Sunday, March 22, 2009

PSA Tests for Men

I wish I would have written the post that Dr. Bob Wachter did on the new evidence about Prostate Specific Antigen (PSA) tests for men. Two new rigorous studies have been published in the New England Journal that address the value of PSA screening.

I can tell you that every man I treat asks for these tests and I have been pretty unsuccessful in influencing anyone to forgo the test or "watch and wait" if their levels were elevated. Yet I have seen elderly men decline rapidly after receiving prostate surgery or radiation that they never needed. Wachter quotes a Dartmouth Endocrinologist:

… In the final analysis, most of these one million extra cases of prostate cancer [diagnosed through PSA screening] represent nothing more than pseudodisease: disease that would never progress enough to cause symptoms—or flat-out would never progress at all… I should be clear that none of this should be interpreted as saying that PSA testing will never work. In fact, while many men may have been hurt by the ensuing treatment, a few others may have been helped. And it is possible that the PSA test can be modified such that it finds much less cancer and therefore makes much more sense. But right now we need to be clearer about the primary effect of the way it has been used so far: it has been making men sick.

You owe it to yourself (and your father or husband) to head over to Wachter's World and read what he has to say.


Kellie said...

Thank you for this valuable, clairfying info. and directing us to Dr.Watcher's post, I had known there was confusion about which way to go on this test.
Isn't there also a chance of inferitality even when the treatment does not cause ED?

Jonathan said...

I think we’d all benefit from a better definition of what “watchful waiting” constitutes, along with its outcomes.

Said another way, what exactly does watchful translate into in terms of follow-up exams, tests, and/or procedures? The idea of an annual biopsy, for example, is a bit unnerving (but taking the emotion out of it, better than unnecessary incontinence). And what of the outcomes? How good are we at catching the aggressive prostate tumor before it metastasizes?

I think the difficulty here is that we have yet to invent a screening test that can distinguish between the benign and the aggressive prostate tumor.

Raymond Bouchayer said...

So what is it ....should we , or should we not ? I have been taking those test for many years now since I had a blockage and a "Turp" procedure .
Saddly , I think that the teat is given if one has some kind of insurance and the ability to see a Doctor .
They have procedure in France that injects ...I think , gasoline in the prostate and that shrinks the prostate . It is not has invasive as a "turp" procedure , no blood loss and a less chance of side effects .