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Should Men Get a PSA Test to Screen for Prostate Cancer?

Should men get a PSA test every year? The experts have been sending contradictory messages and leaving many men confused. What's the latest recommendation?
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Middle-aged men have been getting conflicting messages about prostate cancer screening. A decade or two ago, many were regularly urged to get a blood test for prostate specific antigen; aka a PSA test. In fact, the decision was often left up to a man’s primary care provider. If the family physician ordered a PSA test along with a cholesterol check, few men argued. It seemed like a prudent precaution. In some respects the PSA test seemed to parallel the recommendation women received to get a mammogram to detect breast cancer.

A Reversal Confuses Many Men

Then the pendulum started to swing in the other direction. Men were told that a PSA test was probably inappropriate for many middle-aged guys. A government task force, discouraged routine screening a few years ago, saying that the PSA test was not very specific for prostate cancer and could lead to over treatment.

If the PSA test revealed an elevated number, it would almost inevitably lead to further tests. Many men would be urged to get a biopsy. If there was even a minimal amount of prostate cancer that could lead to what was called unnecessary treatments such as surgery or radiation.

Dying With, Not From Prostate Cancer:

One physician we regularly interviewed on our radio show insisted that most men would die with prostate cancer not from prostate cancer. What he meant was that most older men would eventually have some prostate pathology. But the vast majority of these gentlemen would die from heart attacks, strokes or accidents and never even realize that they had low-risk prostate cancer.

It turns out that 50% of men between 70 and 80 years of age will have some signs of prostate cancer in the gland (Reviews in Urology, Spring, 2008). Yet the risk of dying from the disease is very low. That said, roughly 30,000 men die from prostate cancer each year. Lung cancer is the leading cause of cancer death among men. Prostate cancer is second. For comparison, roughly 41,000 women die from breast cancer each year.

The Pendulum Swings Again:

Now, the U.S. Preventive Services Task Force has revised its recommendations. The experts suggest that men between the ages of 55 and 69 discuss the risks and benefits of prostate cancer screening with their health care provider.

For men over 70 the task force does not recommend screening on the grounds that men whose prostate cancer is detected at that age are likely to die of something else, before the cancer kills them.

The People’s Pharmacy Perspective:

We suspect that many men may find this new advice on prostate cancer screening confusing and unhelpful. Should men get a PSA test once a year or not? The task force leaves that decision up to the man and his physician.

Some prostate cancer specialists fear that a laissez faire approach to screening will mean that more men are diagnosed at a later stage of the disease. That could make it harder to treat. Remember, prostate kills nearly 30,000 men annually. It is a serious cancer.

The trouble is that we don’t have good diagnostic criteria to determine which cancers are “indolent” (slow growing and not scary) and which are likely to be aggressive and lethal.

To help you better make sense out of this very confusing topic we recommend our one-hour radio show with two of the country’s leading cancer experts.

Susan Love, MD is a breast cancer specialist. Charles “Snuffy” Myers, MD, is a prostate cancer specialist. You can stream the audio for free by clicking on the green arrow above Dr. Love’s photo. You can also download the free mp3 file and play it on your computer or smart phone. Scroll down to the bottom of the description of the show to find the link to the free mp3 file.

Share your own cancer story in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Thanks to all. I learned a lot. My PSA jumped from 0.4 to 4.31 in 1 year. We are working on it. Thanks.

My father died of prostate cancer which was discovered after it had spread beyond the prostate. As a result of this, both of my brothers insisted on PSA testing and eventually both were diagnosed with stage one cancer in their 50’s. They both had successful treatment and are doing well today.

It has gotten simple for me. having forgotten to eat mammal meat the paper test shows no blood in my stool. And I asked my doctor if there is a breast palpate test what about for men and pylons. She said yes. She said to feel up there and if it felt soft like the tip of my nose it was not a pylop. If it was hard like the bridge of my nose I should go see a doctor about it. I still wonder if she was kidding.

My uncle died of prostate cancer at 53. He was diagnosed with stage IV by the time it was caught. I think the tests should be done before 50.

Don’t forget to consider your family history. A genetic counsellor can help if your history is positive.

We learned a good lesson! We saw a PA my husband was bleeding I suggested he get his prostate examined because he had a family history of CA. Well PA gave him antibiotics and cleared up and was supposed to go back in 6 weeks! So he felt fine and did not go back!! Well guess what after having a hernia operation my husband could not go urinate!

So for not going back- he had a 100g tumor wrapped around his urethra!!! Thanks to Dr. Ferrandino at Duke he operated successfully and found a miniscule amount of prostate cancer even after a 12 point biopsy. The moral of this story is- if you have a family history of prostate cancer run don’t walk and ask for a prostate exam and demand that it is done!!!

It’s got to depend not only on your chronological age but also on your general health/condition and on your aspirations of perhaps becoming a centenarian. Nearing my 78th birthday, I’m cheerfully undergoing treatment for a recurring malignancy, the first go-round having happened over a decade ago. The thing is, I’d like to help at least my eldest grandchild move into his college dormitory room as a freshman, and he’s only six years old.

My thoughts are that the government should get with it and fund research for a test to differentiate between slow growing and aggressive prostate cancer. Until this happens no one can make an intelligent decision as to treat or not treat the cancer. It is absolutely ridiculous and shameful that this has not been done when billions of dollars have been donated to cure cancer.

My 59 year old husband, fortunately has an Internist who eight years ago, ordered a PSA for him – it came back positive. He had appropriate tests, had pinpoint radiation therapy for 20 minutes week-days for a prescribed period, and is now “cured.” His cancer had not spread, and was encapsulated within the Prostate, and so a cure was expected, and he’s now back to a number that indicates there is no cancer.

I urge all men to have a PSA test starting at age 50, and insist that your MD refer your loved one have it. My husband had few side-effects, and will now enjoy a life well worth living.

My brother is 58. He did not get a PSA test because insurance no longer covered them. Last year he was diagnosed with Stage IV prostate cancer. The cancer had spread to his pelvic bone.

Had he had the test, it may have been diagnosed earlier. I think it’s terrible that the test wasn’t covered; something so simple could have prevented this. Now he has to have much more aggressive treatment. Get the test!

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