Psa testing

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Bottom Line's Health Breakthroughs 2007 Bottom Line Health See book keywords and concepts

Yet now, after years of use, experts disagree about whether men should receive routine psa testing. Some medical groups, such as the American Urological Society and the American Cancer Society, advocate annual screening for all men age 50 and older—and starting at age 40 or 45 for men at high risk (African-Americans and men who have a family history of the disease). Other groups, including the American Medical Association, advise doctors to spell out the risks and benefits of psa testing and let the patients decide. Unfortunately, few men have all the facts about psa testing.

You Don't Have to be Afraid of Cancer Anymore Bill Sardi See book keywords and concepts

The main problem with psa testing is that even if it does help detect prostate cancer, it doesn't help detect the dangerous life-threatening form of prostate cancer. Most men already have cancerous cells in their prostate gland and are likely to have a positive biopsy test, but few will die of this disease. [UrologeA42: 1172-87,2003] Even men with a PSA test ranging from 4.0 to 10.0 (the level at which a biopsy is usually recommended), have a 70% chance that subsequent biopsies will be negative. Therefore, it is now recommended that men undergo a second PSA test before a biopsy is performed.

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In both cases, a rectal exam and psa testing should be done at least every year. SURGERY AND RADIATION The most common treatments for localized prostate cancer—surgery and radiation—are comparably effective. Using either procedure, the cancer usually doesn't come back. They both carry similar (and substantial) risks of impotence and urinary incontinence. •Surgery involves removal of the entire prostate {prostatectomy). Technical advances have improved nerve-sparing surgery, which aims to protect potency and reduce incontinence risk by leaving the nerve bundle next to the prostate intact.

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer Shannon Brownlee See book keywords and concepts

There has been an increase in incidence since the introduction of psa testing, but according to most experts, it does not appear to be due to more cancers, just more detection. most common method of treating the disease. A prostatectomy is a delicate surgical procedure that often renders patients impotent, incontinent, or both, even in the hands of the most accomplished surgeon. In a study of patients at Harvard University hospitals, the majority of men were impotent a year after their surgery and still wearing adult diapers.

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Proponents of psa testing point out that prostate cancer deaths have declined in the years since the test has been widely used. However, PSA skeptics say that this trend could also be the result of better treatment, not just better diagnosis. IMPROVING ACCURACY In recent years, several variations of the PSA test have been used to improve its accuracy and limit the number of men who are advised to get a biopsy. They are... •Free vs. bound PSA. The majority of PSA floats through the bloodstream bound to protein molecules, while a smaller portion of PSA is free.

Unfortunately, few men have all the facts about psa testing. What men need to know... INTERPRETING TEST RESULTS PSA is produced by the walnut-sized prostate gland. When cancer is present, the prostate secretes more PSA than usual. But cancer isn't the only reason for increased PSA levels. Infection or the enlargement of the prostate that accompanies aging, known as benign prostatic hyperplasia (BPH), can also raise PSA levels. Even ejaculation within 48 hours of the test can affect PSA. Therefore, PSA levels can be difficult to interpret. What is a "normal" PSA level?

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A recent editorial in the British Medical Journal sized up the value of the PSA test with this comment: "At present the one certainty about psa testing is that it causes harm." A high enough positive PSA test is typically followed by a prostate biopsy - a painful procedure that can result in bleeding and infection. Recent evidence suggests that a large number of these biopsies are completely unnecessary. In fact, they may be life-endangering. Each year, 98,000 people die in the U.S. because of medical testing errors, PSA tests included.

You Don't Have to be Afraid of Cancer Anymore Bill Sardi See book keywords and concepts

PSA testing ... 182 PSA invalid... 183 What is the accuracy of the PSA test? ... 184 Men falsely reassured they don't have prostate cancer... 185 Staging ... 185 Sleight of hand: Gleason scores... 186 Biopsy is problematic ... 186 The second biopsy ... 187 Strategy against prostate cancer... 187 The hazard of seeding cancer... 188 How men make decisions about treatment... 188 Prostatitis... 190 Treatment for prostatitis ... 190 Saw palmetto berry and prostatitis ... 190 Pygeum and prostatitis... 191 Stinging nettle and prostatitis... 191 Vitamin D and prostatitis...

Submit to psa testing, repeated biopsies, and treatment, following the doctor's lead. 2. Submit to all that modern medicine has to of fer along with the preventive/therapeutic regimen outlined above 3. Practice prevention early in life and employ a regimen that has more promise than existing therapies. 4. Become highly educated about the course of prostate cancer and the advantages and pitfalls of the various treatments available in eluding supplements. Suggested readouts The bottom line is that low-risk patients do well no matter which treatment they receive.

Again, psa testing is deemed unreliable, but it continues to be used.) For men who had elevated PSA counts and took supplements, there was an increased incidence of prostate cancer of borderline statistical significance. The supplement regimen had no effect upon PSA levels.

The Stanford doctors explain how psa testing deceived the medical profession. In the early days, around 1987, it was reported that PSA levels were proportional to the increasing stages of tumor growth doctors could feel while conducting rectal exams on males. The surgical removal of large nodules of benign, but inflamed, prostate tissues was shown to reduce PSA levels. But since 2001, say Stanford researchers, there has been a turnaround.

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer Shannon Brownlee See book keywords and concepts

A study published in 2002 in the British journal BMJ compared psa testing rates in the region around Seattle and in Connecticut between 1987 and 1997. Men in Seattle were five times more likely to get a PSA test than men in Connecticut—yet there was no significant difference in the death rate from prostate cancer between the two regions. (Actually, there was a difference in the mortality rate: Men in Seattle were slightly more likely to die of prostate cancer, perhaps because they underwent more surgery for it.

The evidence suggests that psa testing is not saving any lives, and even if it is, the large numbers of men who are treated unnecessarily are paying a terrible price. They're the equivalent of civilian casualties in our war on cancer. A friend of mine describes the change in her father-in-law, who became a different person after undergoing a prostatectomy that left him permanently incontinent. He grew silent and morose, no longer willing to go out with friends or even leave his house, for fear of an accident. He died two years later of heart disease.

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They note that extracts from saw palmetto berry (serenoa repens) are as effective at inhibiting the enzyme inhibiting drugs (5 al-pha-reductase inhibitors) and don't interfere with psa testing as does the drug. The Belgian doctors state that "In addition to saw palmetto berry extracts, a combination of selenium, lycopene, natural vitamin E and fish oil, seems warranted." [Aging Male 7: 155-69, 2004] A study that employed supplemental vitamin C, vitamin E, beta carotene, selenium and zinc daily for 8 years found a measurable reduction in prostate cancer risk among men with normal PSA counts.

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All of the mathematical derivatives of serial psa testing are expressing the biological process.115 The average PSADT of PC is approximately 48 months, or 4 years. Men with an absolutely healthy prostate gland do not have any appreciable PSADT; their PSA levels remain essentially flat over decades of observation. Men with BPH have very slow PSA doubling times— usually over 12 years. Men presenting with historical data showing PSADT of less than 12 years must be presumed to have PC until proven otherwise.

Even when these supplements become available, psa testing is still mandatory because any substance that increases testosterone should be avoided by most prostate cancer patients. TESTOSTERONE CAVEATS Please, after reading all of this, do not just "treat a number." In dealing with sexual function and libido, there is always a large psychological component to enhancing or regaining performance. There are also many physical causes of dysfunction. Do not assume that a certain test number means guaranteed results or you may end up with performance anxiety over that.

Software on free PSA percentage versus the diagnosis of PC, cotrection for PSA results if ejaculation has occurred within 48 hours of psa testing, and calculators for PSAV and PSADT can be found on tbe PCRI (Prostate Cancer Research Institute) website at www.pcri.org. This software, PC Tools I and PC Tools II, was developed by Glenn Tisman, M.D., a medical oncologist in Whit-tier, California, who specializes only in PC. 5.

PC and that, in such patients, psa testing can be done evety 2-3 years. Patients with first-time values of PSA that are less than 4.0 ng/mL but at least 2.0 ng/mL should not be regarded as having a PSA within the normal range. The guidelines for a normal first-time PSA are up to 1.9 ng/mL. It was also pointed out that the PSA and its derivatives, such as PSA velocity, PSA doubling time, PSAD (total gland and for transition zone), and free PSA percentage, are instrumental in our understanding of biological reality.

In a population in which there is a family history of PC, such as has been described, psa testing should be commenced at age 35 with yearly testing for a few years to establish a trend or profile. Then, if the PSA remains below 1.0 ng/mL, consideration for testing every 2-3 years can be considered. Vigilance on the part of the empowered patient, partner, and physician will also involve digital rectal examination (DRE) at reasonable intervals and tracking of the PSA over time.

PSAV and PSADT determinations are most valid when the psa testing interval selected for the analysis is approximately 6 months ot more. However, what is important to stress in this context is the PSA ttend or slope over time. Serial PSA values showing a progressive increase in PSA should always raise concern that a biological process is occurring. It is the rapidity of such an increase that will suggest if this is a malignant or a benign process.^9 The PSA increases over time associated with a healthy prostate ate tiny. They amount to average increases of less than 0.1 ng/mL a year (range 0.

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In all of these ways, psa testing adversely affects life quality. And you have to ask yourself whether gaining at most a few extra months, ten or fifteen years down the line, is worth the loss of quality and the extra agony you'll be experiencing in the meantime. My best recommendation with regard to prostate cancer screening is for men fifty years of age and older to have an annual digital rectal exam and a PSA test as a follow-up if abnormalities are found.

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A relatively new development that promises more accurate psa testing is the discovery of the existence of two types of PSA—free and protein-bound. A low ratio of free PSA to protein-bound PSA indicates the presence of prostate cancer with 95 percent accuracy; a high ratio indicates a benign condition. • DRE (Digital Rectal Examination). Because the prostate gland is located adjacent to the rectum, a physician is able to feel the gland during an examination to determine if there are any palpable abnormalities in size or shape.

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A recent study published in the Journal of the American Medical Association suggests that "a combination of psa testing and DRE may nearly double the detection rate for localized prostate cancer . . ." The PSA is a test of an enzyme produced by normal and cancerous prostate cells. Normally, a small amount of PSA is constantly released into the bloodstream. When the prostate is irritated or damaged, larger amounts of PSA can be detected by the blood test, suggesting an increased possibility of having cancer. The normal range of a healthy PSA level is 0.0 to 4.0.

The Longevity Code: Your Personal Prescription for a Longer, Sweeter Life Zorba Paster, M.D. and Susan Meltsner See book keywords and concepts

The American Cancer Society recently reversed its position on annual psa testing, recommending that it should be done, but I don't consider their arguments that persuasive. Prevention Several studies point out that prostate cancer risk might be lessened by: • Keeping your weight down (see page 000). • Increasing the amount of physical activity you get every day (see page 000). • Drinking 8 or more glasses of water a day. • Tweaking your diet to include less saturated (animal) fat.

Groups opposed to routine psa testing, including the American Academy of Physicians and the U.S. Preventive Health Services Task Force, also point out that with the exception of very aggressive forms of the disease, which sometimes strike men under fifty, most prostate cancer grows very slowly. Ten, fifteen, even twenty years can pass before it causes symptoms or spreads, if it ever does. Many prominent researchers argue that there is little proof that treatment promotes longevity or cure.

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