Should Too Get A PSA Test!

This entry was posted by Sunday, 12 August, 2012
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Looking for the prostate gland



If you’ve been reading the newspaper lately, you probably know to skip the PSA test. Pretty much a scam, right? You risk impotence and incontinence. And for what? You die when you die and your tombstone won’t say “Saved by PSA”.

As usual. There are two (or more) sides to the story.

Dr. Edward Messing (University Of Rochester Medical Center) took a look at the country’s largest cancer registry and he compared data for the period before PSA testing was introduced and after it was introduced. The work was published in Cell.  What did he find out? Surprise! He found that the amount of “advanced” cases  – metastatic cancers that were going to spread –  would have tripled had it not been for PSA testing.

So getting your PSA tested is a good thing, right?

Maybe. But this isn’t a very accurate test. What if it leads you to get an unecessary needle biopsy and the biopsy, itself, makes you sick? What if you wind up with urinary incontinence or impotence from the biopsy? Or what if the biopsy is positive and you get surgery and you swoon in the operating amphitheater years before the cancer would have nipped you?

Well, well, well. This is so complicated you probably wonder what MISTER Scienceaintsobad thinks. I ain’t givin’ no medical advice, but I will tell you what I would do if my own PSA score were to jump.

I would be very calm.

Why? Because, as I say, the tests are usually wrong. And, also, as I said, this cancer is a tortoise. At least, it usually is. So I would probably figure on being around to blog another day.

Your blog’s so b-o-r-i-n-g, most of us readers’ll go out and celebrate when you bloody slip the mortal coil, MISTER ScienceIsSoPredictable! – ReaderOfYourBlog993. 

Hey WATCH it, ReaderOfYourBlog993!

Well what to do with the knowledge from the test? If you’re just going to ignore it, why waste time and money? Why do the test in the first place?

Precisely the argument of the US Preventative Services Task Force.

Here’s the thing. (Gotta stop saying that.) Why not act intelligently on this information? Instead of calling  up the biopsy guy, why not look at  other noninvasive tests that could be used to narrow down the possibilites? Here’s one worth considering. Here’s another.   And, yes, this test not only gives accurate information about the presence of prostate cancer, it also gives an indication of how advanced it is which, after all, is the key. With that information, you know when to act and when to roll the dice on outliving the cancer.

Just one thing. None of these tests is available. They are still “raw science”. They might not make it to the clinic. Ever.

Am just playing with you? Would MISTER ScienceAintSoBad do that? Course not. I do have something with a bit more immediacy here. This study, using currently available drugs,  takes the sloppy PSA test and sharpens it up. It’s the brainchild of  Dr. Steven A. Kaplan and his colleagues at  the NewYork-Presbyterian Hospital/Weill Cornell Medical Center  (published in the Journal of Urology) . They looked at men who keep getting abnormal PSA tests followed by normal biopsies. For these patients, this would happen over and over. Frustrating!

Since the standard PSA test has trouble telling the difference between an inflamed prostate (which is benign if you don’t mind peeing constantly) and cancer,  they tried using certain drugs – drugs that are currently available –  to  shrink the prostate. THEN they did the PSA test.

Good idea.

After shrinking the prostate, the tests were , in fact,  more accurate. Fewer patients had to undergo a needle biopsy with its risks and more advanced cancers were identified. No. This “drug plus PSA test” approach isn’t standard follow-up to a positive PSA test. Not yet.  More thought has to go into how it might be applied to the general population. And, of course, cost/benefit considerations are important when you make a simple test more complex. But all these tests show that we don’t have to be trapped by our current thinking on the PSA test.

The Task Force raised good questions but the panel members need to get out more. Science can offer a broader range of options than just the plain vanilla PSA test.

Science. It ain’t so bad. Right?

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Image credits: That’s actually Margaret Field in The Man From Planet X which you may have caught back in 1951. He isn’t really checking for a prostate, even though it sure looks that way. The alien is trying to kidnap her and take her back to X where they have a huge shortage of librarians.  Creative Commons License
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One Response to “Should Too Get A PSA Test!”

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