a recent recommendation by a government agency takes hold in the medical community, many men like me might not be so lucky.

That agency is the United States Preventive Services Task Force (USPSTF): an independent panel of non-federal experts in prevention and evidence-based medicine. It is composed of primary care providers such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists. The USPSTF’s purpose is to develop recommendations for primary care clinicians and health systems.

In October of 2011, the USPSTF prepared a draft recommendation against routine Prostate-Specific Antigen (PSA) screening for prostate cancer in men younger than 75. Prior to these new recommendation, the USPSTF had recommended against PSA screening only for men older than 75.

This new recommendation could have huge consequences. For example, the Center for Disease Control (CDC) and other federal agencies follow the USPSTF guidelines, so these recommendations eventually trickle down to primary care physicians and alter their approach to regular screenings. Because of the USPSTF’s decision, it’s possible that health insurance companies may decide to stop paying for this simple, yet potentially life-saving, test.

The USPSTF says it found convincing evidence from various studies that treatment for prostate cancer detected by PSA screening causes moderate-to-substantial “harms,” such as erectile dysfunction, urinary incontinence, bowel dysfunction, and even death. According to the USPSTF, these harms are especially important because some men who are treated for prostate cancer would never have developed symptoms related to cancer during their lifetime. The USPSTF’s position is that routine PSA screening can, and often does, cause more harm than good.

Like the USPSTF’s 2009 recommendation against routine mammography screenings for breast cancer in women under 50, this latest recommendation about PSA screenings has created a huge pushback in the medical community and associated organizations, particularly patient advocate agencies. For example, ZERO—the Project to End Prostate Cancer, and the American Urological Association both condemn these new recommendations.

So what’s a guy to do about PSA testing?

After the experts do battle about conflicting opinions and mountains of medical data, where does that leave the average guy when it comes to PSA testing?

As a former cancer patient (and non-medical person), here’s where I stand.

Concerning the argument that the side effects can outweigh the benefits, I’d prefer to be alive and mitigate possible side effects than be dead. Yes, quality of life is an issue that every man diagnosed with prostate cancer needs to address. But when it comes to making a decision as important as cancer treatment, shouldn’t each patient be armed with all the pertinent information (PSA test, Digital Rectal ExamGleason scores, family history, and so on)? My doctor spelled out the potential side effects for all my treatment options, and then I made my choice.

The USPSTF’s recommendations also do not take into account the severity and aggressiveness of the cancer. Prostate cancer is typically slow growing, yet some types are very aggressive and can spread very quickly. A late diagnosis can be a death sentence. My father was in that category. Early detection translates into higher cure rates.

Although PSA screening is an imperfect science, and it can show high numbers due to other factors such as medications or an enlarged prostate, it is still the best test out there. The American Urological Association emphasizes that it should not be used on its own, but needs to be combined with other information to determine if a man has prostate cancer. I reviewed my family history with my doctor, had a complete physical (including a DRE), underwent two PSA tests, and had a biopsy before we concluded I did indeed have cancer. To rule out PSA testing is to rule out one of the most important ways of knowing what’s going on inside a man’s body.

Beyond the topic of PSA testing, here are some other recommendations based on my experience:

  • Own your own health. Get informed. Many cancers and diseases are asymptomatic, and the cure rate is far better if caught early rather than when symptoms appear. Know your vital numbers through yearly physicals, basic blood tests, and other screenings. Know your family medical history. Discuss all of this with your doctor.
  • Take care of yourself. Find a way to minimize and handle stress, which is increasingly recognized as having an indirect, yet powerful, role in developing cancer. Do all the things necessary for good health—eat right, exercise regularly, find a balance between work and play, socialize, make time to do something you enjoy every day, give and receive love. As the saying goes, prevention is the best medicine.
  • Trust your gut. Question your doctors’s opinions. It’s your life, not theirs. Be vigilant and educated about your health and new trends in medical care. When I was given my treatment options, I was suddenly in control of my unplanned destiny. My doctors gave me options, but at the end of the day, the treatment decision was mine. It was a gut-wrenching time, but I’ll take that anguish any day over never having the chance to get to that point.
  • Live life in the present moment. We don’t know what life has in store for us, whether it be cancer, some other illness, an unforeseen accident, getting laid off, whatever. All we know is what’s here and now.

After my diagnosis, I let my three brothers know about my situation. Since cancer runs in our family, I suggested they all get tested. Two of them told me that their doctor didn’t feel it was necessary that they get a PSA test. When I heard that, I was stunned—and suggested they find another doctor. And these are just the men in my family! Imagine how many times this kind of advice is given every day by well-intended physicians all over the country. That scares me, and makes me think that the USPSFT’s recommendations will steer even more medical providers and insurers further away from what their patients need to know.

Am I better off today than if I had never found out? I’ll never know, but I do know at least I’m taking charge of my health. I’m cancer free, and I’m still around to embarrass my wife and kids.

For a comprehensive medical perspective of this issue, please visit the New England Journal of Medicine’s article from Nov. 24, 2011.



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