PSA Tests: What the Debate Means for Men

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PSA TESTS – Why Everyone’s Talking About Them and What the Debate Means for Men by LIVESTRONG Sr. Medical Advisor, Dr. Brandon Hayes-Lattin

This week the US Preventive Services Task Force issued a recommendation on prostate cancer testing that is attracting a lot of attention. For anyone wondering what this means, we’d like to shed some light and make a few suggestions.

Who is the US Preventive Services Task Force?

The Task Force “…is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems.”

In practical terms, the Task Force is responsible for independently and objectively reviewing evidence to make preventive services recommendations to the nation’s physicians and health care providers. The special expertise of members of the Task Force is how to review medical evidence and apply medical tests for screening. This expertise is a different set of skills from that of actually treating a patient who has that disease, and so specialists (like urologists in this case) may find themselves coming to different conclusions. Members of the Task Force are able to look at these tough questions, like whether or not men should receive PSA testing, without having the same degree of bias: they are not in a position to profit from these tests or to have seen so many unusual or outlier cases that their memories cloud their objective judgment.

Task Force announcements can sometimes spark controversy. In 2009, the task force issued a recommendation that women over 50 should have annual mammograms. This was a big departure from the previous norm which included women 40 and older. The change sparked a national debate among health care providers, breast cancer survivors and policy makers which continues today.

What is the PSA Test and Why is the USPSTF Recommending Against It?

The prostate-specific antigen test is a blood test routinely taken by men to determine the presence of cells that indicate a high likelihood of prostate cancer. Since 1986, when the US Food and Drug Administration approved its use, it has become a routine and widely-used component of medical care for men middle-aged and older.

The USPSTF is now recommending the blood test no longer be used for the following reasons:

  1. The Task Force can’t find convincing evidence that treatment for prostate cancer that was detected by this test leads to more lives saved or to an overall improvement in men’s health.
  2. In many cases, prostate cancer may be present but is so slow-growing, it will never display symptoms or affect health or function.
  3. Also, in many cases, treating the disease can be worse than the disease itself, and can lead to side-effects like urinary incontinence, impotence, and even death.

Why is This Attracting So Much Attention?

This new recommendation puts men in a tough spot. On the one hand, we’ve been told for decades to take a proactive approach to our health, to get as much information as we can and to be aware of the risks. Knowledge is power, right? Now the public is being steered in a different direction. We’re being told we may be better off not knowing if we have prostate cancer. The new guidelines say the treatment can be worse than the disease and that the test doesn’t save lives. In fact, it may lead to needless suffering, both physical and mental.

This latest advice comes on the heels of a 2008 recommendation against use of the test for men 75 and older. While it is true that prostate cancer is the most common cause of cancer deaths in this age group, it was found that the PSA test is just not good enough to actually save more lives, and that men who tested positive would most often suffer side effects without benefit.

What Should Men Do?

This is the most important question, of course.

When looking at the entire male population from a statistical perspective, one can see the logic of the Task Force recommendation. If the test doesn’t save lives and may even lead to unnecessary treatment and suffering, throw it out, right?

But what about those of us who believe that our lives have been saved as a result of the test? It’s true that for some men, the PSA test detected an aggressive and fast-moving cancer that could have claimed their lives. For them, the test was a life-saver.

The troubling question is, how do we know which category we fall into and how do we best prepare ourselves to make crucial decisions about our health? It’s an incredibly tough issue.

The Task Force did not evaluate the PSA test for men who have “highly suspicious symptoms.” So here’s what LIVESTRONG recommends:

  • Men who have symptoms including trouble urinating or pelvic discomfort or who have a father or brother diagnosed with prostate cancer younger than age 60 should report this to their doctors to discuss their risk and their testing options.

 

  • If you have any concerns, talk to your doctor. If that doesn’t help, get a second opinion or even a third. You deserve to know the facts that will allow you to make the best decisions about your health.

What Does This Mean for the Fight Against Cancer?

One thing’s certain: We are seeing again that many of the current tests we have for cancer are just not up to the task. Whether it’s PSA testing this year, or mammography recommendations in 2009, it is clear that we must invest more time and money into developing better tests. What we need are tests that don’t just screen for abnormalities but can detect which abnormalities will lead to serious cancer problems if left untreated.

It’s also clear that you have primary responsibility for your health. Know your risks. Talk to your physician. This can be tough, as many of us know. Doctors’ offices are busy places and sometimes getting in just for a consultation can take a while. However, don’t let that discourage you. Get a second opinion, even a third, if necessary. Ultimately, every medical decision is personal.

14 thoughts on “PSA Tests: What the Debate Means for Men”

  1. John Voci says:

    The PSA test provides information. The discussion should be about the choices men have and better treatment options.

  2. Chris says:

    While I’ll surely get a lot of haters … Seems the second to last paragraph, first sentence: “One thing’s certain: We are seeing again that many of the current tests we have for cancer are just not up to the task.” provides job security for the professional fund raisers. Naively, I wish there was some way to separate the personal & corporate financial interests from the science and its implementation for curing/solving cancer.

  3. Beth Hosmer says:

    As an oncology nurse who has taken care of many prostate
    Cancer patients who were dying and died, I’m sure
    They would say do anything you can to prevent the
    Spread of this cancer. It is an awful way to die.

    1. Del Brander III says:

      Whew! Thank you Beth for saying what I have been stating for weeks now! That a horrible death is experienced when the Prostate Cancer cells exit the Prostate and enter the nearby Lymph System. Men…INSIST on a PSA even if you have no history in your family and no symptons. A PSA saved my life!!! Thank you!

  4. Jim Higley says:

    I was a young 44-year-old guy when an accidental PSA blood test raised a red flag which eventually let to a biopsy confirming I had prostate cancer. It was aggressive. It was fast growing. And I had no symptoms. Let me say that one more time: I had NO symptoms. The PSA blood test saved my life. That said, and in light of this new recommendation, the main message to me with all of this is that all men need to be proactive about their own health. They need an annual physical. And they need open dialogue with their doctor to develop the best course of tests for them.

    1. Thanks for commenting Jim. We appreciate your comment. Read Jim’s story on our blog.

  5. Alli Ward says:

    My dad was diagnosed with Prostate cancer from the PSA test. He was having symptoms, but was certainly not mentioning them to anyone. (Might be a guy thing). His was slow growing and was watch for several years before they did treatment. As an ovarian cancer survivor myself, which is often fast growing and virtually undetectable, I would think that awareness is the first step and a huge one. So if the PSA test is positive for cancer than the physician should work with the patient to determine the best course of action based on their circumstances, which for some maybe doing nothing, but if any routine screening exists than it should be used.

  6. Bob Brace says:

    In 2009 i had a check up and they did a PSA Test my PSA WAS 4.76 at that time i was 55 and they recommended a ultrasound guided biopsi no pain.Out of 10 cores 6 were positive for moderately agressive prostate cancer .On both sides of the prostate stage 2 c Gleason score 3+3= 6 I was told after surgery if i had waited it would have spread and it could be treated but not cured . I work with a lot of prostate survivors when you have symptoms pain ect it is advanced and it cant be cured.You have a window of opportunity if you catch it before it gets out of the prostate. I HAD NO SYMTOMS !Iam a LIVESTRONG LEADER in MI. The PSA TEST SAVED ME. I hope Livestrong takes another look at this. I am very dissappointed with Livestrongs stand at this time and cant support it.

  7. My dad is in the hospital right now, after having a stent put in (his third) so that he can have surgery on Thursday to remove a tumor from a salivary gland. I hope it is benign I (I’m wishing on my fibroid tumors right now that it may be so).

    I might not be so incredibly worried, but my Dad is on his sixth year of androgen therapy for a recurrence of his prostate cancer (from “errant cells” – love that phrase) spread throughout his bones. They found the recurrence with a PSA test. In fact, had he not SKIPPED a year’s PSA test they might have found this recurrence before it spread as far. His original cancer was detected with a digital rectal exam in 1990 when he was in his mid forties. If they’d HAD the PSA test I think they might have also done radiation or other treatment in addition to the radical prostatectomy.

    His father had prostate cancer (but died early of another cause). Two of his brothers were treated in the last two years. My brothers are at great risk.

    This makes me feel so HELPLESS. I try to get my friends who are over forty to get a PSA test (especially an ex-boyfriend who’s father has already had prostate cancer). It’s a simple blood test, but it is STILL like pulling teeth to get them to even think about it. I am AMAZED (and grateful) that my father made the time at their age to get the digital rectal exam. I also wonder what might have happened if he’d been able to get regular PSA screening starting at forty.

    I know there are some real issues with the interpretation and accuracy of the test, but I don’t think we should throw out the baby with the bathwater. YES, we obviously need something better. But what about my family members (and my dad’s closest colleague, an in-law’s father – too many to mention) who found DEADLY cancer because of this test?

    I think the LAST thing we should do is give any man an excuse to AVOID the doctor. I concur that we need to push for something better, but we ALSO need better protocols to guide physicians to interpret test results.

    Kate Bartholomew, Leader
    Northern Utah Supporting LIVESTRONG

  8. Jeff Hanson says:

    I was diagnosed with prostate cancer at the age of 51. I am so grateful my doctor had me take a PSA test in my late forties. My PSA kept going up slowly every year. I had my first biopsy at age 50 which came back negative. A year later another biopsy found the cancer. I had surgery to remove the prostrate almost two years ago. I feel lucky that I have recovered with minimal side effects from the surgery. Watchful waiting may work for some people but I knew I wanted the cancer gone. I watched my best friend’s daughter go through a year of chemotherapy to beat her cancer and I wanted to avoid that scenario. I hope this new information does not stop men from getting their PSA checked because I am convinced that my PSA test saved my life.

  9. Brandon Hayes-Lattin says:

    Thanks for all of the comments. We believe that it is very important for all to share their story, and in fact, we believe in advancing systems that will allow more patients to not just share their story, but to do so (anonymously) using their medical data. The studies analyzed for guidelines, such as this from USPSTF, are an attempt to systematically do that, but there are many thousands and thousands of men who have cancer stories that are not a part of our research base. Wouldn’t it be great if we could learn from everyone who faces decisions about cancer? We need to hear from and learn from more men who have or have not had PSA testing, and who did or did not receive treatment based on those tests to better learn how to use the test. And of course, we ultimately need a better test.

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