The PSA Test...Still Controversial?

No major scientific or medical groups (including The American Cancer Society) recommend routine testing for prostate cancer at this time. These groups (too many to list here) have concluded that studies completed so far do not provide enough evidence to know whether the benefits for testing for early prostate cancer outweigh the possible risks. (ACS: Can Prostate Cancer be Found Early?)

 

Many frequent Forum readers and contributors are familiar with the above statement. It is not new. Still, it angers many, including me. The American Cancer Society and other organizations recommend "that health care professionals offer the option for testing for early detection of prostate cancer to all men who are at least 50 years old (or younger if at high risk)." Simply put, the PSA test is not included in any of the standard blood tests. It is not considered all that reliable. There is no "magic" number, such as 4.0, that is guaranteed to detect prostate cancer. And it is not recommended before the age of 50.

In a July, 2003 issue, The New England Journal of Medicine goes on to say, "If the threshold PSA value for undergoing biopsy were set at 4.1, 82 percent of cancers in younger men and 65 percent of cancers in older men would be missed. Dr. Peter Scardino in his Prostate Book goes on to say"...in 70 to 80 percent of cases, an elevated PSA that triggers a biopsy uncovers no evidence of cancer...20 percent of existing prostate cancers would be missed if doctors relied on PSA results alone."

Now it is easy to cherry-pick quotes knocking the PSA test. But what is the answer? Dr. Scardino continues: "The PSA test properly used remains the best indicator of a cancer's presence." Doctors have to learn how to interput the test. Dr.Scardino goes on to talk about PSA velocity, (the rate or speed of PSA rise or doubling time). "If a PSA level increases more than 0.75 nanograms per milleter per year, there's an increased risk of finding cancer.

This is practical, but how about the man with a low PSA taking his first PSA test? What number do we use to measure against?

Dr. H. Ballentine Carter MD and Professor of Urology at Johns Hopkins Brady Urilogical Institute says the key is to look beyond the cutoff numbers and establish a baseline at a younger age. "Test when the other confounding benign conditions (like BPH which cause PSA to rise) do not exist...about 35 to 40 years of age. This will provide a baseline upon which other measurements of PSA can be compared for the rest of the patient's life. Change for PSA over time is the most valuable tool we have for interperting the PSA.

This year, 234,460 men in the United States will be diagnosed with prostate cancer. about 30,000 will die of it. Source: American Cancer Society

So why should anyone still want a PSA test? Well Dr. Patrick Walsh in his book, Guide To Surviving Prostate Cancer, may have the strongest and most compelling quote of all, "Because it is saving lives." I know it saved my life. How about yours?

Best Wishes,

Vet

Age: 55

Diag: 12/03/05, Biopsy, Gleason 10

Hormone Therapy: 12/15/05

PSA: 5.7

Surgery: 02/14/06

EBRT: May thru July '06

Current PSA .03, 09/21/07

Diag: T3b Seminal Visicle Involvement, Gleason 9 both lobes

Post Edited (veteran1) : 12/6/2007 2:40:29 PM (GMT-7)

My PCP let my PSA go from 4 in 1988 to 10 in 2007, and still did not send me for a biopsy, becouse he could not feel anything with the finger wave. Yet when I could not get a Insurance Company to issue a new life policy due to the hight PSA reading, I refered myself for the biopsy. End result, my prostste was 65% full of cancer, and only due to a miricle, it had not spread. The PSA test may not be 100% accurate, it sure saved my life!

Beachbum

Thanks Veteran for your comments.

There  are many misunderstandings about the usefulness of both psa  and  testing  with psa.  For the most authoritive explanation of these misunderstandings, I recommend a booklet called HORMONE BALANCE  FOR MEN, by John R Lee M.D.  Dr. Lee does a remarkable job of clarifying what men  need to know about prostate cancer and PSA, and he backs it up with ample references to scientific studies. In a nutshell, what Dr. Lee explains are the two biggest fallacies in mainstream medical thinking regarding prostate cancer, which are 1) that it is beneficial to lower the PSA count as an integral aspect of treatment,and 2) that blocking testosterone will inhibit the growth of prostate cancer. One  of the most important concepts you will learn from Dr. Lee"s booklet, that even your doctor may not understand, is that when normal healthy cells of the prostate gland produce PSA it is simply in response to crowding ( or pressure). For instance, an infection on any type of inflamation in the prostate gland generally cause a rise in a man's PSA production because the swelling causes pressure or crowding of the normal cells. Even manually massaging the prostate gland will often cause a rise in PSA producton for the same reason. This PSA rise is the body's way to try to reduce this infection or inflamation, and indeed it has now been proven that the PSA itself is "ANTI-ANGIOGENIC" ,which is a process that  inhibits the growth of new blood vessels to the tumor. So with this understanding,---it is clear that a man with prostate cancer would NOT WANT to artificially lower his PSA production through the use of hormone blocking drugs. Remember , if you have cancer anti-angiogenesis is always A GOOD THING.

Fallacy number two is that blocking testosterone will inhibit the growth  of prostate cancer.  In HORMONE BALANCE FOR MEN, Dr Lee goes into detail about how this medical fallacy got started, and also presents ample scientific evidence that proves this idea is   indeed a fallacy. Common sense points out the fact that prostate cancer is almost non-existant  in younger men,---AT A POINT WHERE THEIR TESTOSTERONE IS THE HIGHEST. You would think  that if testosterone does indeed feed the prostate cancer, then we would have always seen the highest rates of this type of cancer in younger men.

As I said earlier, PSA has anti-angiogenic properties,so a man really doesn't want his PSA production reduced.  Moreover, testosterone  has the ability to oppose estrogen in the body.  Men's bodies make estrogen too, though not as much as women's bodies.  When a man's testosterone level is artificially reduced through the use  of testosterone blocking drugs,---THAT ALLOWS A DANGEROUS SHIFT IN HORMONE BALANCE TO OCCUR,---a shift Dr Lee calls "estrogen dominance" Men can feel and see this shift take place when they take Lupron, Casodex, or other testosterone blockingdrugs,-as they experience enlarged or tender breasts and other syptoms of estrogen dominance.  THIS IS A VERYDANGEROUS SHIFT TO ALLOW TO HAPPEN BECAUSE ESTROGEN DOMINANCE IS LIKELY TO PROMOTE THE GROWTH OF CANCER IN THE BODY.

In a nutshell, conventional doctors THINK they are reducig prostate cancer growth by blocking testosterone and artificially lowering PSA count.  But what they are really doing by employing testosterone -blocking drugs is simply reducing the production of PSA in a cancer patient whose body is producing PSA as a defense agaist the cancer.  This way  of reducing the PSA has no correlation to a reduction in the man's cancer, and the resulting  ESTROGEN DOMINANCE that occurs when testosterone is blocked COULD ACTUALLY PROMOTE THE GROWTH OF CANCER.  Thus the use of testosterone blocking drug for prostate cancer is an extremely dangerous practice,---because it may PROMOTE the cancer growth  in two ways, 1) BY REDUCING THE BODY'S ABILITY  TO PRODUCE PSA THAT IS ANTI-ANGIOGENIC, and  2) BY PROMOTING ESTROGEN DOMINANCE.

iT MAY BE TIME FOR MEN WITH PROSTATE CANCER TO JUST SAY NO TO HORMONE-BLOCKING DRUGS, AND IT MAY ALSO BE TIME FOR A FAIR EVALUATION OF THE TRUE EFFECTIVENESS OF CONVENTIONAL PROSTATE TREATMENT VERSUS THE LATEST THE MORE PROGRESSIVE STUDIES  .

Siberian

age 68, T1c gleason 3+3=6, prostate 66cc, 3 positive out of 13

Scheduling surgery Feb 2008

The question is, what else is there? I believe there is a urinary test under development but I am not sure it is approved, widely available or mot importantly approved by insurance companies.

Good post Vet...
You are preaching to the choir with me. Have a look at my stats and age. The only logical explaination is that the ACS and the insurance companies don't want the added expense. That's my rant.

Tony

Siberian,

So, how would Lee's theory play out with a man who is lean, has a PSA of 20, a testosterone level of say, 600, prostate size of 25gms and an estradiol of 12?
Thems scarey stats when looking at that PSA.

Be well, Swim

Siberian,

Dr Lee has been dead for years. His research was not only incomplete, it may not actually be water tight. While I do believe whole heartedly in hormone harmony, studies say normal testosterone levels in the presence of lymph positive cancer (untreated) may cause a rapid progression for some patients. I'm sticking with the reliability of the PSA until something better comes along. The free PSA is one of our promising early indicators and the serum PSA is absolutely our best post treatment test available. Keeping belly fat down is health wise, cancer or no cancer.

PSSS: Paul did indeed use 2 mgs / day of progesterone cream for quite some time. His cancer / PSA did not progress from diagnosis to treatment. Of course he had a very low testosterone level at the time too. I'm not opposed. I'm simply concerned progesterone is going to do harm to some. DIM or Indole Carbinol 3 / DIM might be the better choice. Who knows? Good luck with surgery soon by the way :>)

Vickie

veteran and swimmon

The reports that i read were studies done at Sloan-Kettering. and Baylor University Hospital.  I also read them in a JAMA report. There was another study out of Johns hopkins, also.  Dr Lee has been dead 3 years, but he was a preeminent doctor in Hormone replacement, and a pioneer in the use of progesterone. The  Johns-Hopkins report was  on web page http://www.sciencedaily.com/releases/2007/10/071001081614.htm. Other information was from the National Cancer Institute. I am only putting this information in the forum, for everyone to view, as additional  background on the different opinions held by the leading prostate cancer researchers.  While I myself have not made up my mind onwhat I would believe to be correct,----I am paying close attention to studies out there that believe there should be a balance in the body of the major hormones,such as insulin, progesterone, estrogen, and testosterone,---and that when this balance is disturbed,--THAT YOU MAY HAVE THE PROMOTION OF PROSTATE CANCER.

Siberian                                                                                                                                                                                                                       

PSA saves in my opionion Vet. Until there is a better way, it's gonna stay the PSA!!!!

1. The PSA is most useful as a post treatment tool..especially following surgery.
2. Velosity is important...marks a trend.
3. PSA testing should begin at 40, earlier with a history.
4. Yeah, why isn't the PSA standard blood work in adults anyway?
5. Free PSA is a useful tool during investigational phase (when a man's PSA is found elevated).

Swim

Hi Vet,

Good post. From my point of view, if my husband had gotten his taken yearly, as he should have, he might not in the situation he's now in. So, it is what it is...not perfect but it can be a life saver.

Bless you Vet,
Susan

Great information here, thanks, 1 item not covered about PSA being lower one time than the one before.
My Uro asked me not to have intercourse for two days before a PSA test. He said that ejaculation would
cause a rise in PSA and could give a false reading. If you look at my stats you can see that it was PSA
tests that have saved my life for a while. I think most of us here agree that it is the best test we have
at this time and I for one am sure glad it was available. My biggest concern is, it is not made available to
those in their 30's and 40's because the family doctors or primary physicians are not aware of how much
it can help and I think a lot of them think that a PSA of 4.0 is OK. Thanks for all the good info. Uncle Dan