Tuesday, April 6, 2010

Prostate Testing Is Not Black And White

Prostate testing remains controversial. In one camp we have those who are pushing for more testing so that more cancers can be detected. This group feels that prostate cancer is under diagnosed and under treated. In the opposing camp are those who feel prostate testing is not helpful as a screening (as against a diagnostic) test and feel that too many men have unnecessary biopsies and surgery with all the associated risks and possible complications. Interestingly, in this latter group is the inventor of the test.

Whilst stories of men who had their life “saved” by having a PSA test make the headlines, stories of men who have incontinence and impotence after unnecessary surgery do not.

What is the average man to make of this? The issues are not straightforward.

The PSA test measures a protein in the blood, which comes from the prostate gland. Like with all tests there is a statistically defined normal range and this increases with age. There is also a sub set of “free” PSA versus PSA bound to another protein.

In an ideal world a raised PSA would diagnose prostate cancer. It does not. The level can be raised for a number of other reasons including benign enlargement, infection and can be raised by some over the counter medications. The PSA can also be normal even if cancer is present. In medical terms this test is classed as having a high” false” positive and negative rate.

It gets more complicated. There are two types of prostate cancer. One form which is fatal and the other is not. In simplest terms it has been regarded that all men will eventually get cancer cells in the prostate if they live long enough. They will die with not of the cancer. Hence the finding of prostate cancer in someone of 70 is regarded as less serious than in someone of 55. Age whilst a guide, is again not an absolute determinant of the form of cancer. The PSA does not give us any clue either.

The final complication is that in many instances we do not know if treatment makes a difference. In other words in many cases we do not know if a man who has undergone surgery and radiation and lives would have lived just as long without treatment.

There are conflicting trial results too. An Australian study claims that Australian men are under diagnosed and under treated. This is based on the fact that 60% of biopsies were positive for cancer compared to 30% in the USA. It also found that when radical prostatectomy was performed that on 5% had “insignificant “ cancer compared to 25% in the USA. This could also be interpreted, as showing that there is better case selection for surgery in Australia.

Once again it would be simple if the finding of cancer and treatment meant a better and longer life. A large American trial over ten years showed PSA screening did not reduce death rates in men over 55. A European study showed a small decrease in death rates. For every 48 operations there was an increased survival of one. This means 47 men had surgery, which can cause incontinence and impotence for no net gain.

The Australian study is being promoted by the Urological Society, which advocates PSA testing for all men over 40. It is worth remembering that their members earn a living from biopsies and surgery. This does not make their advice wrong but they have a vested interest. Other Australian groups recommend screening after 60 or no screening at all.

The tests inventor, Richard J Albin went public saying he never intended the test to be used as a screening tool and claims the original FDA approval was based on it detecting 3.8% of Prostate cancers. Whilst the case rate of Prostate cancer in the USA is 16% there is only a 3% death rate from it.

So to get back to our question of what are we to make of this? The simple answer is we do not know. Those who claim to have the answer need to be treated with great skepticism. Those who claim they are about “saving lives” need to be treated the same. Those who downplay the not insignificant costs in human terms of over treatment are not doing us any favors.

Ultimately the decision needs to come down to the individual based on his circumstances. Factors like family history and symptoms need to be considered. If a PSA is done and is raised it should certainly be repeated before further action is considered. Men need to be aware that it is not black and white; that a positive test may mean nothing and a negative test does not mean absolutely no cancer.

Whilst it would be nice to be able to offer a simple one size fits all advisory, I do not believe this is possible. Hence beware of those who do particularly if they stand to gain monetarily from it.


  1. Sweet blog! I found it while surfing around on Yahoo News.

    Do you have any suggestions on how to get listed
    in Yahoo News? I've been trying for a while but I never seem to get there! Appreciate it

    my web site :: http://slimlipoplusdiet.com

  2. If you want to increase your knowledge just keep visiting
    this website and be updated with the latest news update posted here.

    Also visit my web blog; Muscle BUilding Supplement

  3. Good info. Lucky me I ran across your website by chance (stumbleupon).
    I've saved it for later!

    my site: Lift and glow pro reviews

  4. Great delivery. Solid arguments. Keep up the amazing effort.

    My web site ... Viarex reviews

  5. Good way of explaining, and good post to get data concerning my presentation topic, which i am going to convey
    in school.

    Also visit my site :: Enduros Male Enhancement Free Trial

  6. Thanks for your personal marvelous posting! I genuinely enjoyed reading it,
    you may be a great author. I will make sure to bookmark your blog and
    definitely will come back in the foreseeable future. I want to
    encourage you to continue your great job, have a
    nice weekend!

    Here is my web blog; pureberrymaxreview.net

  7. Pretty! This was an incredibly wonderful post. Many thanks for providing these details.

    Review my weblog; Saffron X Weight Loss

  8. I was suggested this blog through my cousin.
    I'm no longer sure whether or not this post is written by him as nobody else understand such particular approximately my problem. You're amazing!

    Here is my web site: Ultra Celeb Diet Reviews

  9. Fantastic blog! Do you have any hints for aspiring writers?

    I'm planning to start my own site soon but I'm a little lost on everything.
    Would you suggest starting with a free platform like Wordpress or go for a paid option?
    There are so many choices out there that I'm completely overwhelmed .. Any recommendations? Many thanks!

    123 income academy review

  10. Please let me know if you're looking for a article writer for your site. You have some really good posts and I feel I would be a good asset. If you ever want to take some of the load off, I'd love to write some
    articles for your blog in exchange for a link back to
    mine. Please blast me an email if interested.
    Many thanks!

    Here is my webpage :: Order Natural Cleanse

  11. My developer is trying to persuade me to move to .net from PHP.
    I have always disliked the idea because of the expenses.
    But he's tryiong none the less. I've been using Movable-type on various websites for about a year and am
    nervous about switching to another platform. I have heard great things about blogengine.
    net. Is there a way I can transfer all my wordpress posts into it?
    Any help would be greatly appreciated!

    Take a look at my blog 365 day loans

  12. Appreciate this post. Let me try it out.

    my site: raspberry ketone extracct

  13. Sweet blog! I found it while surfing around
    on Yahoo News. Do you have any tips on how to get listed in Yahoo News?

    I've been trying for a while but I never seem to get there! Appreciate it

    Also visit my web page - Green Coffee Diet

  14. Hello to every body, it's my first pay a visit of this website; this webpage contains amazing and truly excellent data in support of visitors.

    build muscle

  15. I do believe all the concepts you've presented on your post. They are very convincing and will certainly work. Still, the posts are very brief for starters. Could you please prolong them a little from subsequent time? Thanks for the post.

    Also visit my web page - Buy authentic green coffee

  16. a week and also transform your physique very quickly.

    Going from skinny to muscle depends on how you approach and execute your workouts as well as how you manage your nutrition and rest.
    Having a six-pack or eight-pack abdomen is a dream for thousands of people,
    which is further fortified by the screen shots of their favorite actors who have the perfect physique with muscular arms and chest.

    Here is my web blog; Power Pump XL Muscle

  17. I pay a quick visit every day a few websites and sites to
    read posts, except this webpage offers feature based content.

    My web page No2 maximus review

  18. Good day! This is my 1st comment here so I just wanted to give a quick shout out and say I really enjoy reading your articles.

    Can you recommend any other blogs/websites/forums
    that cover the same subjects? Thank you!

    Here is my web-site: what is garcinia cambogia

  19. Hi i am kavin, its my first occasion to commenting anywhere, when i read this piece
    of writing i thought i could also create comment due to this
    brilliant paragraph.

    My web page - home jobs online

  20. Fast-fold Projector Screens-adaptable Every one The Instances

    Feel free to visit my website; euro casino

  21. Walt Disney: A Little Bio

    my web site :: payday