Liberty Planet Weblog

Could Your Annual Doctor’s Visit Cause More Harm than Good? Men..say “no” to PSA tests

Posted on: June 27, 2012

By Dr. Mercola

In a startling reversal of years of pressing healthy and symptom-free men to get routine PSA prostate tests, U.S. health officials now say these tests do more harm than good.

What’s more, the United States Preventive Services Task Force (USPSTF) said they aren’t recommending the tests for men of any age.

The task force is basing its new stance on research that shows that only zero to one out of every 1,000 men who are screened would actually benefit from the exam, while many others would suffer from the side effects of unnecessary treatments, ranging from impotence to death.

Task Force Rules PSA Test Not Worth the Risk for Most Men

The prostate-specific antigen test (PSA test), analyzes your blood for prostate-specific antigen (PSA), a substance produced by your prostate gland. When higher-than-normal levels of PSA are detected, it is believed that cancer may be present, even though other factors, such as age or enlarged prostate, can also cause elevated levels. A biopsy is often recommended at that time to determine whether cancer is, in fact, present.

While public health agencies such as the American Urological Association still recommend PSA testing, in 2008 the USPSTF recommended that men over the age of 75 no longer get PSA screenings and began reviewing data to make a decision about younger men.

Their review is now complete, and after reviewing published research to measure the benefits and harms of screening for prostate cancer with PSA testing, they gave the test a “D” rating, meaning that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”

They wrote:i

“For men of any age, the USPSTF recommends that doctors and patients do not screen for prostate cancer because the potential benefits do not outweigh the harms. However, the USPSTF realizes that some men may continue requesting the PSA test and some physicians may continue offering it. The decision to start or continue screening should be an informed one that reflects an understanding of the possible benefits and harms and should respect an individual man’s preferences.”

PSA Levels Can be Elevated for Many Reasons

Many experts agree that PSA testing is unreliable at best and useless at worst for accurately diagnosing prostate cancer, because PSA levels fluctuate for a variety of reasons, one being age, which causes PSA levels to rise. According to the National Cancer Institute:

” … there is no specific normal or abnormal PSA level. In addition, various factors, such as inflammation (e.g., prostatitis), can cause a man’s PSA level to fluctuate. It is also common for PSA values to vary somewhat from laboratory to laboratory. Consequently, one abnormal PSA test result does not necessarily indicate the need for a prostate biopsy.”

However, biopsy is typically what is recommended if a PSA test comes back high. Similar to mammograms (which the USPSTF ruled were no longer necessary for women under 50), the PSA screening has a high false positive rate, and the bulk of the harm is a result of the damage done by subsequent unnecessary treatments.

There are over one million prostate cancer tissue biopsy procedures performed annually in the U.S. Approximately 25 percent of these tissue biopsies are reported “positive,” indicating the presence of prostate cancer. The remaining 75 percent are reported “negative.” One-third of the men with initial “negative” results for prostate cancer actually do have prostate cancer that was missed by the biopsy.

A prostate biopsy involves inserting fine needles into the prostate gland. But specialists have begun to worry about a recent, significant increase in the risk of complications from the procedure. In particular, they are concerned about hard-to-treat bloodstream infections that can require weeks of treatment. Over the past decade, the rate of hospital admissions in Ontario, Canada, for serious infections caused by prostate biopsy increased four-fold.

Many men also experience pain, fever, bleeding, difficulty urinating, or other serious problems following a biopsy, not to mention the worry over the procedure and its negative results. If cancer is detected through a biopsy, which reportedly occurs in about 120 cases in 1,000, surgery, radiation or hormone treatment is typically offered, and upwards of 90 percent of men will accept. This, too, is problematic because the treatment itself can lead to complications, even death, whereas prostate cancer is often very slow growing, may never become invasive, and therefore is sometimes better left untreated.

Reuters reported:

“If a biopsy finds seemingly malignant cells, as happens to 120 in 1,000 screened men, about 90 percent of men opt for surgery, radiation or hormone-deprivation therapy. Up to five men in 1,000 opting for surgery will die within a month of the operation; 10 to 70 more will have serious cardiovascular complications such as a stroke or heart attack. After radiotherapy and surgery, 200 to 300 of 1,000 men suffer incontinence, impotence or both. Hormone-deprivation therapy causes erectile dysfunction in about 400 of 1,000 men.”

Continue Reading at Mercola


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