PSA Testing: What Price Convenience?
The ‘novel device,’ an in-office finger prick test for PSA (prostate specific antigen) was approved by the FDA in January. There’s only one problem: It will cause more harm than good.
I can hear men cursing & screaming at me now. Am I being sexist? Absolutely not! According to the U.S. Preventative Services Task Force (USPSTF) (an independent volunteer panel of experts in prevention & evidence-based medicine) the risk of being harmed by a PSA test result is 30 times higher than the likelihood of benefiting from it! Here’s a summary graphic and here is their detailed assessment. Statically, if 1000 men are screened, 240 will have a result that indicates they ‘may have cancer;’ 100 of those will have a positive biopsy result, 80 of those will choose surgery or radiation resulting in 50 cases of erectile dysfunction and 15 cases of urinary incontinence; 3 cases of potentially metastatic cancer will be identified; 1-2 of which could be potentially fatal. Looking at those stats, 50 to 65 men will have a serious life-long adverse effects in 80 procedures to potentially save 1-2 lives. . . Hello, men, are you listening?
This being the case, one might wonder why the FDA approved the new test. Better yet, one might wonder why PSA testing is done at all. It’s noteworthy that the test is ‘prostate specific antigen,’ not ‘prostate CANCER specific antigen.’ In fact, Robert Ablin, MD who discovered PSA is completely opposed to the way the test is being used. Further, there is considerable evidence of arbitrariness in setting of the levels used to indicate the need for further testing and biopsy. There are also data that show many factors, such as exercise can raise PSA levels but not cancer risk.
Similar stats exist for many other common screening tests; among them mammography, bone density scans and more. But in a culture that says more is better and, by the way, that’s how they get paid, there is incentive to doing more and disincentive to more closely examining and considering what we do and why.
I’m not saying anyone should avoid testing under appropriate circumstances; you find a lump, you see blood in your stool, you have a pain that doesn’t have an obvious source, etc. What I am saying and what the USPSTF agrees with, is that screening for screening sake because of basic demographic data (such as age and gender) has been shown time & time again to do more harm than good.
All of this shows the importance of being an informed medical consumer. Men should understand that the likelihood of dying WITH prostate cancer (not OF it) is higher the older they get, and women should know the same holds true of breast cancer. There is, you should know, considerable talk that some of these “cancers” should be reclassified because they do not behave like what we normally consider as cancer. That is, many are extremely slow growing, don’t metastasize or spread & don’t have other hallmarks we think of when we think of cancer. This is not true of ALL cancers of these organs but is true of the vast majority of them; a fact that holds true statistically even though you or I may know someone that died from cancer of one of these organs. This doesn’t mean I don’t care about those that died; only that I care MORE about those still alive who could be hurt by not having this information from which to make a more informed choice.
Perhaps, in time, we will transform our health care system to one based more in real prevention. (Diet and lifestyle can actually help you avoid these problems rather than just finding them earlier) Unfortunately, until we figure out a system that isn’t based in insurance, drugs & fee-for-service, this is not going to happen. So people like me who can help counsel people, helping them take a more objective look, will continue to do what we can to inform. Hopefully you see or hear from us first.
If you have a health concern you’d like an objective yet caring look at, set up a consultation here.
The above is presented as information only. It is not intended as medical advice.
Photo from https://www.youtube.com/watch?v=TPU3y6C4hvM & The Real Truth About Health