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Issue 146: Man in the Mirror

Man in The Mirror

The recommendation to forego PSA testing was not expected, and you can bet it’s causing some commotion—especially in certain circles. Here’s what’s going on: the U.S. Preventive Services Task Force says that men should just say no to the common prostate screening PSA blood test. 

PSA stands for prostate specific antigen, and about one-third of men over age 40 and about one-half of men ages 65 to 79 get this blood test regularly. The test is designed to measure PSA levels, with emphasis on rising PSA levels signaling early signs of prostate unhealth. Up until now, this testing hasn’t been questioned, but times are changing. One of the major drawbacks cited with this testing is that the test can give a false “unhealthy” signal up to 80 percent of the time. Likewise, not all PSA-detected anomalies are dangerous.

Task force co-vice chair Michael L. LeFevre, M.D., M.S.P.H., and professor of family and community medicine at the University of Missouri states, “The common perception that PSA-based early detection of prostate cancer saves lives is simply not supported by the scientific evidence.”

Understandably so, the task force’s statement is not receiving a warm welcome, especially from the American Urological Association (AUA) as well as other entities. The AUA’s President, Sushil S. Lacy, M.D., contends that the PSA test provides important information, especially “when interpreted appropriately.”

Ben Litchtenfeld, M.D., deputy chief medical officer for the American Cancer Society, however, says that the task force’s proposed guidelines reflect the hard reality that PSA testing doesn’t appear to save lives. “In the American Cancer Society’s 2010 guidelines, we said we were uncertain: the evidence is not convincing that PSA testing works. We feel the task force came to a reasonable conclusion,” says Lichtenfeld. Lichtenfeld adds that just as women were once told that hormone replacement therapy would prevent heart disease—until scientific studies proved otherwise—current evidence strongly suggests that doctors were wrong to tell men that PSA testing would protect them from demise due to prostate cancer.

“Men need to know the truth. We have gone through 20 years where we have had strong voices telling us PSA testing works. So there is a huge component of men who believe PSA testing has saved their lives. Now, when we say it wasn’t necessarily so, that becomes a difficult conversation,” remarks Lichtenfeld.

It’s a conversation that’s necessary, though, because some believe that not only does the PSA have little to no benefit, but also believe that it could lead to harm. Because the PSA test can give a false positive 80 percent of the time, that can lead to a biopsy which may point to further problems. LeFevre, from the task force, says, “The major problem is that most of the cancers we detect do not need to be treated, but we do not know which ones do need to be treated. And these treatments do have significant harms.” For example, for every 1,000 men who undergo prostate cancer surgery, five die within a month. Another 10 to 70 men have complications of surgery, while 200 to 300 of these men go on to experience long-term urinary incontinence, impotence or both.

Lichtenfeld bottom lines it: “The net result is that doctors and patients and families are going to have to have very careful conversations that really emphasize what the scientific evidence shows. And that is not overwhelmingly in favor of PSA testing.”

Even one doctor who supports PSA testing indicates that only a certain group of men should seek it. Ruth Etzioni, Ph.D., of the Fred Hutchinson Research Center says, “We need to understand prostate cancer better and know that it is a very variable disease. There are high-risk cases that need to be addressed and many, many low-risk cases that do not.”

One thing that most doctors do agree upon, however, is eating a healthy diet and getting enough exercise to support a healthy prostate. A diet high in fish, fresh vegetables and fruits as well as the inclusion of healthy fats like extra virgin olive oil—while low in calories and unhealthy fats—is recommended. Also, regular exercise—along with daily doses of sunshine—is preferred, says urologist Sheldon Marks, M.D.

So, gentlemen, the next time you’re looking at the man in the mirror, remember to take good care of him and to make informed choices when it comes to your health.

 

This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.


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