Put away the panic button
A friend of mine recently called and said he had a question for me, but I had to promise not to tell his wife because he didn’t want to worry her.
He said his doctor had just phoned, and his PSA level was up.
And his doctor recommended a biopsy.
I’ve know Craig for years, which is why he doesn’t mind calling and talking about his prostate. And am I ever glad he was comfortable enough to call.
Turns out, this is only his second PSA test. And his PSA isn’t even high — all it did was go up. And based on that — and ONLY that — his doctor wants to stick a needle in his prostate to test for cancer.
I had just three words for Craig: Really BAD idea.
Men, as a rule of thumb, when you hear your doctor start talking about PSA, 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.
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 recent study from Memorial Sloan-Kettering Cancer Center offers a clear warning about hasty decisions based on PSA.
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.
The result was surprising and overturned a lot of what we thought we knew about PSA levels. Upward velocity was an ineffective predictor of 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 have a higher 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 can be grueling. With potential side effects such as bleeding and infection — you DO NOT want to submit to one casually.
“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