Is it Time to Give PSA Tests the Finger?

Ah yes, the old PSA blood test. It tells men if they have prostate cancer, right? Not necessarily. The Prostate Specific Antigen Test or PSA is a blood test designed to detect a specific protein in a man’s blood that’s supposed to be an indicator of prostate cancer. The only problem is that sometimes it is, and sometimes it isn’t, and that’s a big problem. An elevated level of this specific protein in a man’s blood can also be an indication of a benign enlarged prostate that is often bothersome, but hardly deadly. It can also be an indication of recent sexual activity, prostatitis, and even long bicycle rides.(1) The PSA test for prostate cancer in men has essentially fallen out of favor in recent years, so much so that the American Urological Society has gone as far as to recommend that men between the ages of 40 and 54 years at average risk not even get the PSA test at all!(2)

PSA testing risks

While it may seem like a good idea to just get the test anyway and error on the side of caution, it’s not as simple as that. Why? Because prostate testing and subsequent advanced screening (biopsy) carries risks of its own that can produce results that are almost as bad as cancer itself. Men who undergo prostate biopsy or removal risk chronic infection, pain, bleeding and blood blisters (hematoma) allergic reaction to anesthetic, postoperative urination issues and even impotency. With regard to infection Consumer Reports stated:

“In the last decade, some bacterial strains have become resistant to the class of antibiotics that were once highly effective: fluoroquinolones such as ciprofloxacin (Cipro and generic). Studies suggest that about one in five men undergoing biopsies harbor E. coli bacteria that are resistant to fluoroquinolones. They are more likely to develop infections of the urinary tract or bloodstream and land in a hospital’s intensive-care unit” (3)

Why the sudden change of heart on the PSA by the medical community? Many health experts say the test simply isn’t accurate and isn’t very good at helping doctors figure out which men have prostate cancer that could kill them, and which men have cancers that are so slow-growing that they’re essentially harmless.(4) Prostate cancer is typically a type of cancer that grows slowly a man at age 60 that has the first signs of it could very well die of old age before the cancer kills him. Today’s doctors are recognizing that the PSA test is best when taken over a period of years starting early in life, and then used as a gauge over a span of multiple testing events, which is why fewer doctors are quick to suggest a biopsy immediately after getting an early elevated reading. Since the cancer is typically so slow growing, many are suggesting that the risks of invasive biopsy outweigh taking a slower “watch and see” approach.

What’s the best course of action?

As with most things health related, the best course of action is different for each person. Doctors and patients should gather and evaluate as much information as possible before deciding on what’s best for their particular situation, but today’s medical community is trending toward a much less reactionary approach to prostate health. No longer is the traditional knee jerk reaction subsequent immediate jump to risky invasive measures with massive reliance on PSA screening results seen as the best way to approach prostate issues. Realize that the seemingly innocent testing and sampling procedures used to get a definitive diagnosis regarding prostate health can often lead to complications and undesirable outcomes. If you decide you want a PSA test from your doctor, and you do get an elevated reading, don’t panic. Simply discuss the issue with your doctor including your concerns with the dangers and risks invasive testing can bring. If your doctor advises you to get further testing, discuss the risks involved and how those risks can be mitigated. You have options.