The United States Preventative Services Task Force (USPSTF) has made a final recommendation against prostate specific antigen-based screening (PSA) for healthy men based on a belief that "the harms outweigh the benefits."
Had I followed that recommendation a few years ago -- at the age of 44 -- I'd likely be dead today.
So consider this my personal PSA (public service announcement) about PSA screenings.
Ironically, my life-saving PSA blood test was done by mistake. My doctor didn't even include it on my list of blood work for my routine, annual physical. Call it a lab mistake or divine intervention, but my blood tests came back revealing that I had an elevated PSA.
Concerned that it was a lab mistake, my physician suggested that we rerun my blood tests. I agreed and within a few days new results concurred that I had an elevated PSA. I then began working with a specialist who explained that a high PSA by itself does not suggest the presence of cancer. The elevated number could mean, among other things, an enlarged prostate gland or an infection. So we put in place a plan to commence regular monitoring of my PSA.
Over the ensuing six months my PSA did, in fact, rise. That led to a series of biopsies that ultimately revealed malignancy in my prostate. I had surgery to remove my prostate gland and subsequent follow-up therapy. My post-surgery pathology report revealed a fast-growing cancer that had already taken over nearly half of my prostate gland.
At the time of my surgery, I had no symptoms and would have never suspected that I had a life-threatening, cancerous tumor taking up residency in my prostate and surrounding neighborhood. Without that accidental PSA, my medical team concurs that I would likely have had experienced a different outcome.
And my three children, who I am raising alone, would have lost their father.
The USPSTF report, in the Annals of Internal Medicine, states:
"Many men are being subjected to the harms of treatment of prostate cancer that will never become symptomatic. There is convincing evidence that PSA-based screening for prostate cancer results in considerable over treatment."
I'm personally concerned that this language is easy to misinterpret. I am specifically concerned that men may believe that the PSA test, itself, can cause side effects.
PSA-based screening is a simple blood test that provides physicians insight into potential problems associated with a man's prostate. The PSA test, to my knowledge, is no riskier than any other blood test. More simply put: A PSA test does not cause impotence or incontinence -- the commonly-known side effects associated with surgery to remove a prostate.
Why would a man opt to not have a simple blood test that could reveal some potential life-saving information about his prostate?
You can add my small voice to that group.
The advice I give my friends is simple: First, if you have a history of prostate cancer in your family, develop a monitoring plan with your physician when you are a young man. If you do not have a history of prostate cancer in your family, talk to your doctor about when might be a good time to get a baseline PSA. Personally, I'd start it at the age of 40.
And if you ever find yourself with a high or rising PSA, you have plenty of options to explore with your physician. That is the overall moral to this story, men. Please do not dismiss the value of a PSA test as a diagnostic tool.
Talk to your physician. Develop a plan. And follow through whatever is right for you.
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