Despite all the controversy surrounding it, I’ve always maintained that the PSA is not a bad test. But what greedy hospitals and doctors do with the results? Well that’s pretty horrific.
Prostate cancer interventions can be life-altering. And they often carry irreversible consequences, like impotence and incontinence. Performing these procedures based on questionable PSA results has destroyed the quality of life of countless men. (And cost the health care system billions in wasted dollars, to boot.)
So yes, there’s a good reason for all the controversy surrounding the PSA test. But boy, am I glad I didn’t stop screening my patients.
Because brand new study results are showing a significant advantage to PSA screening for men between 50 and 74 years old.
Of course, this is a European study (called the European Randomized Study of Screening for Prostate Cancer, or ERSPC). It’s the largest trial of its kind in the world. But there’s no saying whether the US Preventive Task Force is paying attention. Their current official position is to discourage PSA testing. (Which, consequently, gives insurance companies grounds to deny coverage for it.)
And while I certainly think this position is well-intentioned, it also strikes me as incredibly short-sighted. Because routine PSA testing boosts prostate cancer survival rates—simple as that.
Among the key findings of the ERSPC 13-year follow-up: beginning PSA testing by age 50 cuts mortality rates in half. (If you wait until age sixty, that reduction drops to 20 percent. Still an amazing benefit—but it’s a dramatic difference, to say the least.)
Of course, the same caveats still apply. Even in this study, “overdiagnosis” of prostate cancer and—more importantly—overtreatment of conditions that may never even pose a problem during a man’s lifetime is still very high with PSA testing.
Once again, though, this problem has less to do with the PSA test and more to do with overzealous doctors. And I simply don’t see why we have to do away with a perfectly useful (life-saving, even) tool to solve it.
My solution to this complicated situation has always been to focus my efforts on early detection of high-risk prostate cancer. With most patients, simply watching and waiting is a totally appropriate approach to “treatment.” But routine testing is one of the only ways to identify more aggressive cancers.
There are several ways to do this. One is to get a biopsy to determine your Gleason Score.
If you have a low-risk disease, then your Gleason Score will equal the number of decades you have lived. (In other words, 50 at age 50, 60 at age 60, and so on.) Any number higher than that formula points to a more aggressive tumor.
The other thing to do is to actively monitor quarterly PSA tests. If there is a sharp rise in your PSA, then this is information that, as far as I’m concerned, you need to know. Because knowing means you can do something about it.
And no, I don’t mean surgery or radiation. I mean targeted lifestyle changes and supplementation. In fact, just last year, I told you about a study that showed that omega-3s and CoQ10 can lower PSA levels significantly, within just 12 weeks.
These are two supplements I tell everyone who steps into my office to take (at least 3,000 mg of EPA/DHA and at least 300 mg of CoQ10, every single day).
And these are just two examples of simple, natural, research-supported approaches that can make a real difference—without destroying your quality of life.
“Largest Prostate Screening Trial Still Shows It Saves Lives.” Medscape. Apr 23, 2014.
European Association of Urology (EAU) 29th Annual Congress. April 15, 2014.