Well, here we are…back to the seemingly endless PSA screening controversy, once again.
Of course, for me, it was never a controversy. I’ve always stood by this test’s value — because at the end of the day, when used appropriately, it can save patients’ lives. And thankfully, for once, I’m not alone in this stance.
As you might recall, the U.S. Preventive Services Task Force (USPSTF) came out against routine PSA screening for healthy men back in 2012. But in the years since, a whole lot of smart doctors — and I’m proud to count myself among them — have pushed back in the PSA test’s defense.
Published research shows that PSA testing does, in fact, reduce prostate cancer deaths. So while it may not be appropriate for everyone, men who are at high risk should absolutely be getting screened more often. And even otherwise-healthy men should, at the very least, have a baseline PSA test done by the time they’re in their 50s.
In fact, that’s exactly the recommendation one team of experts made in a recent paper published in the Journal of Clinical Oncology. And it makes a whole lot of sense, if you ask me.
But as usual, this country just can’t resist a good pendulum swing…So based on whatever the current consensus is, doctors test everyone in sight or no one at all. Rather than using their brains to exercise sound clinical judgment.
And honestly, that’s one of the biggest problems with medicine today. For some reason, everyone is afraid of actually using their intelligence. Doctors pale at the thought of rejecting guidelines or not toeing the line with “evidence-based” approaches (practices largely forced on us by Big Pharma) for fear of being sued.
And yet, making educated decisions is what we, as doctors, are supposedly trained to do. Obviously, no one is infallible — and that includes the people writing these guidelines. So doctors should be encouraged to think for themselves and their patients. This is the main reason I’ve had so much success as a practitioner.
When faced with a patient’s health problem, I actually think, instead of merely reacting. And while I certainly can’t force your doctor to do the same, I can arm you with the tools you need to make informed decisions about your own health.
Which, of course, is the main reason I keep coming back to PSA testing. Because this is a controversy with questionable origins if there ever was one.
As you may recall from our last discussion about PSA testing, the American Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) Screening Trial that started this mess was pretty fatally flawed.<
Re-analysis revealed that 90 percent of the men assigned to the supposedly “unscreened” arm of the trial had, in fact, received PSA testing.
Meanwhile, the results from the European Randomized Study of Screening for Prostate Cancer (ERSPC) came out back in 2014. This was the largest trial of its kind in the world. And it showed that PSA testing cuts prostate cancer deaths in half.
I think it’s pretty clear which of these two studies is more credible. Yet for some reason, it’s the first study that has largely dictated access to the PSA test for the better part of the last five years. Despite the fact that U.S. data shows a “dramatic and sustained decrease” in prostate cancer mortality since the first introduction of the PSA test.
The PSA test is valuable — end of story. But we’ll see whether the USPSTF actually takes any of this REAL science into consideration with its recommendations.
In the meantime, I continue to advise PSA testing to all of my male patients over age 50.
And bear in mind that there are now a number of more advanced tests that you can receive to put PSA results into a more meaningful context.
Like the PCA-3 test, for example, which is specific to cancer (since PSA can be elevated for a number of completely harmless reasons). Or the PSA 4K test, which can help to determine whether or not you need a follow-up biopsy. Not to mention newer MRI technologies that view the prostate more closely and make t biopsies more accurate.
And those are just the valuable screenings I can think of off the top of my head. These tests and technologies are all currently available — so don’t let your doctor sell you down the river because of some unilateral, poorly thought out “guideline.”
You’re a patient, not a statistic. And you deserve to be treated like one.