Going on high alert
P – S – A
Men, when you hear your doctor say those three letters, it’s time to go on high alert. Because when PSA rises, some doctors get crazy ideas.
And it’s up to you to put on the brakes.
Just doesn’t add up
To be fair, doctors are only going by the book. Unfortunately, the book is junk.
Here’s the problem…
Let’s say your digital rectal exam (DRE) indicates no enlargement of your prostate. In addition, your level of prostate-specific antigen (PSA) is low. (As you’re probably aware, high PSA is a cancer red flag–but more on that in a moment).
So–you’ve got a low PSA, a good DRE–you’re good to go, right?
If your PSA starts rising, two organizations (the National Comprehensive Cancer Network and the American Urological Association) recommend a biopsy, even when your highest PSA level is still considered low.
Now your doctor may figure, “Who am I to argue with the hallowed scholars of NCCN and AUA?” And you might figure the same.
But a new study from Memorial Sloan-Kettering Cancer Center warns, “Don’t buy it!”
In more than 5,500 men with low PSA, researchers measured PSA every year for seven years. PSA velocity (the rate of change from one year to the next) was compared to frequency of biopsies.
Result: Upward velocity was an ineffective marker for cancer, resulting in far too many unnecessary biopsies. Velocity was also completely ineffective in revealing aggressive forms of prostate cancer.
The researchers concluded that PSA velocity should not be used as a basis for biopsy in otherwise healthy men.
Finally, a sane recommendation. After all, cancer is just one of the factors that can cause PSA to rise rapidly. If you have sex just prior to your blood test, you’ll raise your PSA. Infection of the prostate or bladder can also spike PSA. Even riding a bicycle before a blood test can boost your level!
In addition, different labs test PSA in different ways, producing different results.
And let’s be honest: Prostate biopsies are grueling, with potential side effects such as bleeding and infection. So you DO NOT want to submit to one casually. And we can now count PSA velocity as a casual basis for a biopsy, especially if other factors indicate that your prostate is healthy.
But you’re still not quite out of the woods.
The Sloan-Kettering study only addressed biopsies. The S-K team didn’t mention that when PSA rises, some doctors skip the biopsy and as a precaution prescribe a class of prostate cancer drug known as GnRH agonists. Brand names include Lupron, Zoladex, and Trelstar.
But late last year, the FDA warned that GnRH agonist drugs are linked with increased risk of diabetes and heart disease.
In other words, this “precaution” could be a killer.
So gentlemen, don’t assume your doctor has heard about the FDA warning or has read the S-K study. When he starts talking about your PSA, NEVER agree to any treatment or biopsy without discussing these concerns and warnings with him first.
“An Empirical Evaluation of Guidelines on Prostate-specific Antigen Velocity in Prostate Cancer Detection” Journal of the National Cancer Institute, Published online ahead of print, 2/24/11, jnci.oxfordjournals.org
“Prostate Guideline Causes Many Needless Biopsies, Study Says” Nicholas Bakalar, New York Times, 2/17/11, nytimes.com
“GnRH Agonist Warning Restates the Facts” Charles Bankhead, MedPage Today, 10/28/10, medpagetoday.com