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Here’s why you may NOT want to do a PSA

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It’s Men’s Health Week

So you’ll probably be getting all the information about why you should go for a “Prostate test” or PSA….but most people don’t tell you why you may decide, that  you do  not wish to do this. There is no right or wrong answer. Be warned: This is controversial. It’s controversial because doctors don’t always agree on the right answers!

The PSA or Prostate Specific Antigen is released by the prostate.  The prostate continues to grow as men get older. The bigger the prostate the higher the PSA…and the PSA cannot differentiate between non cancerous and cancerous growth.

So let’s say you have no symptoms but you decide to be good and go for your PSA. Maybe your PSA is high. No one really knows what that means so it then means you have a biopsy of your prostate. That isn’t just a harmless test. It carries a risk of sepsis,  risk of hospitalisation and a risk of incontinence.

Maybe you decide to risk it and you go ahead and have the biopsy without any ill effects.

Then you get your result: It’s cancer. Now what to do? “What do you mean what to do?” I hear you ask. “It’s cancer, I need treatment!” you cry. Well wait, not necessarily. You see some prostate cancer is aggressive and can definitely kill you, but some  prostate cancers are so slow growing, that had you not gone looking for it, you never would have found it and you would have died from something else before you even knew you had it. The problem is that we find it hard to tell the difference. In fact there was a study done on men over 75 who were having autopsies because they died of other causes. These men were not known to have prostate cancer. However something like 75% of them DID have prostate cancer at autopsy. But they didn’t know it….and something else killed them first.

So some men end up having something called “watchful waiting” where they just get monitored for years until they do die from something else, all while having the grim knowledge that they have the dreaded “C” hanging over them. Others, with medical advice, may decide to have treatment. That could be surgery, radiotherapy, hormone therapy etc. All of these treatments can cause impotence and incontinence as a side effect.

The upshot is that research has shown that PSA screening for prostate cancer, has not unfortunately led to a decrease in Prostate cancer mortality. This is not the case with other types of screening for other cancers like the pap or cervical smear for cervical cancer or the colonoscopy for bowel cancer. I am not saying that Prostate cancer can’t kill you. We all know someone who has died from prostate cancer… what I am saying is that it DOESN’T kill a lot of other people and that PSA screening isn’t so good at saving lives. Also, I have heard Caribbean doctors say that men of Afro Caribbean decent are more likely to have aggressive prostate cancer than white men. Well yes, this is indeed unfortunately true. So if if you are of afro Caribbean decent and you have a family history of prostate cancer you should definitely take that into consideration when making your decision. But not all Trinidadians and Tobogonians are of afro Caribbean decent. Also, some men may not want to know they have the Big “C” and others definitely would want to know. We are all different!

I wish we had a better test. Now, special MRIs can help us make better decisions. but it’s still not such a simple choice after all. So much so that the international recommendations are not to routinely and blindly do a PSA test but to instead counsel our patients so that hey can make an informed decision….Note the words. I did not say “Do not have a PSA” I simply want to inform you of the potential harms/benefits so that you can make a choice, instead of blindly ticking the PSA box on your blood test form or Executive Medical because you are over 50. Please note that this is different if you have symptoms of Prostate problems. (See picture below). If you do, then it might be helpful to have a PSA and a digital rectal examination. That is not the same as screening. Screening is when tests are done in people WITHOUT symptoms.

“Well that’s helpful Doctor. Thanks. What am I supposed to do now?” I am sorry I can’t answer that for you. But, at least I am not pretending I have all the answers and that there is no harm in a test! 

What I definitely DO RECOMMEND you do is that you do not smoke, only drink alcohol in moderation and have lots of (protected) sex. What?! Yes. studies have shown that ejaculation protects against prostate cancer!

As for the tests: Get a colonoscopy from age 50  to screen for colon cancer – That one really DOES save lives. Also get screened for an Abdominal Aortic Aneurysm, from age 65…Iook out for your invitation coming soon to your inbox if you are a Male aged 65 or over!

For more helpful information on PSA testing click on the link below.

https://www.nhs.uk/conditions/prostate-cancer/psa-testing/