The United States Preventative Services Task Force has done it again. They have made the absurd claim that men should not be checking routine PSA levels. This recommendation is on the heels of recommendation against mammography for under 50s. What’s up? Doesn’t routine PSA testing save lives?
I think I need to start this with a quick story. Last week I had a 52 year old patient who confided in me that he was diagnosed with prostate cancer 2 months ago. They plan on doing the daVinci robotic surgery in the next 6 or 7 months. The outcomes for these are generally good, but impotence is on the list of potential side effects.
Here’s the problem. He was completely unaware that prostate cancer was anything but luck of the draw. He’s not alone. Luckily, there are many things he can begin to implement in his lifestyle to change his trajectory. Who knows–maybe if his PSA changes in the next 6 months the surgery can be avoided.
Back to the USPSTF PSA screening recommendations.
Over 5 years ago we already had research strongly suggesting that PSA and DRE testing does not save lives. Obviously this research was brushed under the rug because and actually seems to have fueled an opposite reaction–I hear more of a push for men to get screened for prostate cancer then ever before. I don’t remember large POP (prostate on-site project) events or billboards promoting DREs a few years ago.
The problems with prostate PSA screening are much the same as those with mammography. (If you’d like the opinion of the doctor who first identified PSA, read more here)
First, prostate specific antigen (PSA), is not actually specific to cancer. Other factors like heavy exercise, prostatitis, BPH, age, large prostate volume and sexual activity can lead to elevated PSA. Some temporary, some permanant. Because of this, there is a heavy variation in what “normal” is. To confuse this issue, a little over 1/3 of prostate cancers have PSA levels within the “normal” range. This means that setting a value as “elevated” is going to catch a percentage of men who do not have prostate cancer and miss a large number of cases of prostate cancer. This weakens the value of the testing.
Next, prostate cancer, by its nature, has a tendency to be slow growing. Because of this, many die with prostate cancer, not of prostate cancer. Many procedures are done as a result of PSA testing. These include surgery, biopsies, chemotherapy and radiation implants. So what happens when these procedures are done because of an elevated PSA due to non-cancer causes or procedures are done on slow growing cancers that would not have caused significant problems? The society costs are dramatic and result in no true life extension. If sure is easy to make it look like treatment is powerful at saving lives when the life was not at risk in the first place.
Third, and most importantly, PSA testing does not seem to trigger an educational process for the patient to lower their risk of progression. The factors that play a role in prostate cancer prevention are the same that can help with treatment. These include:
- Increase your intake of non-GMO, unprocessed soy products (tofu, miso, soy milk, edemame)
- Increase your intake of the omega-3 fatty acid ALA (pumpkin, flax, walnuts)
- Avoid dairy products
- If you drink juice, stick with darker juices like pomegrante and cherry
- Increase your intake of cruciferous veggies (broccoli, cauliflower, radish, bok choy, brussels sprouts)
- Add Vitamin E in the mixed tocopherol form (NOT just alpha-tocopherol)
- Increase intake of the red carotenoid lycopene (tomotos, grapefruit, watermelon)
- Cut back on your calories
- Avoid BPA in plastic water bottles and many canned goods
- Maintain an anti-diabetic lifestyle and maintain an ideal body weight
- Take a vitamin D supplement
So overall, there are many things we can do to lower our risk of prostate cancer. As always, I am not against cancer screening. I am, however, very strongly against using cancer screening as prevention. With all this knowledge about how to prevent prostate cancer, we should not rely on an uncertain test like the PSA to save our lives. Makes these changes to lower your risk of prostate cancer.