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5 Ways to Prevent Unnecessary Treatment for Prostate Cancer

5 Ways to Prevent Unnecessary Treatment for Prostate Cancer

Now that the government panels and medical associations no longer recommend PSA testing, consider this: in the 1980s, before PSA testing, 50,000 men died annually from prostate cancer. In the 1990s, with PSA testing, 30,000 died annually. PSA testing saved 20,000 men each year (about 25,000 now) from slow, painful deaths from prostate cancer. And they are telling us to stop doing this test?

Prostate cancer is the second leading cause of cancer death in men. PSA testing, which measures the level of prostate-specific antigen in the blood, is our only reliable early-warning method. A PSA level above 4 ng/ml is considered high and may be a sign of prostate cancer. The problem is, PSA is nonspecific. Yet doctors often rush men with an elevated PSA to prostate biopsy. If the biopsy shows cancer, even a low-grade one, many doctors recommend aggressive surgery or radiation, with their serious long-term side effects, even when treatment isn’t really needed.

Consider: 50,000 prostatectomies are performed each year for prostate cancer, yet 40,000 of these surgeries are unnecessary. The numbers are similar for radiation therapy.

This is why mainstream medicine has retreated from routine PSA testing. Retreating into the past, meaning 25,000 additional prostate cancer deaths a year, isn’t the answer. Here is what you can do to protect yourself from undiagnosed prostate cancer as well as from overzealous doctors recommending unnecessary treatment.

1. Men over 50 should continue to get annual PSA testing. Men at greatest risk are African-Americans or those with a blood relative with prostate cancer. Begin PSA testing at 40.

2. Always get a repeat PSA. An elevated PSA does not always mean prostate cancer. Common causes of elevated PSA include an enlarged prostate or prostate infection. Orgasm within 48 hours before PSA testing can cause an elevated result. So can pressure on the prostate caused by biking or an exercise bike. Laboratory error can occur. Many doctors aren’t aware of these factors.

3. Make sure you really need a biopsy. Biopsies are important to verify that you actually have prostate cancer and to identify the aggressiveness. However, of the 1.2 million biopsies done annually in the US, half aren’t necessary. And biopsies can cause problems: 4 percent of men biopsied require hospitalization for infection or bleeding.

4. Learn about new technologies, which can help you avoid a biopsy you don’t need. The multiparametric, 3.0 Tesla MRI, now available at a handful of top medical centers, can identify suspicious areas that might warrant a biopsy. If none exist, a biopsy can be avoided. Some institutions are now using MRI to direct biopsy needles, providing a “targeted biopsy,” far more accurate than the random biopsies we do now. Color doppler ultrasound is another technique that can see into the prostate. A couple dozen doctors in the US use this method to identify areas of concern and to guide biopsy needles.

5. Educate yourself on new treatments. These diagnostic methods facilitate a spectrum of new treatments. Previously, our choices were to cut out or fry the entire prostate, or just wait and see. Now, with MRI guidance, new treatments such as cryosurgery (freezing), high-intensity focused ultrasound (heat), and focal laser ablation can be used to remove half of the prostate or to perform local treatment, like the lumpectomy some women get for localized breast cancer. The new tests also make active surveillance an effective and attractive choice for some men.

Rather than retreating from PSA testing and causing 25,000 additional deaths from prostate cancer each year, we can keep PSA testing for early warning — and also apply the new technologies we already have to avoid biopsies, surgery, and radiation treatment when they are not really needed.

 

Read more: Health, Men's Health, Testosterone, Testosterone

By Jay S. Cohen MD

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Jay S. Cohen MD

Jay S. Cohen MD is a prostate cancer survivor, faculty member at the University of California, San Diego, and author of Prostate Cancer Breakthroughs: New Tests, New Treatments, Better Options (2013). Learn more at www.MedicationSense.com. Contact: jacohen@ucsd.edu

55 comments

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10:55AM PDT on Aug 25, 2013

ty

10:54AM PDT on Aug 25, 2013

Thank you

10:52AM PDT on Aug 25, 2013

The Problem with PSA is that there can be many reasons why it is high, even such simple ones like riding a bike. But anyway I do the testing because my grandfather and my father had Prostata cancer and it is one early sign that something is wrong there.

2:36AM PDT on Aug 23, 2013

Thanks.

10:26PM PDT on Aug 20, 2013

don't believe in the doctor thing.....if I were to find out I had prostate cancer it would be huge doses of hash oil........better than radiation and or chemo.......

8:03PM PDT on Aug 20, 2013

My husband's PSA was very high. He suffered a biopsy. Not cancer. Now after taking a drug called DUODART his last PSA was way down.Unfortunately his nightly urination is worse.

12:39PM PDT on Aug 20, 2013

I'm riding a race bike (small and solid saddle) regularly, especially in summertime. My PSA value moves between 9 up to 13 for a long time, about 20 years. There were doctors who did want to take a biopsy (2-times now), but I refused. After 4 biopsy routines it is said your prostate is full of scars and seriously injured. I have an enlarged prostate, just in the nights I have to get up sometimes (toilett). But with tamsulosin (every two days a pill) the nightly interrupts could be remarkably reduced. We check the prostate twice a year, also the PSA value. Now I'm 66.

12:38PM PDT on Aug 20, 2013

thanks

8:59AM PDT on Aug 20, 2013

Our healthcare is now healthscare. Knock wood, I'm hoping to take all my junk, diseased or not, with me when I go. I haven't had a GP for longer than I can recall. After my families choice physician retired and St. E's took over everything in my State, when I go for the flu or another ailment I can't shake on my own, it's always a new guy and all of them just want to write a prescription for everything (guess they get a kickback)??. If "they" find out you have good HC coverage they find things wrong with you. Guys, hang on to your junk.....you'll be better off in most cases.

11:37PM PDT on Aug 19, 2013

Look at studies- prostrate cancer kills fewer than colon cancer.

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Disclaimer: The views expressed above are solely those of the author and may not reflect those of
Care2, Inc., its employees or advertisers.

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