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PSA Screening for Prostate Cancer: Every Man Decides

The US Preventive Services Task Force has changed its mind. The recommendation on PSA screening for prostate cancer is that each man should decide.
Prostate cancer of a human, highly detailed segment of panorama. Photomicrograph as seen under the microscope, 10x zoom.

The U.S. Preventive Services Task Force has done a U-turn on PSA screening for prostate cancer. In 2012 this national group of experts recommended against routine PSA screening for men without urinary symptoms indicating prostate problems. They worried that too many men would be subjected to prostate biopsies and surgery, which can lead to complications. While prostate specific antigen, or PSA, can be useful for some purposes, a one-time measurement is not a very accurate screening tool.

Task Force-Every Man Makes His Own Decision:

Now the Task Force recommends instead that middle-aged men (ages 55 to 69) discuss PSA screening for prostate cancer with their doctors. Each man should decide for himself whether the benefits outweigh the risks. The committee still holds that routine PSA tests in men over 70 have a serious potential to produce more harm than help.

Prostate specific antigen is produced by prostate cells. Levels of this antigen rise rapidly if prostate cells are growing quickly, as they do in the case of prostate cancer. But individual men can have very different levels of PSA without having prostate cancer. The Task Force was concerned that too many men might get unnecessarily aggressive treatment for low-grade prostate cancers.

When Measuring PSA Makes a Big Difference:

The most useful part of a PSA measurement may be determining whether there has any change since the last measurement. This blood test can be used to track whether possible prostate cancers are mushrooming or whether they are lying low. Men and their doctors use this indicator in an approach to prostate cancer known as active surveillance.

The idea is to avoid treating prostate cancers that offer no threat. Doctors prefer to treat aggressive tumors that cause PSA to double quickly before they escape the prostate into other parts of the body.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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For a number of years my PSA test results ran from 1.4 to 1.8, then when I reached 80 years of age it abruptly shot up to 8.9. The urologist no longer wanted to order the test after I was 79, but I insisted, fortunately, or I wouldn’t have known of the big change. I was given the same line as others reported in this column, “We’ll do watchful waiting!” What else do you want to watch for, was my question. Look at the sudden high number change, and the reply was also the same as reported here, “Even if it is cancer, it is usually slow moving and at your age, you’ll probably die with cancer, not from it!”

The answers given were BS. At that point they didn’t know the Gleason score (rate of cancer activity) nor how long I would live. I continued my insistence until I was given a biopsy of my prostate, which revealed, of the 15 samples taken, 12 were positive for cancer! I’ve seen what may happen when the cancer cells spread to other parts of the body, including brain, and thought, first of all, what a terrible thing to put my family through, and certainly, myself. I couldn’t help thinking, what kind of medicine is being advocated and practiced, and is this only in our country?? Only a couple of minutes every day of a beamed radiation for 7 weeks has me cancer free, with PSA back down to 1.2 and 1.3, but why must men have to fight to save their lives????

My doctor stopped the PSA until I told him I wanted them to continue. I had a friend that his PSA jumped and it was right, he did have cancer and it was controlled. My PSA has been good before the doctor stopped it and after it was started again. I will keep getting the PSA even though I’m 80 years old and was told I would die from something else before the cancer, if I had it would kill me, UNLESS my PSA jumped, then they would check it out. I also will NEVER have a biopsy for it when you can get an MRI that tells you EVERYTHING that a biopsy does not cover at all.

I had a PSA of 7.4 and decided to have a biopsy. I had cancer in four cells. But they could not tell me if it was the fast growing or slow growing kind. I will submit to you this is the basic problem. Until they can answer this question, the decision of what to do next cannot be answered properly by anyone. I think I had the slow growing kind of cancer, but I decided to have the radiation treatments because I wanted to err on the safe side. I think it is terrible to have to make a decision like this. Medical science should work on a solution to this instead of all the hemming and hawing about men making a decision. Too much BS.

Can putting someone on too many medications cause more trouble than help? My husband has for years trouble completing emptying his bladder. He has been on HCTZ and Linisipril or many years for blood pressure. The VA doctor put him on Flomax and Proscar. Now he is having trouble walking or doing anything he was doing. According to reading I did, I told him to get off the Flomax. I finally got in touch with the VA doctor who told us the same thing. Has anyone else had this problem? I feel that a 79 year old man is better off with quality of life rather than quantity.

Talk to your Dr. about having that PSA. My husband’s Dr. was not in favor of having one – he’s 66, I insisted, it came back 4 on the Gleason Scale, he was successfully treated with pinpoint radiation, and he’s now considered “cured.” Had we waited, the cells would have continued to grow, and the outcome could have been deadly. Insist that your loved one have the PSA around the age of 50-55 and we’ll see more men survive.

My PSA was elevated so my doctor suggested I have it checked out. I wasn’t going to do anything since I am 70 but my wife who is a nurse said I should. She said if I have cancer it could spread to other parts of my body. I was checked out and found it to be cancerous but not a high amount. I had the radiation seeds implanted about 6 weeks ago and I feel fine. Cancer is a scary word so I think it is worth the risk. I am active, I jog about 2 miles several times a week, play softball and work out a bit at the gym. If I was a couch potato like most of my friends I probably would not have done anything since they might not live into their 80’s anyway. But who knows???

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