a doctor and a patient getting for a prostate checkup

Middle-aged men have been getting conflicting messages about prostate cancer screening. A decade or two ago, many were regularly urged to get a blood test for prostate specific antigen; aka a PSA test. In fact, the decision was often left up to a man’s primary care provider. If the family physician ordered a PSA test along with a cholesterol check, few men argued. It seemed like a prudent precaution. In some respects the PSA test seemed to parallel the recommendation women received to get a mammogram to detect breast cancer.

A Reversal Confuses Many Men

Then the pendulum started to swing in the other direction. Men were told that a PSA test was probably inappropriate for many middle-aged guys. A government task force, discouraged routine screening a few years ago, saying that the PSA test was not very specific for prostate cancer and could lead to over treatment.

If the PSA test revealed an elevated number, it would almost inevitably lead to further tests. Many men would be urged to get a biopsy. If there was even a minimal amount of prostate cancer that could lead to what was called unnecessary treatments such as surgery or radiation.

Dying With, Not From Prostate Cancer:

One physician we regularly interviewed on our radio show insisted that most men would die with prostate cancer not from prostate cancer. What he meant was that most older men would eventually have some prostate pathology. But the vast majority of these gentlemen would die from heart attacks, strokes or accidents and never even realize that they had low-risk prostate cancer.

It turns out that 50% of men between 70 and 80 years of age will have some signs of prostate cancer in the gland (Reviews in Urology, Spring, 2008). Yet the risk of dying from the disease is very low. That said, roughly 30,000 men die from prostate cancer each year. Lung cancer is the leading cause of cancer death among men. Prostate cancer is second. For comparison, roughly 41,000 women die from breast cancer each year.

The Pendulum Swings Again:

Now, the U.S. Preventive Services Task Force has revised its recommendations. The experts suggest that men between the ages of 55 and 69 discuss the risks and benefits of prostate cancer screening with their health care provider.

For men over 70 the task force does not recommend screening on the grounds that men whose prostate cancer is detected at that age are likely to die of something else, before the cancer kills them.

The People’s Pharmacy Perspective:

We suspect that many men may find this new advice on prostate cancer screening confusing and unhelpful. Should men get a PSA test once a year or not? The task force leaves that decision up to the man and his physician.

Some prostate cancer specialists fear that a laissez faire approach to screening will mean that more men are diagnosed at a later stage of the disease. That could make it harder to treat. Remember, prostate kills nearly 30,000 men annually. It is a serious cancer.

The trouble is that we don’t have good diagnostic criteria to determine which cancers are “indolent” (slow growing and not scary) and which are likely to be aggressive and lethal.

To help you better make sense out of this very confusing topic we recommend our one-hour radio show with two of the country’s leading cancer experts.

Show 1039: How to Reduce Your Risk from Breast or Prostate Cancer

Susan Love, MD is a breast cancer specialist. Charles “Snuffy” Myers, MD, is a prostate cancer specialist. You can stream the audio for free by clicking on the green arrow above Dr. Love’s photo. You can also download the free mp3 file and play it on your computer or smart phone. Scroll down to the bottom of the description of the show to find the link to the free mp3 file.

Share your own cancer story in the comment section below.

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  1. Brenda
    Wilmington, NC
    Reply

    My father died of prostate cancer which was discovered after it had spread beyond the prostate. As a result of this, both of my brothers insisted on PSA testing and eventually both were diagnosed with stage one cancer in their 50’s. They both had successful treatment and are doing well today.

  2. Paul R
    Reply

    It has gotten simple for me. having forgotten to eat mammal meat the paper test shows no blood in my stool. And I asked my doctor if there is a breast palpate test what about for men and pylons. She said yes. She said to feel up there and if it felt soft like the tip of my nose it was not a pylop. If it was hard like the bridge of my nose I should go see a doctor about it. I still wonder if she was kidding.

  3. Sarah
    Ballwin, MO
    Reply

    My uncle died of prostate cancer at 53. He was diagnosed with stage IV by the time it was caught. I think the tests should be done before 50.

  4. Bob
    Chapel Hill, NC
    Reply

    Don’t forget to consider your family history. A genetic counsellor can help if your history is positive.

  5. Deborah
    Durham
    Reply

    We learned a good lesson! We saw a PA my husband was bleeding I suggested he get his prostate examined because he had a family history of CA. Well PA gave him antibiotics and cleared up and was supposed to go back in 6 weeks! So he felt fine and did not go back!! Well guess what after having a hernia operation my husband could not go urinate!

    So for not going back- he had a 100g tumor wrapped around his urethra!!! Thanks to Dr. Ferrandino at Duke he operated successfully and found a miniscule amount of prostate cancer even after a 12 point biopsy. The moral of this story is- if you have a family history of prostate cancer run don’t walk and ask for a prostate exam and demand that it is done!!!

  6. Frank
    North Carolina
    Reply

    It’s got to depend not only on your chronological age but also on your general health/condition and on your aspirations of perhaps becoming a centenarian. Nearing my 78th birthday, I’m cheerfully undergoing treatment for a recurring malignancy, the first go-round having happened over a decade ago. The thing is, I’d like to help at least my eldest grandchild move into his college dormitory room as a freshman, and he’s only six years old.

  7. Jerry B
    Reply

    My thoughts are that the government should get with it and fund research for a test to differentiate between slow growing and aggressive prostate cancer. Until this happens no one can make an intelligent decision as to treat or not treat the cancer. It is absolutely ridiculous and shameful that this has not been done when billions of dollars have been donated to cure cancer.

  8. Lyn
    Washington
    Reply

    My 59 year old husband, fortunately has an Internist who eight years ago, ordered a PSA for him – it came back positive. He had appropriate tests, had pinpoint radiation therapy for 20 minutes week-days for a prescribed period, and is now “cured.” His cancer had not spread, and was encapsulated within the Prostate, and so a cure was expected, and he’s now back to a number that indicates there is no cancer.

    I urge all men to have a PSA test starting at age 50, and insist that your MD refer your loved one have it. My husband had few side-effects, and will now enjoy a life well worth living.

  9. Marie
    Reply

    My brother is 58. He did not get a PSA test because insurance no longer covered them. Last year he was diagnosed with Stage IV prostate cancer. The cancer had spread to his pelvic bone.

    Had he had the test, it may have been diagnosed earlier. I think it’s terrible that the test wasn’t covered; something so simple could have prevented this. Now he has to have much more aggressive treatment. Get the test!

  10. Robert
    Va.
    Reply

    I am 77 and have been watching my PSA for 15 years. I started with a low number around 4. , it is now 16. A jump from 14. Of two points. I choice to have the biopsy. Yes I have cancer. I have made my own choice to watch and wait. We all have decisions to make in our lives and only time will deside if they were good or bad. Remember they were my choices. R.F.

  11. Philip M.
    Dallas, TX
    Reply

    I am age 77 and have had PSA’s below the 4.0 nG/mL cutoff every year so far. My last of 2.37 was in November of 2016.

    I have a physical coming up in a week and intend to ask for another PSA test even though the current conservative advice is to decline the test. Because aggressive prostate cancer can suddenly appear, even if the likelihood is low in my case, I don’t want to be caught with my “head in the sand”.

    It is so emotional for me to think about prostate cancer and the severe downsides to ignoring it, biopsying and/or treating it, but the mature thing is to get the best information available regardless of age, then deal with that, chips fall where the may. We only go around once, I am told.

  12. victoria hallerman
    New York
    Reply

    As the wife of a prostate cancer survivor and the author of How We Survived Prostate Cancer: What We Did and What We Should Have Done (William Morrow, 2009), I find it infuriating that medicine can, at times, resemble the world of fashion; one day a treatment or test is all the rage, the next decade, not so much.

    My husband may (or may not) have been the victim of the PSA testing fashion, in the early 2000’s, when he was tested, biopsied and treated for a cancer he might well have died with, rather than of. A doctor prominently involved in developing the PSA testing process has been quoted as saying that the trouble is you either have a rabbit in the box or a tortoise. The rabbit (aggressive PCa) will jump out of the box (spread), but the tortoise will stay in there forever.

    My husband’s cancer treatment changed our lives irrevocably, and might well have been a tortoise cancer, but you never know. Writing a book about it helped, and persuaded a lot of people to get a second opinion (we didn’t) and really think about the treatment process.

    Dean and I are alumni of The People’s Pharmacy; we were recorded for the show: the interview aired on April 17, 2010. We’re real fans of everything you do!
    Victoria Hallerman (www.victoriahallerman.com)

  13. Mark
    Milwaukee, WI
    Reply

    I have a family history of prostate cancer on my paternal side. A PSA is an important part of the diagnostic process. My PSA was fairly steadily raising at a mildly alarming rate. My primary care said we could continue to monitor it or I could see an urologist. I saw a urologist and discovered my prostate was 37% cancerous. I had a the surgery and am now doing fairly well.

    Seeing my MD on a regular basis, having frank discussions and a good relationship with the MD is a great form of health care.

  14. Patrick
    Houston
    Reply

    At 55, I was getting my PSA done yearly by my Urologist. One year my PSA more than doubled, to over 8.

    A biopsy revealed a rather aggressive form of cancer.The prostate was removed, and 20 years later I’m doing great.

    Don’t put off getting a PSA. It may not be the ultimate diagnosis tool, but it’s the first step.

  15. Robert
    Virginia
    Reply

    I know four men whose aggressive prostate cancer was discovered by a routine PSA test. One of them was successfully treated by Dr. Snuffy Myers, who did one of your shows. Yet all have had serious side effects. My own urologist still gives me a PSA test and digital test. Since I have had trouble with prostatitis for some time, we are waiting to see if a biopsy is necessary. As new tests become available, perhaps the decision making process will be easier. Here’s one new test. I do not know when or if it will be fully approved:

    https://newsroom.clevelandclinic.org/2017/05/11/cleveland-clinic-led-study-finds-new-blood-test-accurate-predicting-overall-risk-prostate-cancer-standard-prostate-specific-antigen-psa/

  16. Bob
    Reply

    My urologist still believes in the PSA test, and I take it every year.

  17. Barb D
    Ohio
    Reply

    I feel at younger ages of people that prostrate and mammograms need done on a regular basis. Testing for all cancers as well.

  18. Lori
    Atlanta
    Reply

    My father was diagnosed 2 years ago at the age of 87 with prostate cancer. He was discouraged from getting PSA’s after age 80. When his urologist told him that he probably had prostate cancer after his physical exam, my dad told his doctor that there was no need to do anything because”he most likely would die from something else”.

    When my dad told me of this visit with his doctor, I insisted he get “information “ in order to make a sound decision on what to do. Results were PSA over 125 and an aggressive form of cancer. It was all in his bones. As result, I was angry that his doctor didn’t encourage him to do further testing and instead accepted his statement that he wouldn’t be dying of PC.

    Men hear that at later years most cancer is slow growing. They need to be educated that some are aggressive and will take their lives. They need the facts in order to make the decision not to treat it.

  19. Mary T
    Barrie Ontario
    Reply

    Please do not allow any risk of a ‘false positive’ to prevent you from getting a baseline PSA at 50 and then once a year.

    My husband went to several doctors who did not believe in doing PSAs because of the fear of a ‘false positive’. By the time a doctor specializing in male health ordered the PSA test when he was 65, his PSA was 61, highly elevated! Treatment ensued. We are thankful that he is alive today due to the excellent care of a urologist.

    Only an uninformed doctor does not know how to deal with an elevated PSA. You repeat the test, then if it is slightly elevated you watch and wait. You also check for other things that can cause it such as BPH, which is an enlargement of the prostate that can cause an elevated PSA.

    I have had several mammograms where I was subsequently sent back to radiology for an ultrasound. I believe the result from the mammogram would be called a false positive. And yet no one suggests I stop having mammograms.

    Please watch Dr. Myers. He is one of the most respected Prostate Cancer doctors in the world.

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