To PSA or NOT to PSA--A Man's Dilemma

...another controversial medical recommendation

Recently, the USPSTF (U.S. Preventive Services Task Force) published a recommendation against routine PSA screening for men of all ages. They cited numerous clinical studies (some inconclusive or contradictory) showing no statistical survival benefit for men getting regular prostate cancer screening with a PSA compared to those men who did not have a PSA screening.

Further, the report pointed out the risk of men having unneeded and risky treatments that could result in impotence, incontinence, infections, heart attacks, and other unpleasant side effects.

There is no way to determine from a PSA test whether a tumor is aggressive (life threatening) or slow growing (not life threatening). A biopsy can help determine the growth rate of a tumor but there is some risk of infection (albeit small) from that invasive procedure.

So, they contend, no screening is better for the 5 out of 6 men who are likely to never get prostate cancer. And of the 1 in 6 who will get prostate cancer some will have a slow growing type and will not need immediate treatment.

But what about those poor guys (like me) who have or will have an aggressive (life threatening) tumor in their prostate? Although statistically not significant, determining risk and getting treatment early would be really helpful‑‑maybe even life saving.

Maybe the problem is not with the PSA test, which can detect cancer, but with the decision making by doctors and patients after the test. Could this, perhaps, be an area for further study?

I have had and will continue to have PSA tests on a regular basis. I know a number of men who are being treated for an aggressive form of prostate cancer. To a man they are happy to have been diagnosed and treated and still be alive. Me, too. We do not believe that our lives are not significant. The discussion is not over. There must be a better solution!

axman