Friday, October 14, 2011

Should You Get a PSA Test?

According to the Mayo Clinic, "Prostate cancer screening can help identify cancer early on, when treatment is most effective. And a normal PSA test, combined with a digital rectal exam, can help reassure you that it's unlikely you have prostate cancer."

But according to a recent finding of the U.S. Preventive Services Task Force,"The vast majority of men who are treated do not have prostate cancer death prevented or lives extended from that treatment, but are subjected to significant harms." The American College of Preventive Medicine (ACPM) does not support the efficacy of PSA tests or the digital rectal exam (DRE) for prostate cancer screening.

PSA tests have been used for men over 50 since FDA approval in 1994. DREs have been done even longer.  When a PSA test turns up prostate cancer in a man with no outward symptoms, that early warning could help him beat a tumor that otherwise would have killed him. But there are two other possibilities: Either the tumor is so aggressive that the patient dies anyway, or it is so slow-growing that it wouldn't have been fatal, even if left untreated.

According to the task force, fully 95% of men whose prostate cancers are detected with PSA tests will be alive 12 years later even if they don't get treatment. And, the panel added, no study on prostate cancer screening has ever shown that screening reduces the number of deaths.

I started having the PSA test, in addition to a digital rectal exam (DRE), annually after age 55.  Over the years, my PSA gradually rose,eventually reaching double digits (no pun intended). My urologist recommended a biopsy. The first one he performed did not reveal any cancer, but my PSA continued to rise, and I had a second biopsy, which did show traces of cancer. Incidentally, although the biopsy is an unpleasant out-patient procedure, and has its own risks (infection, blood in urine and/or sperm), it is not one of your more involved or painful medical tests.

After considering my situation further and doing some research on the Internet, I opted for the "watch and wait" option, rather than having surgery immediately. My urologist was okay with this. While I "watched and waited," I researched treatment options, specialists, and medical centers. I talked with men who'd had various treatments. I documented my findings systematically, using an Excel spreadsheet. I was focused and meticulous. I knew the probable effectiveness and risk probabilities of each form of treatment, from doing nothing, to radical prostatectomy.

I waited a year. After another biopsy showed cancer, I asked to discuss the findings of the biopsy with the local pathologist (tissue samples had been sent to a pathologist in another city, as well as being examined by our local pathologist). The local pathologist was very willing to discuss the results with me and even sat me down in front of a dual microscope and showed me what he was identifying as cancerous tissue. This was a very interesting experience for me and demonstrated quite dramatically how important experience is in the examination of tissue samples, for what the pathologist saw, I would have definitely missed.

Prostate Tissue Sample

I decided that I wanted my prostate removed. For me the deciding factor was my life expectancy. I was 68. Both my parents had lived into their 100s. I opted for a procedure that attempted to preserve the nerves attached to the prostate. These nerves are crucial for a man's erectal function. Nerve-sparing prostatectomy requires very precise surgery, and therefore I chose retropubic prostatectomy; it is more invasive, but provides the surgeon the best clearance.

Once I decided on my treatment, I looked for the best surgeon to do the job. I found the man who pioneered the technique, Dr. Paul H. Lang. He was located at the University of Washington Medical Center in Seattle, a 4-hour drive from where I lived. My urologist did this type of surgery, but I talked to him about it and he agreed that Dr. Lang would likely be a better choice for the technique I'd chosen. It may also have been that given how much effort I'd put into deciding my course of action, he'd rather have someone else responsible for the result. Frankly, I didn't care about hurting his feelings -- it was my prostate, and my future.

I had my prostate surgery 5 years ago and I've been extremely happy with the result. For those pondering their options given the most recent findings regarding screening for prostate cancer, my advise, for what it's worth, is, be your own consultant and advocate. No single test, whether for that pain in your left knee, or your problems urinating, is going to be sufficient for making a decision on screening or treatment.

When it comes to early detection of prostate cancer, and what to do about it, you have to consider all the relevant factors, including your age, health, family history, and so on. The PSA test is simple and painless and can be done along with other blood work. I'd recommend doing it and the DRE annually for men over 55 who have concerns about their predisposition for prostate cancer. If your PSA is elevated, don't panic, take the next steps and gather all the information available to you -- you'll find there's a lot -- before deciding what your course of action will be. And when dealing with your doctor, remember, it's your future.

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