Talking to Men About PSA Testing

 This applies to me just as it does to most men my age. What to do? This is similar(but some big differences to having a mammogram in women). Many of my friends have had prostatectomies, with all the problems that go with it – I know many of them did not need to have it done, but try telling that to them. They all believe it saved their lives. Read ” Mammograms” on my web-site under “Breast Screening” for the latest recommendations.

Talking to Men About PSA Testing

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My patient looked back at me with a blank stare. I had just finished my take on the pros and cons of having a PSA test, and he looked lost. “What would you do if you were me, Doc?” he said.

I had just finished explaining the decision every man faces when he turns 50: whether to be screened for prostate cancer with a prostate-specific antigen (PSA) test. The decision is still unsettled despite the results of a giant, long-term study published earlier this month in the journal The Lancet. The study did not support the use of widespread screening.

What makes the decision so tricky? It’s partly that prostate cancer is a weird cancer. Unlike cancer of the breast or the lung or the colon, which tends to kill people within five or 10 years, prostate cancer is usually slow growing. Men tend to die with it rather than of it. In fact, many live with it for 30 years or more and never even know they have it.

That said, 3 percent of men do die of prostate cancer. So if we had an easy, safe treatment for prostate cancer, it would make sense to screen everyone and treat all the cancers we found. But the main treatments for prostate cancer carry a high risk of causing urinary incontinence and erectile dysfunction.

As a result, when a man decides to be screened for prostate cancer, there’s a high risk he will sustain permanent harms from treating a cancer that he never would have known he had. And that risk is probably much higher than the chance that he will live longer because he was screened.

This complex bottom line is very hard for doctors to explain. So many doctors skip explaining it, and instead simply order PSA tests routinely, brushing off expert guidelines recommending against such routine screening.

Why is it so hard for doctors to change how they approach the test? Partly it’s because the pros and cons of PSA testing are so difficult for doctors to explain to patients. But doctors are also understandably afraid of missing cancer. What if their patient decides not to get the PSA screening test, and then later is found to have an incurable prostate cancer? Patient and doctor might look back with great remorse at a missed opportunity.

Friends’ and celebrities’ stories play a role as well. People who have been treated for prostate cancer are relieved and want to spread the word. Their stories of a life-threatening diagnosis followed by a lifesaving cure are compelling, but they gloss over the fact that the majority of those cancers didn’t need to be treated. Their stories are even more compelling next to the stories of men who opt not to be tested, men who might live happily for decades with a cancer that causes no symptoms. Those stories are not told at all, because men with those stories don’t know they have a story to tell.

In response to my own patient, who asked what I would do, I paused. I am asked that quite a bit, and it’s tough to answer, because it depends on the man, his priorities and experiences. In the end, I told him that it’s such an individualized decision, it’s a difficult one to make for someone else.

Doctors can’t make this decision for patients. We need to learn to face this issue head on and become better at helping men understand the pros and cons of PSA testing so they can make an informed decision. The alternative, continuing to automatically screen men for prostate cancer starting at age 50, is causing a lot of harm.

About Dr Colin Holloway

Gp interested in natural hormone treatment for men and women of all ages

Posted on November 24, 2014, in Uncategorized. Bookmark the permalink. Leave a comment.

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