Just over three years ago I went to have a normal check up, which included a (prostate-specific antigen) PSA test. The doctor noticed that it was a slightly higher than it should be for a man of my age at the time, 53 years. Everything else came out OK – all other tests and physical examinations detected nothing. The doctor suggested I do another PSA test a month or so later to see whether the level had gone up.
If PSA levels keep going up, it is often a sign that something is wrong, either the prostate is enlarging, or that there is a cancerous growth.
The second PSA test was slightly higher than the first. The doctor and I discussed the pros and cons of “watchful waiting”, I concluded that two months of rising PSA levels would interfere with my sleep and make me anxious. So I opted for a biopsy. Several samples are taken from different parts of the prostate gland, and then examined under a microscope for signs of cancer.
I was not looking forward to the biopsy procedure because I had heard varying accounts of discomfort, pain and no pain. Fortunately, it was not as painful as I had expected, perhaps a little when samples were being taken from the base of the prostate, but no more uncomfortable than the average visit to the dentist. During the following 48 hours my discomfort was not a problem.
A few days later the doctor called me. During the visit he explained that they had detected cancerous cells and that I had prostate cancer. I then discussed and researched extensively on whether to treat it with radiotherapy, which today means inserting radioactive pellets in the prostate gland, or go for a radical prostatectomy (have the prostate gland surgically removed).
I decided, that at the relatively young age of 53, my long-term health would have a better chance with surgery.
I underwent the radical prostatectomy (“My Prostate Cancer Operation – A Personal Diary”), went through all the urinary incontinence and erectile dysfunction and came out free of cancer and with everything restored. The urinary incontinence took a couple of months to resolve, while the erectile function took over a year.
This picture was taken the following morning, after my operation
A US federal report has just recommended that most males do not receive routine PSA screenings, as they believe the tests offer little benefit. Several medical groups and patient advocate organizations will be disputing this view. The report says that if about half the men aged 65 to 75 now get a blood test, there seems no point in the other one.
I am aware of some of the arguments in this debate, but will stay within my personal situation. I was 53, not aged between 65 and 75 like the people quoted in the federal report. Had I not had a routine PSA test I would probably still be walking around now with an advancing prostate cancer – completely unaware. By the time I would have started having symptoms, how advanced would the cancer have become? In my case definitely, the PSA test was extremely beneficial.
The American Urological Association says it will carry on recommending PSA screening “for well-informed men who wish to pursue early diagnosis.” The Association also warned against over-detection and overtreatment. The Association says it would like to see the Federal Panel’s final conclusions before issuing new guidelines.
Skip Lockwood, chief executive of “ZERO – the Project to End Prostate Cancer”, a group that believes in PSA testing, said:
“Just because it’s difficult to make a decision isn’t a
reason to say you shouldn’t know.”
It is important to find a balance which does not cause unnecessary tests, does not miss out on diagnosing people with cancer, does not over-treat those with the disease, but at the same time controls or cures the cancer.
My opinion is strongly influenced by personal experience, sometimes personal experience clouds judgments, other times it is only by being there yourself that you can fully understand what is at stake. I believe PSA testing, if there is a family history of prostate cancer, should be recommended to patients. Regarding routine PSA screening for all males after a certain age, I would like to see the Panel’s conclusions. Recent studies have shown that routine PSA testing does not appear to reduce mortality. Other studies have criticized over-treatment of a disease, and often disease that is not there, because of PSA testing – in such cases it is not the PSA testing that is to blame, but rather what happens after it.
“My Prostate Cancer Operation – A Personal Diary”
Added after Reading US Preventive Services Task Force report and recommendation – after reading their conclusions, I am inclined to agree with them. The numbers speak for themselves. It does appear that PSA screening has virtually no impact on overall prostate cancer mortality; and patients are being overtreated. I would like to see more studies into why overdiagnoses and overtreatments after PSA tests occur. (“Why Federal Panel Recommends Against PSA-Based Screening For Prostate Cancer”)
Written by Christian Nordqvist (Editor-in-Chief, Medical News Today)