Last updated: August 2022
I've just read Gogs Gagnon's article on this subject and thought I'd add to the conversation.
PSA test misconceptions
This is such an important area. We don't screen for prostate cancer in the UK and our GPs, particularly the old-school ones, are dyed in the wool in their views that the PSA test does more harm than good. That's because they think of the PSA as a diagnostic test when it's not. It's actually no more than an indicator tool that starts the process.
Historically, a high reading led straight to biopsy and the risk of infection, and this is where GPs get their view that PSA is a bad test. A scattergun biopsy could see 30 samples being taken, still missing a cancer lesion but leading to infection/sepsis with serious consequences.
However, times have changed and GPs need to up their game.
A high PSA can now lead to a risk assessment being undertaken, along with an mpMRI scan. This scan offers more detailed pictures than a regular MRI scan, and can help determine if a person needs a biopsy.3
Then targeted biopsies can be done, potentially reducing the risk of the old-style scattergun biopsies and lowering the chances of developing infection/sepsis and all the consequences of that.
The mpMRI scan may help identify cancers that may never cause a problem, and thus avoid overtreatment, which has historically been the problem with PSA testing.
Advocating for PSA testing
A European Prostate Cancer Awareness webinar put forward evidence of better outcomes using PSA testing to screen than not using it,1 and they hope to get this included in the EU cancer plan. I think this could be a significant step forward, potentially leading to earlier diagnosis, less overtreatment, and reduced mortality. Truly a win-win situation.
By the numbers
Some important facts are that many men with a higher PSA level do not have cancer.2 This should help allay anxiety caused by being told you've got a high reading after testing, if it's properly communicated to men by medical practitioners. Perhaps the medical practitioners need more training in this area!
Regrettably, some men with a normal PSA level do have cancer. Until a more robust test is developed, these men may not be diagnosed until they develop symptoms which, as Gogs says, is often too late.
Detecting prostate cancer early
From a personal viewpoint, they think I'd had the cancer for 10 years, completely asymptomatic, when I was diagnosed stage 4 aged just 60.
If I'd known about the PSA test and that I'd had a right to one from age 50, my cancer could have been caught early, and I could have had curative treatment with a much better outcome. Instead, I'm living life on a knife edge waiting in the full knowledge that my treatment will eventually fail. It's often a bleak existence.
The real key is making sure that men are aware and get regular PSA tests done. It's about ensuring they are proactive about their prostate health, rather than reacting when symptoms develop, which is often too late.
Fellas, find out what your baseline is and monitor it. Take action if it rises in anything other than a normal manner.
A man that I know monitored his PSA religiously every year, because he lost a friend to prostate cancer. His PSA level rose gradually over the years, as it does, but one year it jumped by one-third, and that was significant enough to get investigations done. Sure enough, he had cancer. He then had brachytherapy and was cured, and he's still with us 15 years later and fighting fit!
I also find it interesting that urologists who generally sort prostate cancer problems out at the sharp end are pro PSA testing, yet GPs still have reluctance. Who would you trust?
What influences your decisions when choosing a physician? (Select all that apply)
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