Tag Archive for: PSA

PSA: Sharing the Decision

/in /by

PSA screening is controversial because it may or may not indicate prostate cancer without additional testing and it may or may not indicate mortality from prostate cancer. As I said, many elderly men will die with prostate cancer but not of it. How do you know what to do? A recent study may provide some guidance.

Regular PSA Testing and Mortality

The Veterans Administration can be a challenging bureaucracy, but it’s one entity that can provide medical information on millions of subjects. Researchers wanted the answer to a simple question: Do higher rates of PSA testing yield a reduction in metastatic cases of prostate cancer?

The survey population included male patients getting a PSA test at 128 U.S. Veterans Health Administration facilities across the system from 2005 to 2019. The reason those years were chosen is that the U.S. Preventive Services Task Force (USPTF) had modified guidelines for PSA screening to recommend less frequent use of the test for men over 70. Over those years, there was a decrease in annual testing by 10% to 15% in non-VA healthcare facilities, and that was matched in the VA system. The USPTF recommended against screening all men, and PSA testing again fell in all age groups.

The data showed that as PSA testing decreased, the rates of metastatic prostate cancer increased. Drilling down into the data, those VHA facilities with higher rates of PSA screening had lower rates of metastatic prostate cancer.

Shared Decision-Making

The researchers were diplomatic in their conclusions. They simply presented the findings and suggested that the physician and patient should jointly decide on the course of action. Should we test? When do we proceed with a biopsy? What do we do if it’s benign? If it’s malignant? And a whole bunch more.

The Bottom Line

The researchers easily could have recommended that everyone gets tested and everyone gets a biopsy if the PSA is too high, but PSA testing is not precise enough. Some men have prostate cancer with PSA less than 4.0 and some do not have it with PSA over 10. The best course is having a discussion with your urologist and coming to a joint decision that satisfies you both. It’s also not a bad idea to get a second opinion, of whether you agree with the plan or not.

One thing for sure: always do the screening test again, regardless of whether it’s PSA, cholesterol, or HbA1c. For the most part, tests are accurate and reliable, but there’s always the possibility of a mistake; one test does not a diagnosis make. Retest, discuss, and plan a course of action with your healthcare professional.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Oncol. doi:10.1001/jamaoncol.2022.4319

Controversy: PSA Testing

/in /by

Medical testing is a blessing at times, a curse at others, and a source of controversy in the medical profession itself. I recently wrote about colonoscopies and why they provide information other colon health tests do not. The PSA (protein specific antigen) screening for prostate cancer has also been controversial. Here’s why.

If the PSA exceeds a specific number (another point of controversy), especially if a digital rectal exam reveals an enlarged prostate, more tests follow. The prostate biopsy takes samples of the prostate to see if cancer is present. If not present, the PSA was a false positive that resulted in a much more expensive test that probably increased the anxiety of the individual.

But wait—there’s more. Even if cancer is diagnosed, it may or may not indicate treatment. That’s because many prostate cancers are very slow growing, especially in elderly men, and will not impact how long they live. They may die with prostate cancer but not of prostate cancer.

How do you decide whether testing PSA is necessary? A new study may provide some direction, and I’ll cover that Saturday.

The Insider conference call is tomorrow night, and the topic is important: a recent study and the medical press that followed have indicated your ability to purchase dietary supplements may be under attack. If you’re an Insider, you don’t want to miss this call. If you’re not, purchase your Insider membership by 8 p.m. ET Wednesday night to get the latest information as well as all the other benefits of membership.

What are you prepared to do today?

        Dr. Chet

Diagnosing Disease: The Canine Frontier

/in /by

Malcolm Gladwell, one of my favorite authors, recently did a show on his podcast “Revisionist History” concerning the use of dogs in screening for prostate cancer. You probably recognize his name from his many books including “The Tipping Point”; if you haven’t tried his podcast, I recommend it.

If there’s one thing that keeps men from getting their prostate examined, it would be the invasive nature of the prostate exam known as the digital rectal exam. This refers to the old meaning of digital: performed with a finger. If any problems are suspected, the typical follow-up procedures include the protein specific antigen test (PSA) and prostate biopsy. I know first-hand how uncomfortable these exams can be, and I understand why men would put it off whenever possible, even to the detriment of their health. But what if there were another way? Time to let the dogs out.

No, this new method did not involve dogs doing what they always seem to do, which is to sniff behinds; these dogs were trained to identify prostate cancer in urine samples. Exactly what they’re trained to identify is still a mystery, but most likely it’s a protein. How accurate were they? Over 95%. Anyone that tests positive by canine would then be followed up by a human physician.

Will we be making appointments to see our canine diagnosticians anytime soon? Probably not—even though just about every type of cancer you can think of has been canine-tested and found to be accurate. Are there other conditions that canines can identify? Yes, and I’ll cover that on Saturday.

The Insider Conference call is tomorrow night. I’m going to talk about the COVID vaccine as well as answer Insider questions. Become an Insider before 8 p.m. Eastern Time, and you can join in on the call.

What are you prepared to do today?

        Dr. Chet

Reference: Urologiia. 2019 Dec;(5):22-26.

Coordinating BPH Herbals and PSA

/in /by

Happy Father’s Day to all the fathers, father figures, and so on. Now let’s work on making you all healthier.

If you take one of the BPH medications, you have to work with your physician to determine how you’ll work out your PSA testing. What might not have been clear was that the medications don’t cause prostate cancer, but they can mask a rising PSA level by keeping it artificially low and that could delay detecting prostate cancer. I left you with the question: what about herbals that are used for BPH such as saw palmetto? Do they impact the PSA levels?

Based on a couple of studies, the answer is no. The mechanism by which the herbs help with prostate issues is different from BPH medications. So if you’re one of the many men who use saw palmetto, I wouldn’t be concerned based on current research to date.

However, I would be prudent. There are only a couple of studies that have looked at specific combinations of herbals and the impact on PSA levels. While they showed no impact on PSA levels, that’s not a completely free pass. What I would do is to stop using saw palmetto or any other type of herb or plant sterol a couple of weeks before your next PSA test. There’s no research to know how long it may take to clear the system, but two weeks seems reasonable. Once the blood is drawn, go back to using the product as before. That seems to be the best way to approach herbal treatments for BPH.

BPH can really mess with a man’s life and especially with sleep. If that’s you and you’re taking a medication or an herbal, there’s no reason to stop. Just be smart. Talk with your physician; understand how to deal with the potential issues and live your life. That’s a bottom line we can live with.

What are you prepared to do today?

        Dr. Chet

References:
1. Int J Cancer. 2005 Mar 20;114(2):190-4.
2. Prostate. 1996 Oct;29(4):231-40.

BPH Treatment and PSA

/in /by

One of the reasons I love what I do is that I learn something new just about every day. In this case, it may help some men sooner rather than later if they have benign prostatic hyperplasia (BPH).

The urethra runs right through the prostate gland. As a man ages, the prostate gland has a tendency to enlarge, and when it does, it can interfere with urine flow. The result is the inability to empty the bladder completely, which can cause frequent urination; a man may have to get up multiple times through the night to urinate.

The typical treatment is to use a medication called a 5-alpha reductase inhibitor that includes finasteride and dutasteride. By reducing the production of a specific form of active testosterone, the prostate can stop enlarging and urination improves. The problem with using the medication is that it can reduce the protein specific antigen level, a marker that can indicate a man has prostate cancer. Could it impact the diagnosis, treatment, and even death from prostate cancer? We’ll look at a recently published study that examined those very questions on Thursday.

The monthly Insider conference call is tomorrow night. You can take part by becoming an Insider today at drchet.com; if you’re a Member, you can upgrade to Insider and the charge will be prorated.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Intern Med. 2019;179(6):812-819. doi:10.1001/jamainternmed.2019.0280.

Tracking Your Rate of Change

/in /by

The U.S. Preventive Services Task Force (USPSTF) just published new recommendations for prostate specific antigen (PSA) testing for men 55 and over. In effect, they don’t recommend PSA testing on a regular basis. I think that’s a mistake. I’ll cover the specifics for PSA testing during the Prostate Health webinar, but I think regular testing is important regardless of age for this reason: monitoring the rate of change.

Monitoring changes in medical tests does not just apply to PSA, it applies to just about every test: cholesterol levels, triglycerides, blood sugar, HbA1c, body weight, vitamin D. Even non-medical tests such as food intake. By monitoring changes, we can identify how each component of our health is changing, especially the rate at which they’re changing. It also tells us how well our lifestyle modifications are working. Those are valuable pieces of information.

No single number is important; it’s how that number fits in relation to other results of the same test that may be important. If it increases at a higher rate or at a faster rate, that may indicate a problem that needs to be addressed. Let’s say your PSA goes from 0.5 to 1.0 in a year. That’s a whole different story than if it went from 0.5 to 3.5 in a year; in that case, closer monitoring would be necessary. Same for your weight; if it went up two pounds in a year, your doctor probably wouldn’t be concerned. But if it went up 20 pounds in a year, something serious is happening and needs attention now.

I understand why the USPSTF took the position they did with PSA in those age groups: they want to prevent unnecessary tests and treatment. What they didn’t consider is that monitoring the rate of change could identify who needed to be treated now versus those who did not.

For those factors you can track for yourself, such as blood sugar if you’re prediabetic or a type 2 diabetic, fat intake, blood pressure, weight, and many others, you should make the effort. Those measurements can provide a lot of information for your health over time—information you can use to improve your health.

What are you prepared to do today?

Dr. Chet

 

Reference: JAMA. 2018;319(18):1901-1913. doi:10.1001/jama.2018.3710.