Why I Won't Get a PSA Test for Prostate Cancer

[Michael Scally MD]

Why I Won't Get a PSA Test for Prostate Cancer
Why I Won't Get a PSA Test for Prostate Cancer

I recently had an awkward conversation with my doctor. I was getting a routine physical, and he recommended that I get a PSA test for prostate cancer. I’m 63.

I told him the PSA test harms more men than it helps. He acknowledged that PSA tests produce false positives, but he insisted that follow-up tests and biopsies will determine whether you really have a life-threatening cancer. He knew someone whose life had just been saved by the test.

When I still declined to get tested, he looked as though he felt sorry for me. He should feel sorry for the millions of men who have gotten unnecessary biopsies, surgery and radiation as a result of taking the PSA test.

...

Just to be clear: you are 240-120 times more likely to misdiagnosed as a result of a positive PSA test and 80-40 times more likely to get unnecessary surgery or radiation than you are to have your life saved.

 

[virginian]

Sounds like a reasonable decision to me.

 

[Dr JIM]

Why I Won't Get a PSA Test for Prostate Cancer
Why I Won't Get a PSA Test for Prostate Cancer

I recently had an awkward conversation with my doctor. I was getting a routine physical, and he recommended that I get a PSA test for prostate cancer. I’m 63.

I told him the PSA test harms more men than it helps. He acknowledged that PSA tests produce false positives, but he insisted that follow-up tests and biopsies will determine whether you really have a life-threatening cancer. He knew someone whose life had just been saved by the test.

When I still declined to get tested, he looked as though he felt sorry for me. He should feel sorry for the millions of men who have gotten unnecessary biopsies, surgery and radiation as a result of taking the PSA test.

...

Just to be clear: you are 240-120 times more likely to misdiagnosed as a result of a positive PSA test and 80-40 times more likely to get unnecessary surgery or radiation than you are to have your life saved.

To be clear the suggestion a PSA diagnoses or "misdiagnoses" PCA is misleading at best.

PSA is best utilized as a screening assay rather than some black and white "therapeutic" algorithm.

For example the relative risk ratios mentioned are obviously based on "all comers" rather than incorporating the magnitude of PSA elevation, family history of PCA, baseline/chronological comparisons, a patients DRE, etc as a means of enhancing true positive to false positive ratios.

Patients should be provided sufficient evidence pro and con, to ensure they can make an informed decision.

 

[MR10X]

my PSA was 11.4 and i had a biopsy done which wasnt bad at all.....it came back i had high grade gleason 8 but confined to the prostrate..had the seed implants and 5 weeks of IGRT radiation. 5 years later my last PSA was 0.1.

 

[TheOldFart]

my PSA was 11.4 and i had a biopsy done which wasnt bad at all.....it came back i had high grade gleason 8 but confined to the prostrate..had the seed implants and 5 weeks of IGRT radiation. 5 years later my last PSA was 0.1.

A good reason why I will continue to get an annual PSA and DRE. I've been very stable at about 0.8 for at least 10 years, so a rapid rise would be a good indicator that something's wrong.

 

[Dr JIM]

The problem remains although sensitive PSA remains a relatively nonspecific assay.

Consequently exclusive of BX the most reliable means of enhancing PSAs specificity are the risk factors I mentioned.

In addition bc the course of PCA can be difficult to predict many of the algorithms in use today lean toward more aggressive forms of therapy rather than say watchful waiting and repeat PSA testing.

IMO this is not to surprising as many of the algorithms were/are developed by Urologists who approach PCA management from a better safe than sorry perspective.

Nonetheless it's disingenuous to
suggest PSA has hurt more folk than it has helped, and those that make such assertions don't know how to use PSA testing to maximize its yield IMO

 

[MR10X]

in my opine catching the cancer early before it spreads is EXTREMELY important...

 

[TheOldFart]

in my opine catching the cancer early before it spreads is EXTREMELY important...

It always is the case. Early detection at Stage 1, Grade 1 is why my wife is cancer free 8 years after her ovarian cancer diagnosis and surgery.