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How to get some answers on the PSA test and prostate cancer screening

Gavin Mooney wrote in Crikey today about the frustrations of trying to get some useful answers to his questions about the merits, or otherwise, of PSA screening for prostate cancer.

Thanks heavens for the internet; in cyberspace you don’t have to rely on finding a doctor who’s up to date with the latest evidence and with the time and inclination to work out what it means for you.

This Canadian site will take you to several decision aids that have been developed to help men negotiate the PSA maze. The side bar on the Croakey homepage also links to some more info on decision aids generally.

It’ s just a shame that many of those who might most benefit from this sort of information may not have the ability to access it.

UPDATE: Here’s a report of a new study in the US re PSA screening and overdiagnosis

Comments 4

  1. Jon Hunt says:

    The difficulty in obtaining good advice about prostate cancer from doctors is that they are probably as confused as the patient. It’s confusing because the disease is different in different people. You can have a high PSA and no cancer, a normal PSA and cancer, and a normal biopsy with cancer. The cancer may be aggressive or indolent. The treatment may or may not be worse than the disease.

    A good GP or specialist should be able to counsel you regarding these allowing you to make up your mind whether you want to be screened or not. A good doctor shouldn’t tell you what to do; it’s your decision. That’s the basis of consent. If your GP or specialist hasn’t done this properly, the best thing would be to find someone who will.

  2. robert says:

    While not perfect, the PSA test along with a digital recal exam are the best tools available in the early diagnosis of prostate cancer.

    I am of the opinion that I want to know, rather than que sera sera if possible. I am one who had regular psa tests for several years, and because of a rapid rise in the PSA, was sent for other tests which revealed a fairly aggressive tumor, which was treated.

    Without the regular PSA test, the tumor would not have been found, and I would have probably had a diagnosis a couple of years down the road, and the possibility that the cancer would have spread outside of the prostate.

    I meet too many men who do not have a regular PSA test, and by the time they have symptoms, and go to find out what is causing their problem, it, in many cases results in a poor diagnosis, few treatment options and in many cases premature death.

    Have a PSA test done on an annual basis once you reach 50. If there is a history ofe prostate issues in the family, or are of African descent, then start testing at the age of 40.

  3. Jon Hunt says:

    Robert, I am in two minds whether I should further comment or not. Anyway it appears that I am.

    The PSA test is a poor screening test with many flaws. It is nowhere near as useful as say a pap smear, or a faecal blood test. Thats why it shouldn’t be performed unless these flaws are fully explained to the patient. You mention that men who have had a diagnosis of prostate cancer would have been better off had they had the test sooner.

    Unfortunately this isn’t necessarily true. Their PSA could have been normal, or it could have already spread before it went high. No-one will ever know. If it were as simple as high PSA=earlier diagnosis and a cure you would be right, in which case everyone (male that is!) at risk should have one. But because it isn’t we suggest you discuss this with a doctor before embarking down this path because if you think this is complicated wait until the diagnosis is unclear. I hope this isn’t confusing, because this topic certainly is.

  4. robert says:

    Jon,

    You are right, the PSA test is not perfect. There are some men with low PSA who have prostate cancer, and men with high PSA and biopsy indicate no prostate cancer. The argument that one should not have REGULAR PSA tests because of potential false positive or false negative is, in my opinion, flawed.

    What many suggest is to ignore the potential benefits of PSA testing, and live in blissful ignorance. That is not for me. Certainly no one should automatically count on cancer with a high PSA, but again I am of the mind that I would rather investigate the cause of a higher PSA than the alternative which is know nothing, do nothing.

    This controversy may be mute in a few years as I have read of new more accurate tests coming, but in the meantime, check your PSA annually in combination with a digital rectal exam.

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