Ignoring New PSA Recommendations Could Save Your Life

Ignoring New PSA Recommendations Could Save Your Life

Written by Dr. Geovanni Espinosa
Posted October 28, 2014

I’ll never forget a recent patient of mine — let’s call him Bob. He was a friendly, cheerful guy — a retired banker and world traveler who had just turned 70.

He came to me with prostate cancer that had spread to the bone.

Bob found out about his disease two years before, when he decided — for the first time in about 30 years — to get a general check-up, along with full body MRI. At the time, he had no symptoms and was relatively healthy for a 68-year-old.

But to his (and his new doctor’s) surprise, Bob had metastatic cancer in his spine and pelvis. His PSA was 1,022 ng/ml. You read that right — one thousand twenty two. (Though I can’t blame you for thinking that was a typo. Even I’ve never seen a PSA higher than 1,000.)

When I asked Bob why he’d never seen a doctor before then, his response was the same one I’ve heard time and again. “I was fine,” he said. “I figured I didn’t have to see anyone unless something was wrong.”

Why am I telling you all of this?

Because if Bob would have started PSA testing at 50, then his disease would have probably been caught early — and treated appropriately.

Simply put, men need to screen for prostate cancer. And like it or not, the PSA test is one of the only tools we’ve got to work with. So the latest recommendation from the United States Preventive Services Task Force (USPSTF) against routine PSA screening?

Well, it could wind up creating a bigger disaster than the one it was issued to fix. Let me explain...

The PSA is an imperfect blood test that increases for a variety of non-malignant reasons: common issues like infection of the prostate, enlarged prostate, or simply having a digital rectal prostate exam before blood test. Even recent ejaculation can send that PSA soaring.

These are the facts. PSA isn’t very sensitive or specific to prostate cancer. And yes, at the very least, that leads to a lot of unnecessary worry for men both before prostate cancer diagnosis and after prostate cancer treatment.

The problem is that this is all we urologists really have right now. And despite what the USPSTF says, watching your PSA can actually tell you a lot, if you’re interpreting results correctly.

A single high PSA value may not mean much. (In other words, a 52-year-old man with a PSA of 7.2 ng/ml may have no cancer in his prostate.) But PSA kinetics — that is, how fast PSA increase or decreases within time — is a major contributor in the total prostate cancer picture.

So if your PSA is rising quickly over a short period of time, your doctor needs to be on a lookout for trouble. Especially if you also have a single PSA score above 10 ng/ml. Together, these results could be a red flag for malignant disease, and further investigation is in order.

Responsible urologists know the difference—and they treat their patients accordingly.

So yeah, I’ve got a bone to pick with the USPSTF’s latest PSA recommendations. We’re talking about a bunch of primary care physicians who are rarely ever confronted with the challenge of diagnosing men with prostate cancer — let alone treating them.

And as imperfect as this blood test is, the PSA saves lives.

It should be one of several factors that your doctor relies on to both identify prostate cancer, and to determine the appropriate next steps. Which is why — at least, until a better, non-invasive test comes on the scene — PSA, along with a properly done physical exam, should always be part of your prostate health work-up.

Here are the basic PSA pointers I give to all of my patients:

  • You should receive regular PSA testing starting at 40 years old. If there’s a first degree family history of prostate cancer (e.g. your brother or your father), start screening at 35.

  • A “normal” PSA level is anywhere from 0.0 to 4.0ng/ml, and depends a lot on your age. (A PSA of, let’s say, 3 is high for 40-year-old—not so much for a 60-year-old.) But like I said, the rate of change of your PSA is a lot more important than the actual number.

  • If PSA is “high” it could be an infection. Ask your doctor about that possibility, and rule it out first.

  • You need at least three values within roughly nine months to see how your PSA is changing with time. Again, how PSA changes with time is likely more valuable than the initial number.

  • If your urologist recommends a biopsy, get a second and third opinion to make sure that it’s definitely the right approach. (I’ll explain why this is so important in the next couple of weeks.)

Of course, this leaves the onus on you to actually go see your doctor every year. Which brings me to the other reason I’m talking to you about this today...

I’ve witnessed a lot of wakeup calls in my day. And nine times out of ten, they shine a harsh light on the steep cost of skipping routine health screenings.

Men are notoriously stubborn — especially when it comes to their health. I know this because I happen to be a man myself. And also because I see patients just like Bob every single day.

Maybe you’re one of them.

These guys show up at my office in crisis. And you’re both hoping that at that point, whatever they’re up against isn’t life-threatening. But way too often, it is.

And believe me, it’s not that I don’t get it. I know there are a lot of reasons why you might be putting off a trip to the doctor. Fear of being vulnerable and out of control. A hectic schedule. Or even plain old machismo. (How many times were you told to “shake it off” in your life? If you’re anything like me, enough to do it without skipping a beat.)

Well here’s the deal: It’s time to stop being that guy.

Look, there’s no doubt that the “if it ain’t broke, why fix it?” approach makes a lot of sense sometimes. After all, mainstream doctors are trained to find abnormal values and treat them with drugs or other harsh therapies. Treatment protocols that often result in more health problems that are often treated by more harsh therapies.

The fallout from the PSA test is a perfect example of this kind of aggressive overtreatment. And it’s no secret how many men have had their lives outright ruined by the unnecessary interventions that fell into their lap like dominoes from one set of iffy results.

But guess what? “Bad lab numbers” don’t necessarily mean you need a prescription drug or a surgical procedure. And the PSA test isn’t the problem here. It’s what your doctor does with it that counts.

Including a naturopathic doctor as part of your team is one way to avoid this kind of collateral damage. (If you’re not already working with one, the American Association of Naturopathic Physicians has a searchable directory to help you find a doc near you.)

Sticking with my recommendations is another. I’ll be sharing more of those next week — and every week after. So until then...

Stay tuned and stay well,

Dr. Geo

Geo Espinosa, N.D., L.Ac, C.N.S., is a renowned naturopathic doctor recognized as an authority in integrative management of male and urological conditions. Dr. Geo is the founder and director of the Integrative Urology Center at New York University Langone Medical Center (NYULMC), a center of excellence in research and integrative treatments for urological conditions.

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