He was sitting in his recliner, pale as snow, thinner than a scarecrow. It had only been a month since I last saw him. How could a healthy and vibrant man lose so much weight in such a short time?
It started shortly after Christmas. I got a call saying dad was sick. They had taken him to the doctor, who told them that Dad’s PSA test result was high and that the doctor had told them that he was sure that Dad had prostate cancer and that he had metastasized. He recommended biopsies of the prostate, lymph nodes, and bone. Dad had watched Mom undergo chemotherapy and radiation therapy when she had breast cancer. Dad wanted nothing to do with medical cancer treatments. In fact, he refused medical attention, including further tests to determine if he really did have cancer.
But, in dad’s mind, he believed the doctor that he had cancer and that it had spread. The family also believed the doctor. Everyone’s life was turned upside down due to a test and a doctor’s interpretation.
Little did they know that the PSA test has been shown to be an inaccurate test for prostate cancer.
The PSA test stands for Prostate Specific Antigen. It was promoted for use as a tool to detect prostate cancer in 1987. The theory behind the test was that the prostate releases the antigen into the bloodstream. In those with prostate cancer, the prostate would release more PSA, in theory.
However, with more studies, it was determined that too many people with elevated PSA tests did not have cancer. In a study of 1 million men with elevated PSA levels, 75% of these men did not have prostate cancer when biopsied.
The large number of false positives has led clinicians and researchers to reconsider the use of the PSA test as a diagnostic tool for prostate cancer and to rethink its recommendations. Dr. Thomas Stamey, professor of urology at Stanford University, stated that “high PSA levels are signs of an enlarged prostate and are of no value as diagnostic tools for cancer” (prostatecancer.about.com). Dr. Stamey had been the leading urology specialist who pushed for the PSA test to be available for prostate cancer screening in 1987.
In addition, it is not clear whether the use of the PSA test outweighs the risks of follow-up diagnostic tests, such as biopsies, which can lead to infection, impotence, and urinary incontinence.
Since the beginning of the PSA test to detect prostate cancer, 14 causes have been found to raise PSA levels:
1. Enlarged prostate (called benign prostatic hypertrophy, BPH)
2. Urinary tract infections
3. Stones in the prostate
4. The presence of genetic variation: a single nucleotide polymorphism
5. Vigorous prostate massage
6. Aging
7. Infection inside the body
8. Infection or inflammation of the prostate
9. Sexual activity within 5 days of the test, including masturbation.
10. career
11. A recent cystoscopy (a medical test in which an endoscope is inserted through the canal of the penis to view the bladder)
12. Large doses of some drugs used to treat cancer
13. Rough handling, contamination or improper refrigeration of the blood sample
14. Prostate cancer
Because the most common cause of an elevated PSA test is an infected prostate gland, the new protocols for an elevated PSA are to put the man on 2-4 weeks of antibiotics and then recheck the test to see if it went down. The new recommendations indicate that most men with elevated PSAs responded favorably to antibiotics, even those with extremely high PSA readings.
Although the higher the PSA reading, the greater the indication that cancer may be present, Dr. David Bostwick, a professor of pathology at Mayo Clinic, cautions men to remember that even an extremely high PSA does not necessarily mean cancer; it could be a serious prostate infection or an enlarged prostate gland.
It is also a new protocol to watch for changes in the PSA level, that a PSA reading may not be indicative of cancer. If a person’s PSA level changes by more than 2 points in 12 months, there is a greater indication that the person may have cancer and a biopsy may be warranted for further diagnosis. Still, biopsies are recommended only after antibiotics are given and after looking at PSA changes. Biopsies are expensive, painful, and not always accurate; And they have their own complications.
Too many men have suffered emotional distress and invasive medical procedures due to an elevated PSA reading. Men should be informed of the new protocols for an elevated PSA. According to Dr. Isadore Rosenfeld, “America’s Most Trusted Physician,” prostate cancer is very slow growing. If you are diagnosed with an elevated PSA level, waiting 4 weeks while taking antibiotics will not cause the cancer to grow quickly, if you have cancer. But taking antibiotics for 4 weeks can lower your PSA levels and lessen any symptoms you have. When the cancer is not treated, it usually takes 7 to 15 years to spread beyond the prostate gland. Also, with prostate cancer, a man rarely has any symptoms that something is wrong. Prostate cancer remains silent until the late stages. If a man has symptoms, such as urinary frequency or pain, he is more likely to have an infection or an enlarged prostate, not cancer.
It is possible that dad really has prostate cancer. Without further testing, we may never know. But Daddy believes it, and as long as Daddy believes it, his body will respond accordingly. Dad will continue to lose weight, tired and sad at not being able to attend his son’s wedding or his granddaughter’s graduation. The moment the thought of cancer entered his head and he believed it, he was destined to die from the ideation of cancer.
If 75% of 1 million men with elevated PSA levels did not have prostate cancer (in the study), imagine how many men were told about elevated PSA levels each day, and how many of them were told says they have cancer based on that. test That’s too many men. The thought of cancer is devastating to everyone emotionally connected to the person with the diagnosis. An elevated PSA test no longer automatically means cancer. Always get a second opinion. And always remember the new protocols put in place by university hospitals – it could save your life.
Information about those who have studied PSA and prostate cancer
David Bostwick, MD, is a pathologist and professor of pathology at the Mayo Clinic in Rochester, MN, who has spent more than 17 years studying prostate cancer and its origins. He is the author of more than 200 scientific articles on the subject.
Harry Fisch, MD, is the director of the Male Reproductive Center and directs urologic microsurgery in the Department of Urology at New York Presbyterian Hospital Columbia University Medical Center in New York City. He is also a professor of clinical urology at Columbia University.
Thayne Larson, MD, trained at the Mayo Clinic in Rochester, MN. He is now a consultant in urology at the Mayo Clinic in Scottsdale, AZ and an assistant professor at the Mayo Clinic in Rochester. In his 9 years of practice he has treated hundreds of men with prostate cancer.
Gregory MacLennan, MD, is board certified in both urology and anatomic pathology. He practiced urologic surgery for 11 years in North Dakota and has treated many men with prostate cancer.
Isadore Rosenfeld, MD, is a bestselling author of 9 books, including Dr. Rosenfelds Guide to Alternative Medicine. He is a Distinguished Faculty Member at New York Presbyterian Hospital/Cornell University Weill Medical College and is an Associate Physician at New York Presbyterian Hospital and Memorial Sloan-Kettering Cancer Center.
