Sometimes, it seems like the ongoing controversy over the risks and benefits of the Prostate-Specific Antigen (PSA) test will never end.
Case in point: A new review shows that over the course of a decade, PSA screening reduces prostate cancer mortality by only a small amount — but it doesn’t have an effect on overall mortality. Not very encouraging news, to say the least.
But as usual, there’s more to the story. And as usual, the facts show that maybe it isn’t the PSA test that needs reconsidering…
No benefits, plenty of risks?
This latest analysis looked at five different trials featuring nearly 750,000 men. Four of the studies looked at PSA testing’s effect on all-cause mortality. And combined, they show that it only saves one life per 1,000 men screened.
All five trials, meanwhile, showed that PSA testing didn’t spare any more men from prostate cancer deaths. Though it was associated with a fair amount of complications.
Estimates suggest that for every 1,000 men who receive the PSA test, one would be hospitalized for sepsis. Three would suffer urinary incontinence. And 25 would experience erectile dysfunction.
Is this a problem? Sure it is. But did it ever occur to anyone that maybe it’s our approach to biopsy — not the PSA test — that needs to change?
Look, I agree that the PSA test isn’t the greatest screening tool. Mainly because many of the cancers it might sniff out would never have caused any problems in the first place.
But the PSA test isn’t the one ordering unnecessary biopsies. Doctors are doing that. And as far as we’ve come in prostate cancer detection, I can’t be the only one wondering why there’s still so much emphasis on this one subpar test.
Smart screening goes beyond PSA score
You know what bothers me about this analysis, and all the rest before it? It’s always the same question on the table. Is the PSA working as intended?
Clearly, the answer is no. But again, the problem isn’t really with the PSA test itself. It’s with how doctors are using it… and more specifically, what they’re doing with the information they get from it.
The patient may only know about the PSA test as a tool. But your urologist or general practitioner should be up to date on the latest science. Whether it’s on the benefits of active surveillance, or MRI before a biopsy.
Avoiding the straight shot from the PSA test to blind biopsy reduces a lot of the supposed risks of this screening method. Instead, the PSA becomes just one piece of information your doctor uses to cobble together a larger picture.
Now tell me… why isn’t there more discussion about all of the other, more reliable tests we have at our fingertips now?
In fact, in the January 2017 issue of my monthly Logical Health Alternatives newsletter (“Why the government’s backpedaling on PSA again — and how you can make the most of this lifesaving prostate test”), I touched on a few standby prostate markers — like about how the latest MRI technology, in combination with simple blood tests like the PCA-3 and the 4K, can allow your doctor to offer you a much clearer idea of what you should (and shouldn’t) do about your prostate.
So don’t let your doctor tell you that your only options are a PSA, an MRI (if you’re lucky), or a biopsy to choose from. We have so many valuable tools in our prostate cancer toolbox these days…
The bottom line? Prostate cancer really shouldn’t scare you. But uninformed doctors should.
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