Alternative healthcare pioneer, Dr William Campbell Douglass has never been a fan of PSA tests or their follow-up biopsies. According to Dr. Douglass PSA Tests and prostate biopsies are the mainstream’s typical slash-and-burn approach to prostate cancer.
A 2003 editorial in the British Medical Journal put it another way: “At present the one certainty about PSA testing is that it causes harm.”
Hold your horses
Last week, I told you how every man is likely to have his PSA levels tested at some point after the age of 40.
However, it’s not the PSA test itself that causes harm. It’s the reaction to the test.
When your test shows that your PSA levels are elevated, many doctors will recommend a prostate biopsy – a painful procedure that involves a thin needle being inserted through the rectum (transrectal biopsy), through the urethra, or through the area between the anus and scrotum (perineum), to remove small samples of prostate tissue to be examined under a microscope.
Needless to say this can result in numerous unpleasant side effects ranging from infections to impotence. What makes matters even worse is all of this can be avoided simply because the results of one single PSA test are very likely to be unreliable.
In a study from the Memorial Sloan-Kettering Cancer Centre in New York City, US researchers examined fluctuations in PSA levels to test the reliability of a single PSA result.
Over a 4-year period, the Sloan-Kettering team collected five blood samples each from nearly 1,000 men whose median age was 62 years. More than 20 per cent of the subjects were found to have PSA levels high enough that many doctors would have recommended a biopsy. Half of those men, however, had follow-up tests with normal PSA levels.
The Sloan-Kettering team concluded that an isolated PSA screening with an elevated level should be followed with an additional screening several weeks later before proceeding with further testing or a biopsy.
This research backs up another study in which doctors at the Fred Hutchinson Cancer Research Centre (FHCRC) in the US estimated that PSA screening may result in a prostate cancer over-diagnosis rate of more than 40 per cent.
Now the latest study, published in the Journal of Clinical Oncology, shows how “watchful waiting” or “active surveillance” is not only a good idea after your first PSA test results but even after a prostate cancer diagnosis.
In this long-term study of 1,268 older men, who were all diagnosed with low-risk prostate cancer and followed with active surveillance, less than a third of the patients eventually needed treatment. In fact, only 2 of the participants died of their cancer during the 18-year study.
Of the two men who died of prostate cancer, both were originally diagnosed with very low-risk cancer and one of them died within 15 months of diagnosis. The other died 16 years after diagnosis, with a prostate tumour that was distinct from the one originally diagnosed.
The researchers added that some prostate cancers need to be treated on diagnosis, but older men with small, slow-growing cancers may die of other causes – often heart disease – before their prostate cancer shortens their lifespan.
Lead researcher, Dr. H. Ballentine Carter of Johns Hopkins Hospital in Baltimore said: “It’s extremely unlikely someone (meeting low-risk) criteria is going to be diagnosed with a cancer that is ultimately going to kill them.”
He added that for men with very low-risk cancers “the first thing you should be asking is not which treatment, but do I need treatment at all.”
As part of active surveillance, the men had twice-yearly rectal examinations and blood tests for prostate specific antigen (PSA). There is now considerable evidence suggesting that, not only does active surveillance appear to be safe, but based on the latest study results it is incredibly safe for certain individuals.
I guess the challenge is now to teach doctors how to identify which patients are less likely to be at risk.
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Disclaimer: Bear in mind the material contained in this article is provided for information purposes only. We are not addressing anyone’s personal situation. Please consult with your own physician before acting on any recommendations contained herein.
Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer, published August 2015, American Society of Clinical Oncology
PROSTATE CANCER, SCREENING FOR PROSTATE CANCER, published online, mskcc.org
Overdiagnosis Due to Prostate-Specific Antigen Screening: Lessons From U.S. Prostate Cancer Incidence Trends, JNCI J Natl Cancer Inst (2002) 94 (13): 981-990. doi: 10.1093/jnci/94.13.981
Can Fiber Help Protect Against Cancer?, published online, webmd.com
International journal of cancer. Journal international du cancer 2005; 113(5): 835-40