Like most men concerned about their health I’ve followed my doctor’s recommendations to get a regular P.S.A. (Prostate Specific Antigen) test and a DRE (digital rectal examination) once a year. I’m aware that over 200,000 new cases of Prostate Cancer are diagnosed annually and over 40,000 men will die of prostate cancer in the United States this year. I don’t want to be one of those who die, so I’d like to prevent cancer from occurring and detect it early if it’s present.
The PSA test is one that most men now know about. Regular testing for men would seem to be a good thing. But that may not be true. A number of years ago, my PSA score was elevated from the last time I was tested. My family doctor sent me to a urologist for further testing. The urologist said I should have a biopsy done to see if I might have cancer. That scared me a lot. I sure didn’t want to have cancer, but since there was some suspicion I wanted to know the truth. He told me the procedure was quick, simple, and relatively painless. He was wrong on all counts.
I lay on my side as directed and pulled my knees up to my chest. Some numbing medication was used before inserting a not-so thin probe into my rectum. Once the biopsy device was situated, the doctor told me to relax (not so easy) as he retrieved a number of thin, cylindrical sections of tissue with a hollow, spring-propelled needle. Each time he “pulled the trigger,” there was a significant discomfort as the sample core was removed. He took 12 samples from various parts of the prostate looking for possible cancer.
After the procedure, I felt shaky and sat in the waiting room for a while. I was told to take a course of antibiotics to prevent infection. The good news was I was told the tests came back negative and didn’t have prostate cancer. The bad news was that I got an infection despite taking the antibiotics and eventually had to have a catheter inserted so that I could pee. It took me two months for the infection to heal. Emotionally, I still haven’t fully recovered. I began to wonder if the test was worth the pain, discomfort, and the risk of infection.
I still get tested regularly, but I decided I wasn’t going to have a biopsy done ever again if I could help it. I’ve since learned that the PSA test may not be that reliable in detecting prostate cancer. Richard J. Ablin, PhD discovered PSA in 1970, but believes the test which was developed from his discovery may cause unintended problems that men and their families need to know about.
In 2010 he wrote an Op-Ed piece in the New York Times, The Great Prostate Mistake. There is a lot of fear about cancer and most of us want to know if we have it so we can be treated early. But Ablin notes that the risks of getting prostate cancer and dying as a result are a lot lower than many people believe. “American men have a 16 percent lifetime chance of receiving a diagnosis of prostate cancer,” says Ablin, “but only a 3 percent chance of dying from it. That’s because the majority of prostate cancers grow slowly. In other words, men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it.”
With these odds I wondered about the value of testing. As I learned, if the PSA is elevated, there is a tendency to have a biopsy and if the biopsy indicates a cancer there is tendency for doctors to recommend surgery, even though other less invasive interventions may be the best option for many men. Ablin believes that widespread testing leads to too many biopsies and surgeries which can have serious consequences and may be unnecessary.
“The test is hardly more effective than a coin toss,” he says. “As I’ve been trying to make clear for many years now, PSA testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t.”
As I learned there are a lot of reasons we may have a higher than normal PSA test. Ablin says, “The test simply reveals how much of the prostate antigen a man has in his blood. Infections, over-the-counter drugs like ibuprofen, and benign swelling of the prostate can all elevate a man’s PSA levels, but none of these factors signals cancer. Men with low readings might still harbor dangerous cancers, while those with high readings might be completely healthy.”
Dr. Ablin, along with science writer Ronald Piana, have written a book, The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster. All men and their families need to know that every year, more than a million men undergo painful needle biopsies for prostate cancer, and upward of 100,000 have radical prostatectomies, which can result in incontinence and impotence. But the shocking fact is that most of these men would never have died from this common form of cancer, which frequently grows so slowly that it never even leaves the prostate. This is another example of the “cure” being worse than the “disease.”
Ablin and Piana ask, “how did we get to a point where so many unnecessary tests and surgeries are being done?” In their excellent book Ablin and Piana show how PSA was co-opted by the pharmaceutical industry into a multibillion-dollar business. Now, doctors and patients are beginning to speak out about the harm of the test, and beginning to search for a true prostate cancer-specific marker that can save lives.
I’ve found, personally, that the problem with the PSA test is that there are too many “false positives.” That means the score indicates there may be a problem when there actually isn’t one. As a result we begin on the path to more tests which, like the needle biopsy, are invasive and are dangerous themselves. If we get tested enough they are likely to eventually find a cancer, which leads too many men to surgeries they may not need. I recommend every man and his family read The Great Prostate Hoax before getting your next PSA test.
My own doctor says I would do better to eat in ways that are likely to prevent prostate cancer from ever occurring than worry about what the PSA test might reveal. He says, “While the evidence behind what follows is not truly proof, there is very little down side to eating less red meat, less milk, less white bread, and more fish, more vegetables and some supplements. There is proof that this will lower your risk of heart attack or stroke, and I believe the evidence is strong that it will reduce your risk of prostate cancer or reduce the risk of spread if you already have prostate cancer.”
So, I still get a regular PSA test, but I don’t worry so much about prostate cancer. I’m definitely more interested in preventing cancer by eating well than trying to find a cancer. I believe that what we focus our attention on matters. PSA focuses our attention on cancer. Eating well focuses our attention on health and well-being. I’ll be interested to hear your thoughts, feelings, and experience.
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I absolutely agree with this view of things Jed. Went up the same spiral of fear myself ten years ago. Afterwards my urologists told me that he has a 1% mortality rate from post-prostate biopsy septicaemia!! And I have had three of them! So in a sense you were lucky. In my view prostate biopsy should be banned. Too little reward for too much risk. PSA – DRE – Ultrasound – MRI are the way forwards.
My PSA went up to 65 due to Chronic Prostateitis. It is now back around 18 for some reason. Like you, I will keep and eye on it but do nothing unless it goes over 100. Thanks for the post. It is an interesting subject too seldom aired.
Andrew,
Thanks for the comments. As I say, too many men buy into the belief that “cancer” must be immediately removed to insure our survival. For too many the PSA test triggers the fear, that leads to the biopsies, the produces the 100,000 yearly prostate removals. The Health $care Industry can then continue to get us for the post operative complications including impotence and incontinence. We need to alert all to the real consequences of our money-dominated system and get back to real health care which relies more on diet, exercise, engagement with family, friends, and community; than on tests, drugs, and surgeries. I’ll be interested in hearing more from people and what your experiences have been. By the way, Andrew, where do you live?
My primary recommended a PSA in 1999 when I was 65. My DRE then was “normal” PSA was up, and went up slowly at first and then the doubling time shortened. DRE’s still “normal,” though, for a man my age, Biopsy recommended. Held the container of the recommended antibiotics in my hand, and I felt very uncomfortable. I cancelled the biopsy. I stopped getting PSA’s, and remembering that I had been taught in pathology (yes, I’m a surgeon today) that every 80+ tear old prostate has cancer cells in it. I rely on my peeing function and the annual DRE for indication for biopsy…. just another man’s story, Jed Please note that the only fear I had was of the biopsy, not of the presence of a cancer.
Ken, Thanks for the comments. Particularly the ones about PSA going up for all of us as we age. We all have cancer cells in our body takes care of them. Getting tested often leads to fear and worry, which leads to more testing, and eventually a finding of “cancer” which scares us even more. At every stage the health $care system will try and convince us that we absolutely must have what they are selling, otherwise we will certainly die a horrible and painful death. Of course, they minimize the risks and damage of what they are selling us.
We need to tell all our friends and neighbors, children and grandchildren. Thanks Ken for all the work you do.