by Loretta Van Coppenolle
For many men, the PSA (prostatespecific antigen) test is considered a prudent preventive care option that can help detect the development of prostate cancer. The blood test, approved by the FDA in 1994, measures the level of the PSA protein in blood; the higher the PSA level, the greater the likelihood of prostate cancer.
The test is now widely used to screen men for prostate cancer, to determine if a treated cancer has returned and to detect other prostate abnormalities.
As the number of men tested has increased in recent years, the volume of criticism has grown from medical professionals and groups raising questions about the test’s value and noting that the test can result in more harm than good. Much of the criticism focuses on the fact that the test can produce both false positives and false negatives and that the amount of PSA in blood can be high for reasons other than cancer.
The AARP in March 2014 published an article in its Bulletin called “10 Tests to Avoid.” One of the 10 tests was the PSA for prostate cancer screening. In the article, Reid Blackwelder, M.D., president of the American Academy of Family Physicians, says, “The evidence is extremely convincing that in a man with usual risk and no symptoms, the PSA test causes more harm than benefit.”
Blackwelder says that medical professionals can over-react to screening results and order “ultrasounds, repeat lab tests and even biopsies for a problem that isn’t there.” He says that about 75 percent of tests that show high levels of PSA (the norm is considered to be 4 ng/ml or below) turn out to be false alarms. For up to 40 percent of those treated with surgery or radiation for these false alarms, impotence, incontinence or both can result.
In May 2012, a U.S. Preventive Services Task Force made public its decision that “no man of any age” should be screened routinely for prostate cancer with the PSA test. The task force found that in the U.S. and Europe, PSA testing and early treatment resulting from it meant only one man avoided prostate cancer death for every 1,000 tested.
Otis Brawley, M.D., the American Cancer Society’s chief medical officer, defended the task force opinion, saying in an editorial, “Many have a blind faith in early detection of cancer and subsequent aggressive medical intervention whenever cancer is found. There is little appreciation of the harms that screening and medical interventions can cause.”
In his book, How We Do Harm, Brawley devoted two chapters to the story of a patient, 70-year-old Ralph De Angelo, who was encouraged by his wife to have a free PSA screening at a mall and who died seven years later after a spiral of events that followed his screening. In a nutshell, De Angelo was told that his test results were abnormal and subseqently endured 12 biopsies, a cancer diagnosis, prostate removal and a colostomy. He died of a related urinary tract infection.
Brawley points to the financial incentives that pharmaceutical companies and hospitals have to provide free screenings as a relatively low-cost way to bring patients into the system as paying customers. He has also been critical of non-profit organizations that promote screenings by drug companies and hospitals for a cut of the profits ultimately stemming from the screenings.
It is important to note that prostate cancer is a very slow-growing cancer. Only about 15 percent of new prostate cancer diagnoses need immediate treatment, according to the Centers for Disease Control. Most new cases are low-or intermediate-risk cancers. “Watchful waiting” or “active surveillance” is the approach many oncologists recommend to patients with newly diagnosed low-risk malignancies. This approach can reduce or eliminate the need for surgery, chemotherapy or radiation.
The PSA test is often used to monitor patients during the “watchful waiting” period to help determine the cancer’s rate of growth. It is also during this period that dietary changes can help lower PSA levels and even slow prostate cancer growth. For example, a United Kingdom study noted in 2013 by the American Society of Clinical Oncology found that four polyphenolrich foods—pomegranate seed, green tea, turmeric and broccoli—combined in a pill supplement slowed prostate cancer growth markers by a median of almost 64 percent. This study is outlined in the December 2013 issue of Life Extension magazine.
Loretta Van Coppenolle is a San Antonio environmental and health activist and a consultant/coach in holistic nutrition. She can be reached at firstname.lastname@example.org.