Originally Posted by
zandoval
The PSA is a terrible test... But I order them on my patients all the time. We really don't have a good test at all so I run the PSA, do the rectal exam, and question my patient's family history. In my practice an elevated PSA gets you to the urologist period.
Biopsy... Biopsy... Biopsy... And then cross your fingers...
But the biopsy isn't a benign procedure and it also has a high risk of false positives.
The question of whether to do a PSA test and what to do with the results is not a "one size fits all" question - some will want any disease detected in the body treated at all cost, plan to live to be 90+, and may not care that much about side-effects; others will have different priorities. But with all due respect, do NOT take your doctor's advice without doing your own careful reading and assessment. Doctors, in general, are predisposed to treat disease and to prolong life at all cost, and are not in a good position to make difficult tradeoffs between small reductions in risk vs. huge side-effects of treatment.
Here's what the United States Preventative Services Task Force has to say about PSA tests:
USPSTF Assessment
Although the precise, long-term effect of PSA screening on prostate cancer–specific mortality remains uncertain, existing studies adequately demonstrate that the reduction in prostate cancer mortality after 10 to 14 years is, at most, very small, even for men in what seems to be the optimal age range of 55 to 69 years. There is no apparent reduction in all-cause mortality. In contrast, the harms associated with the diagnosis and treatment of screen-detected cancer are common, occur early, often persist, and include a small but real risk for premature death. Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit. The inevitability of overdiagnosis and overtreatment of prostate cancer as a result of screening means that many men will experience the adverse effects of diagnosis and treatment of a disease that would have remained asymptomatic throughout their lives. Assessing the balance of benefits and harms requires weighing a moderate to high probability of early and persistent harm from treatment against the very low probability of preventing a death from prostate cancer in the long term.
The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.
- Mark