The PSA and Paralyzing Fear
Prostate specific antigen, or PSA, is a protein produced by both normal and malignant cells of the prostate. Physicians have measured the blood levels of this antigen since the 1970's because it's widely recognized as a reliable diagnostic tool in detecting prostate cancer in men.
However, at the risk of being beaten up by the medical community, chained pantsless to a hypoallergenic stock, and then subjected to painful digital rectal exams by the "Top 100 Prostate Surgeons" as determined by USA News and World Report, I'm going to cast some aspersions on the PSA test.
My motive is this: I've had at least three friends who were told they had abnormally high PSA readings. In all three cases, they were told to wait three to six months to be re-tested. The subsequent tests all came back within normal ranges, but all three men spent the six-month waiting period in hell, paralyzed by the fear they had prostate cancer.
So in order to maybe spare someone else the stress, I did some research. Now you may be too young to worry about the PSA test, but sooner or later, a doctor will advise you to get one. Or you might have an older male in your life right now who you care about that might be interested in this info.
According to the latest 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 and/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 forced concluded that you're 120-240 times more likely to be misdiagnosed as a result of a positive PSA test and 40-80 times more likely to get unnecessary surgery or radiation than you are of having your life saved.
As bad as that task force's findings were, it was kinder to PSA tests in general than another analysis done in 2013 by the Cochrane Group, an international collaboration that provides impartial assessments of medical procedures.
The group carried out a meta-analysis of five major studies of the PSA test, including the U.S. and European trials. 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."
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 3 billion dollars.
You see where I'm going here? But by no means am I trying to dissuade someone from getting the test. By all means, if you're closing in on 50 or 55, or have a close relative with prostate cancer, think about getting your PSA tested. After all, the test has clearly 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.
- Horgan J. Why I Won't Get a PSA Test for Prostate Cancer. Scientific American, June 14, 2017.
- Ablin R, MD. The Great Prostate Mistake. The New York Times, March 9th, 2010.