The Ugly Truth About Prostate Testing

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Pros and Cons of the PSA Test

Here's what you need to know before you agree to get a PSA test.

Prostate-specific antigen, or PSA, is a protein produced by both normal and malignant cells of the prostate. It’s widely recognized as a reliable diagnostic tool in detecting prostate cancer. But there’s a problem with PSA blood testing. Several, in fact.

For one, thousands of men are told they have abnormally high PSA readings. These men are told to wait three to six months to be re-tested. A lot of the time, the second test comes back within normal ranges. But imagine waiting six months, paralyzed by the fear you have prostate cancer.

You may be too young to worry about the PSA test, but sooner or later, a doctor will advise you to get one. Here are some things to consider.

Is the PSA Test Worth It?

According to an assessment by the US Preventative Services Task Force:

  • If 1,000 men ages 55 to 69 get tested regularly for 10 to 15 years, 240 of them will test high enough for PSA that they require a biopsy.
  • One hundred of these men will get bad news from the lab.
  • Eighty of them will require surgery or radiation, and 60 will suffer side effects from this treatment, including incontinence and impotence.
  • Only one to two prostate cancer deaths will be prevented.

Additional data from the task force concluded that you’re 120-240 times more likely to be misdiagnosed because of a positive PSA test and 40-80 times more likely to get unnecessary surgery or radiation than you are to have your life saved.

As bad as these findings were, it was kinder to PSA tests than another analysis done by the Cochrane Group, a group that provides impartial assessments of medical procedures. They carried out a meta-analysis of five major PSA test studies. The combined data showed “no significant reduction in prostate cancer-specific and overall mortality.”

The report added:

“Harms associated with PSA-based screening and subsequent diagnostic evaluations are frequent and moderate in severity. Common major harms include over-diagnosis and overtreatment, including infection, blood loss requiring transfusion, pneumonia, erectile dysfunction, and incontinence.”

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A Profit-Driven Disaster?

Even the guy who discovered PSA, pathologist Richard J. Ablin, called it a “profit-driven public health disaster” because it led to approximately 30 million American men being tested every year at a cost of at least three billion dollars.

We’re not dissuading someone from getting the test. If you’re closing in on your 50s or older, or have a family history of prostate cancer, think about getting your PSA tested. After all, the test has saved some lives. However, it’s not foolproof and it comes with its own list of serious drawbacks, including potential severe emotional stress, often for nothing.

Keep Your Prostate Healthy Now

To alleviate some worries, start giving your prostate some love. (No, not like that.)

Two of the best things for your prostate are lycopene and punicalagin compounds from pomegranates. It’s difficult to get a prostate-supporting amount of these things in whole foods, however, so take the supplement route. P-Well (Buy at Amazon) contains 30 mg of lycopene and 180 mg of punicalagin from pomegranate whole fruit extract. Both help keep your PSA levels in check.

As a bonus, a healthy prostate equates to having healthy erections. So even if you’re not worried about prostate health yet, you probably want to keep everything else down there performing optimally.

PWellAmazon

References

  1. Horgan J. Why I Won’t Get a PSA Test for Prostate Cancer. Scientific American, June 14, 2017.
  2. Ablin R, MD. The Great Prostate Mistake. The New York Times, March 9th, 2010.
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I have to wonder if other testing industries have some of these same problems. Breast cancer screenings for example, which lead many women to have double mastectomies, some of which may not be necessary but make big $$$. They can save lives, for sure, but I wonder if the profit motive for testing/surgeries/drugs is affecting things.

I read an article recently about the dental business. Lots of chicanery there, from fillings and root canals to braces for kids. Basically, lots of unnecessary procedures.

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Funny, I was just talking about this with my wife, about colon and prostate testing, versus the risk of getting either of these cancers. I have gotten contacted monthly by the doctor’s office to do my 50 year old colonoscopy, for the last three years lol. Kind of like ambulance chasing. The chance of me having either one of these cancers is less than 1%.

Bry

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I did the Cologuard (poop in a cup and mail it off) home test. No idea how bad the false positives are, but mine came back fine. I’ve read too many horror stories about invasive colon tests causing far more problems than they detect.

Also, in 2021, the U.S. Preventive Services Task Force recommended that adults at average risk for colorectal cancer should start screening at age 45 instead of 50. “This change was based on the increase in cases among younger adults.”

But I remain a bit of a conspiracy theorist about these things. Like, someone is making millions of extra dollars by lowering the age of testing. See also cholesterol testing and the “bad” ranges getting lower and lower, so more drugs are prescribed.

Also, I think I saw a black helicopter today following my car. :wink:

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This article is not accurate and risks men overlooking what is a fairly benign test that if done regularly, can detect cancer early and deal with it before it becomes fatal. It would seem the US is way behind the UK and suffers from the affliction of a highly monetized health care system driven by profit as the major aim over patient care. In the uk, if you have a raised PSA you are likely to have an MRI or Ultrasound that can detect cancer with a high degree of accuracy. You may then have a transperenial biopsy which is much safer than old methods, to determine the aggressiveness of the particular cancer (gleason grading) and from there make an informed decision on the need for surgery. As 1 in 6 men are likely to get Prostate cancer in their lifetime, the PSA test and recent improvements in outcomes make it a no brainer to do regularly, and a lifesaver for many, not an ugly truth.

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I hear you, those darn black helicopters. But my faith and trust in the machine is gone, so I question. Plus I got chickens, and from what I hear chickens are a gateway drug to conspiracy theories.
Also, is T-Nation listening in on my phone mic???

Bry

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I believe the false positive rate is reported at 13% for Cologuard. Not sure how that compares with more invasive tests, but that’s high enough to give me pause, as they’ll just want you in for the more invasive test after a false positive to confirm (whether you still have money left in your wallet?).

I studied biology at Washington University in St. Louis and Exercise Physiology at James Madison University (in fact was in the same 400-level Ex Phys class as Tim Henriques our senior year (contributor and VA deadlift record holder here at T-Nation).

At Wash U, I wanted to go to med school but quickly became disillusioned. It just became more and more apparent that the industry was far more interested in treating symptoms than curing illness.

I’m sure there are individuals that care, but the health care systems are set up in a self-serving way that generates enormous amounts of money compared to the lives it saves. “Outcomes” is what they call it in the biz, and you’d be appalled at how poorly chronic treatment modalities translate to actual positive outcomes (obviously, things like emergency surgery are different).

I’ll put it this way - you wouldn’t take your car to the same mechanic twice if he charged you this much money and failed to correctly diagnose / fix things with this frequency.

Nothing has made this more apparent than the insurance companies unwillingness to even pay for things like real blood work. Want to know if you’re Vitamin D deficient or have low T levels - you know something that might actually improve outcomes? Get your pocket book out, because your insurance company is having none of this “health” stuff.

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In all fairness, Chris, I challenge anyone to show me that earlier / more screenings aren’t making them more money.

The burden is also on the system to demonstrate with sound science that the screening protocols are improving outcomes.

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What would you state, specifically, is inaccurate in the article?

Additionally, I don’t think Chris is saying not to have to procedure done, but that one must advocate for themselves and research the pros and cons of any screening or treatment.

Perhaps things are different the UK, but over here there is a preponderance of evidence that supports the notion that some treatment modalities have more to do with profit than with outcome.

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Always. We also have access to your camera, but only to track your dietary choices. :grinning:

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I’d say it is inaccurate because the article states
“ you’re 120-240 times more likely to be misdiagnosed because of a positive PSA test and 40-80 times more likely to get unnecessary surgery or radiation than you are to have your life saved”
The steps after a PSA test should ensure that nothing ‘unnecessary’ happens, the article seems old and behind current ‘best practice’ however we have access to a free healthcare system should we choose to use it, that in itself supports a level of professionalism because as i stated before, the US system is very much monetized and profit driven. A good friend who recently had a radical prostectomy lives between New York and the UK and his experience was that the US was very ‘competitive and profit driven’ over patient care. He elected to have his surgery in the UK (Privately outside the Free Health Service)and could not be more positive about his level of care as a patient, and the information available to him at all stages to be able to make an informed decision as to how he wanted to proceed.

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“the US is way behind the UK”

This must be why world leaders fly to the UK for their healthcare. Oh wait…

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  1. It’s common for men’s prostates to enlarge when they reach their 60s. It’s called BPH. I have it and I take P-Well along with pumpkin seeds, etc. Strenuous activity causes the enlargement to increase and PSA increases with enlargement.
  2. If you have BPH and your PSA increases from 3 to 5 or 6, you’re probably fine. If your PSA goes from 3 to 20, see a doctor.
  3. Primary care docs and urologists usually know next to nothing about hormones. The conventional wisdom is that higher testosterone is bad for your prostate. Completely false. I highly recommend YouTube vids of Dr. Albert Morgantal - the father of TRT - to get educated on this topic.
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That’s a very ‘Trumpian’ misquote there demonthrall!
obviously an exaggeration of a comment i never made, however your statistic is based on what source there demon? The world’s top 10 medical destinations rates the UK squarely in the middle ranking, and the US?……. nowhere to be seen, and definitely not a place id like to get sick in when Medical expenses directly cause 66.5% of bankruptcies, making it the leading cause for bankruptcy. Additionally, medical problems that lead to work loss cause 44% of bankruptcies. Sounds like you’ve got a hell of a system there Demon, you keep on going defending it, you’ll make America great again!

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I’m not sure why you brought politics into this discussion, and I won’t speak for demonthrall, but I will say your inclination to denigrate one who may or may not support Donald Trump speaks volumes about your own personal biases, and is not a good look.

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Dicey issue. I agree with the main article: buyer beware, know what information the PSA can and can’t provide and be smart about how you use it. But I will be getting my PSA checked annually and would urge any over-50 man to do so as well and here’s why: in 2012 my Dad was told he no longer needed the PSA because of the reasons stated in the piece—potential for false positives, harmful biopsies and surgeries, and needless worrying. Cut to 2017: my Dad is diagnosed with inoperable, stage IV prostate cancer. Since then, the cancer has been slow-growing, and my Dad had a great seven years. But cancer’s a tricky m-fer: over the course of the last year, it’s spread and grown and defeated all efforts to stop it. My Dad’s now in hospice and likely will not live out the year. Had he continued getting an annual PSA test, this cancer probably could have been wiped out by surgery or targeted radiation, and he likely would have lived many more years. I don’t know, boys. I’ll take a little worrying to stay informed and avoid such a fate. My 2 cents. The PSA is one single data point—but it’s a data point that might save your life. I say take it—along with a grain of salt. Take care of yourselves, and whatever choice you make do it with your eyes wide open.

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No, it’s a shit system. They’re all shitty. No use arguing whose is worse. Either get care and go bankrupt or get on a list and die while you wait. Or third option, Canada will kill you if you ask nicely.

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Those Canadaeranians are good like that!
Lift heavy and stay fighting fit!!

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It wasn’t political, just a reference to a style, of taking an opinion and spinning it beyond its actual remit, it wasn’t what i said, but the response had a style of misrepresentation akin to a certain politician who has a habit of warping reality. It’s surprising that you take offence to my reference, but a politician who lies, twists truth, runs a line in racism, mysoginy, and law breaking on an industrial level somehow flies under the radar of reality in the US…… or are you offended that i even referenced him?