Prostate Cancer and the PSA Test

I am not a physician and you should consult your physician about any medical decisions that you make.

The handling of prostate cancer is a confusing area of medicine for many men.
Prostate cancer is one of the most common cancers in men. It will affect about 1 in 6 men. In the US in 2008 there were about 185,000 new cases diagnosed and about 29000 deaths.

The diagnosis of prostate starts with two simple and inexpensive tests, a digital rectum exam or DRE test and a PSA (Prostate Specific Antigen) blood test. Generally the PSA test will indicate the possibility of cancer before the DRE test. Neither test definitely identifies prostate cancer, for that a biopsy is required, which is a more expensive and more involved procedure. If cancer is found, treatment options include surgery to remove the prostate and radiation. Both are major procedures and can result in complications. With surgery, if the cancer is confined to the prostate and if the surgery removes all of the prostate material, then the patient should not have to worry about prostate cancer again. A third option is called "watchful waiting" which involves doing nothing major but following up with regular exams to monitor the spread of the cancer and perhaps changes in diet and taking supplements.

On one hand you might think, have the tests annually and if a biopsy is indicated, have it, and if cancer is found, treat it. Seems simple enough. Many men follow that path. However prostate cancer can be very slow growing so many or most of these men were treated for something that will never affect them.

There were some recent studies published on the PSA test. In the US study 77000 men were split into two groups, one got the PSA test and the other did not. While more cancers were found and treated in the first group, the men in that group did not live longer. A European study found it took screening 1,410 men and to treating 48 to prevent one death.

Prostate cancer is usually slow growing. However it can be aggressive. And there does not seem to be a way to identify the aggressive cancers.

I think that right now there are no right or wrong answers. The choice you make depends on your physical and psychological make up. If you are elderly or have an expected short life expentency, why be tested at all. I have a friend who is a retired medical doctor with diabetes. His view is that the diabetes will get him before the cancer, so he is not tested.

You might chose to forego the PSA test. Based on the European study that would mean that 1410 men would be spared a biopsy, and 47 would avoid treatment. However one would die. If you can live with yourself taking the chance, why not? Of course, many can not.

If you are found to have cancer, them maybe "watchful waiting" should be given more serious consdideration. I have a friend who has been "watching" for 8 years or so and he is doing fine. However, if you are "waiting" and the cancer gets out of the prostate then you face much more difficult treatment and perhaps death.

In my opinion the one thing that is clear is that a man should not panic if his PSA indicates the need for a biopsy nor should he panic if the biopsy says prostate cancer. Time is clearly not the enemy and he should gather as much information as he can about his situation before making a treatment decision.