Is the PSA Test Worse Than the Disease?

By Jed Diamond, PhD, LCSW

Like most men concerned about their health, I’ve followed my doctor’s recommendations to get a regular P.S.A. (Prostate Specific Antigen) test and a DRE (digital rectal examination) once a year. I’m aware that over 200,000 new cases of Prostate Cancer are diagnosed annually and over 40,000 men will die of prostate cancer in the United States this year. I don’t want to be one of those who die, so I’d like to prevent cancer from occurring and detect it early if it’s present.

The PSA test is one that most men now know about. Regular testing for men would seem to be a good thing. But that may not be true. A number of years ago, my PSA score was elevated from the last time I was tested. My family doctor sent me to a urologist for further testing. The urologist said I should have a biopsy done to see if I might have cancer. That scared me a lot. I sure didn’t want to have cancer, but since there was some suspicion I wanted to know the truth. He told me the procedure was quick, simple, and relatively painless. He was wrong on all counts.

I lay on my side as directed and pulled my knees up to my chest. Some numbing medication was used before inserting a not-so thin probe into my rectum. Once the biopsy device was situated, the doctor told me to relax (not so easy) as he retrieved a number of thin, cylindrical sections of tissue with a hollow, spring-propelled needle. Each time he “pulled the trigger,” there was a significant discomfort as the sample core was removed. He took 12 samples from various parts of the prostate looking for possible cancer.

After the procedure, I felt shaky and sat in the waiting room for a while. I was told to take a course of antibiotics to prevent infection. The good news was I was told the tests came back negative, meaning that didn’t have prostate cancer. The bad news was that I got an infection despite taking the antibiotics and eventually had to have a catheter inserted so that I could pee. It took me two months for the infection to heal. Emotionally, I still haven’t fully recovered. I began to wonder if the test was worth the pain, discomfort, and the risk of infection.

I still get tested regularly, but I decided I wasn’t going to have a biopsy done ever again if I could help it. I’ve since learned that the PSA test may not be that reliable in detecting prostate cancer. Richard J. Ablin, PhD discovered PSA in 1970, but believes the test that was developed from his discovery may cause unintended problems that men and their families need to know about.

In 2010 he wrote an Op-Ed piece in the New York Times, The Great Prostate Mistake. There is a lot of fear about cancer and most of us want to know if we have it so we can be treated early. But Ablin notes that the risks of getting prostate cancer and dying as a result are a lot lower than many people believe. “American men have a 16 percent lifetime chance of receiving a diagnosis of prostate cancer,” says Ablin, “but only a 3 percent chance of dying from it. That’s because the majority of prostate cancers grow slowly. In other words, men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it.”

With these odds I wondered about the value of testing. As I learned, if the PSA is elevated, there is a tendency to have a biopsy and if the biopsy indicates a cancer there is tendency for doctors to recommend surgery, even though other less invasive interventions may be the best option for many men. Ablin believes that widespread testing leads to too many biopsies and surgeries which can have serious consequences and may be unnecessary.

“The test is hardly more effective than a coin toss,” he says. “As I’ve been trying to make clear for many years now, PSA testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t.”

As I learned there are a lot of reasons we may have a higher than normal PSA test. Ablin says, “The test simply reveals how much of the prostate antigen a man has in his blood. Infections, over-the-counter drugs like ibuprofen, and benign swelling of the prostate can all elevate a man’s PSA levels, but none of these factors signals cancer. Men with low readings might still harbor dangerous cancers, while those with high readings might be completely healthy.”

Dr. Ablin, along with science writer Ronald Piana, have written a book, The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster. All men and their families need to know that every year, more than a million men undergo painful needle biopsies for prostate cancer, and upward of 100,000 have radical prostatectomies, which can result in incontinence and impotence. But the shocking fact is that most of these men would never have died from this common form of cancer, which frequently grows so slowly that it never even leaves the prostate. This is another example of the “cure” being worse than the “disease.”

Ablin and Piana ask, “How did we get to a point where so many unnecessary tests and surgeries are being done?” In their excellent book Ablin and Piana show how PSA was co-opted by the pharmaceutical industry into a multibillion-dollar business. Now, doctors and patients are beginning to speak out about the harm of the test, and beginning to search for a true prostate cancer-specific marker that can save lives.

I’ve found, personally, that the problem with the PSA test is that there are too many “false positives.” That means the score indicates there may be a problem when there actually isn’t one. As a result we begin on the path to more tests which, like the needle biopsy, are invasive and are dangerous themselves.  If we get tested enough they are likely to eventually find a cancer, which leads too many men to surgeries they may not need. I recommend every man and his family read The Great Prostate Hoax before getting your next PSA test.

My own doctor says I would do better to eat in ways that are likely to prevent prostate cancer from ever occurring than worry about what the PSA test might reveal. He says, “While the evidence behind what follows is not truly proof, there is very little down side to eating less red meat, less milk, less white bread, and more fish, more vegetables and some supplements. There is proof that this will lower your risk of heart attack or stroke, and I believe the evidence is strong that it will reduce your risk of prostate cancer or reduce the risk of spread if you already have prostate cancer.”

So, I still get a regular PSA test, but I don’t worry so much about prostate cancer. I’m definitely more interested in preventing cancer by eating well than trying to find a cancer. I believe that what we focus our attention on matters. PSA focuses our attention on cancer. Eating well focuses our attention on health and well-being. I’ll be interested to hear your thoughts, feelings, and experience.

Jed Diamond, PhD, LCSW, is the Founder and Director of the MenAlive, a health program that helps men live well throughout their lives. Though focused on men’s health, MenAlive is also for women who care about the health of the men in their lives. Diamond’s new book, Stress Relief for Men: How to Use the Revolutionary Tools of Energy Healing to Live Well, brings together the wisdom accumulated in 40 years helping more than 20,000 men, women, and children.