PSA Test Scores: What Your Doctor Isn’t Telling You
Very few days go by without me seeing a patient who is concerned about his prostate. And who can blame them? During the next few years, I expect to see cases of prostate cancer continue to increase, until the disease achieves the dubious distinction of being the number one cancer among men.
Yet, in spite of the fact that prostate cancer is quite common, myths and misconceptions make it difficult to sort out the treatment options. Here, for example, are four statements I hear just about every day. See if you can tell which are true and which are false.
- A PSA test can determine if you have prostate cancer.
- An elevated PSA level score means you have cancer.
- A standard biopsy is the best way to confirm the PSA findings.
- Prostate cancer requires immediate treatment.
These are all very common beliefs, things that I hear from patients every day. And they are all wrong. So let’s clear up the confusion, because having the correct information could save your life.
How the PSA Test Helps – and Hurts
As I explained in an earlier newsletter, the PSA (prostate-specific antigen) blood test is widely used to screen for problems with the prostate, the gland that manages the flow of urine and semen into the penis. Although the PSA test is not the final word on prostate health, I do recommend it to all of my male patients, simply as a baseline to measure changes in the gland over the years.
Conventional doctors usually consider a PSA test level score below 4 to be normal, and those above 4 signal that it’s time for further tests, such as a biopsy. Just to be clear, however, a score of 4 or more does not mean you have prostate cancer. A number of factors influence your PSA score, including:
- Inflammation (prostatitis)
- Benign enlargement of the prostate (BPH, BPE)
- Having had sex recently
- Using a different lab
- Urinary tract infection
- Riding a bicycle
- Consuming certain foods, including sugar, red meat, and unhealthy, omega-6 fats from common oils, like corn, safflower, and soybean.
Personally, I think it’s more important to watch the direction of these test scores over a few years to see if the numbers are going up or down. An upward trend indicates something is amiss. That “something” could be common inflammation, which can be corrected with lifestyle changes, or it could be a malignancy.
I consider a PSA score above 1 to be reason enough for a patient to start making some changes (those are discussed in detail in the earlier newsletter on inflammation.
That said, the next thing you need to know is this: The annual PSA test is no longer automatically recommended for men over the age of 40. According to the U.S. Preventive Services Task Force (USPSTF), the benefits of the test are outweighed by the harm it does. That’s because many physicians advise patients with elevated PSA scores to undergo biopsies and even surgery to check for cancer.
Here’s the problem with that approach: After reviewing numerous, highly regarded studies, the USPSTF concluded that the PSA test produces a startlingly high number of false positives, nearly 50 percent, according to some experts. As a result, hundreds of thousands of men, along with their spouses and families, endure the horrific stress of a possible cancer diagnosis, followed by a biopsy, and treatment in the form of radiation, surgery, and/or chemotherapy – when they never had any cancer to begin with.
In addition to worrisome false positives due to PSA testing, there is another concern – overtreatment. Approximately half of all prostate cancers identified with PSA tests are of the slow-growing variety that requires no treatment. The idea of simply living with cancer is truly a game-changer, but it’s based on fact. According to the American Cancer Society, although one in six men is diagnosed with prostate cancer in his lifetime, just one prostate cancer patient in 35 dies from the disease.
In other words, even if you do have prostate cancer, you could do nothing and simply live with it for the rest of your life without experiencing symptoms or complications from treatment, such as incontinence or impotence. Of course, it’s up to your physician to explain this to you. If yours does not, I recommend asking detailed questions – and possibly seeking a second opinion – before agreeing to any treatment.
Prostate procedures are not cheap; a prostate cancer diagnosis can run up a substantial tab, well into the tens of thousands of dollars, very quickly. But what’s far more troubling is the simple fact that PSA tests do not save lives. Studies have repeatedly shown that groups of men who are not tested or treated have essentially the same outcome as men who were tested, biopsied, and treated. In other words, treatment did not result in longer lives or better health. And I would add, the men who were not tested and treated probably had a better quality of life with far less stress and none of the complications that can occur with treatment.
You should also know that when the decision to stop recommending routine PSA tests was announced in 2012, two physician groups – the American Urological Association (AUA) and the American Association of Clinical Urologists (AACU) – counterattacked, calling the change “irresponsible,” “absurd,” and “misleading and harmful.”
Did the fact that urologists stand to lose a significant portion of income play a role in their stance? There’s no way to tell for certain. But a year later, one of those groups, the AUA, has changed its tune, recommending that men between the ages of 55 and 69 simply talk to their doctors about the PSA. So, if your physician mentions a PSA, be aware that the test results could be wrong and that it could lead to serious, irreversible procedures that will affect your health for the rest of your life.
Bottom line: The PSA test is a useful tool for observing changes in your prostate, but please don’t let those test scores alone intimidate you into undergoing needless procedures that can do serious damage to your health.
A Better Way: The PCA3 Test
So, let’s say your PSA levels have been rising during the past few years, and your doctor wants to find out if you have prostate cancer. While most physicians recommend a biopsy, I suggest my patients have a test known as the PCA3 first. This simple genetic test uses urine to look for the expression of genes that are only found in prostate cancer cells.
The PCA3 gene is over-expressed in 95 percent of all prostate cancer cases, so it is highly accurate. Even though it has been available since 2004, not many physicians use the PCA3 test yet, so you might have to educate your doctor about it.
How To Make Biopsies Better
Although biopsies are commonly used in diagnosing cancer, they are imperfect tools. During a biopsy, a technician inserts very fine needle into an organ, withdrawing cell samples that are then examined for the presence of cancer.
It can require numerous painful insertions – sometimes as many as 12 or more – to obtain sufficient samples. The problem is, even with multiple insertions, it’s entirely possible to miss a tumor completely.
To avoid that problem, I prefer a Color Doppler Ultrasound (also known as a sonogram) for my patients, since it allows the doctor to easily determine whether or not prostate tumors and/or abnormalities are present and where they are located. It also allows the doctor to gauge the cancer’s type, location, size, and stage. If you’ve ever had an ultrasound, you know that the procedure is non-invasive, painless, and takes about 30 minutes.
If you’re concerned about prostate cancer, I understand that waiting for a diagnosis can be very difficult. That’s why I urge you to research, research, research before agreeing to any procedure.
Doctors often talk about “informed decision making,” which is simply another way of saying, “Do your homework.” As one recent study found, men who have taken the time to read about their condition and treatment options are less likely to have PSA tests because they understand the limits and consequences of treatment options.
If your doctor is insisting that you “need” to be tested, I hope you’ll ask about the PCA3 test and Color Doppler Ultrasound because these tests are considerably more helpful than PSA tests and standard biopsies. If your physician continues to push you toward a specific therapy, ask for references of other patients who have had similar procedures so you can talk with them about their experiences. That includes so-called “nerve sparing” robotic surgeries and supposedly less damaging external beam radiation, which are not as benign as they are often described.
Finally, if you are living with the difficulties and discomfort caused by an enlarged prostate, a condition that is much more common among men over the age of 50 than prostate cancer, you might be interested in my prostate-specific supplement, which combines ingredients shown to support a healthy prostate in clinical trials. These substances can ease prostate ailment symptoms while reducing the size of the prostate, as well.
Last Updated: August 16, 2018
Originally Published: July 30, 2013