There is a quiet revolution taking place in the world of prostate cancer diagnosis and treatment. Last year, the US Preventive Services Test Force issued a directive to discontinue PSA testing in men in order to prevent the widespread misinterpretation of PSA findings by doctors and the harmful overtreatment of men. In April of this year, the American College of Physicians (ACP) released new prostate cancer screening guidance that urged doctors and patients “to balance the small benefits from screening with harms such as the possibility of incontinence, erectile dysfunction, and other side effects that result from certain forms of aggressive treatment.” (Read more here.)
It’s great that the medical world is acknowledging the dangers of unnecessary invasive screening procedures, surgery, and radiation. But if men shy away from the PSA test, where does that leave them? Prostate cancer strikes 1 in 6 men and is the second leading cause of cancer death in men, so it’s not a subject to take lightly.
I knew virtually nothing about prostate cancer when I was diagnosed in December 2011. As a doctor and medical writer, I was in a unique position to do original research on the topic of the best and newest prostate cancer tests and treatments. What I found was a medical model of diagnosis and treatment that’s outdated, error prone, and harmful, often permanently, to a majority of men diagnosed with prostate cancer. Overtreatment with prostatectomy and radiation can cause many serious side effects, including long-term impairment of bladder control and/or sexual functioning. This is especially concerning when the vast majority of men with prostate cancer have nonthreatening or slow-growing cancer and don’t require radical treatment.
As I went through PSA testing, biopsy, and was scheduled for prostate surgery, I learned many things that every man needs to know about dealing with prostate cancer to avoid being harmed unnecessarily. I learned that there’s a smarter, safer, and more effective way to deal with this disease than merely putting your head in the sand, on the one hand, or having your prostate removed on the other.
1. Regular PSA Testing Is not the Enemy.
When caught early, prostate cancer is almost always treatable, and our most proven tool for catching prostate cancer early is the PSA blood test. Studies have repeatedly proven that since the implementation of PSA testing around 1990, deaths from prostate cancer have dropped dramatically. The problem is that PSA is a nonspecific test. An elevated PSA does not always mean cancer. It may indicate infection or enlargement of the prostate. Sometimes, when doctors see an elevated PSA result, they assume it’s cancer and rush men to prostate biopsy.
2. “Blind” Biopsies Should Be Avoided.
Most biopsies are done “blind.” Although usually safe, biopsies can cause blood loss or infection. The doctor uses a needle to puncture the prostate in 12 different places, hoping to find evidence of the cancer if it is there. Prostate biopsies sometimes find nothing, and because biopsies have been shown to miss cancer 20 percent of the time, doctors will often want to perform repeated biopsies just to be sure a cancer wasn’t missed. Further harm can ensue. Prostate biopsies should be recommended only when truly necessary.
3. Get a “Targeted” Biopsy Instead.
Blind biopsies can be avoided with new technologies that have become available just recently. The parametric, contrast 3.0 Tesla MRI is able to show areas of possible cancer. Then a “targeted biopsy” can be performed. And if the MRI shows no areas of concern, then the biopsy can be postponed, and the man can be followed with successive PSA tests and a repeat MRI in 6 or 12 months. Another test, the color doppler ultrasound, can be used in a similar way.
4. Get Tests that Are Helpful, Treatment that’s Appropriate.
In addition to these new diagnostic tests, there are also revolutionary new treatments for prostate cancer, including high-intensity focused ultrasound, cryosurgery, laser surgery, and others that are soon to emerge. These new methods allow doctors to remove half of the prostate, or just the part with cancer. With these focal treatments, vital nerves are spared and adverse effects are much less. Doctors haven’t heard about this revolution in prostate cancer care, nor have most men.
5. Be a Circumspect, Well-Informed Patient.
Because most prostate cancers are nonaggressive or slow growing, there is usually time to gather information and obtain a more thorough approach than most men receive. Even though a diagnosis of “cancer” terrifies many men and their families, resist the urge to rush into surgery and “get the damn thing out.” Remember, prostatectomy and radiation are not always curative. They fail to halt the cancer about 25 percent of the time. Educate yourself, as I did, so you can get the tests that are most helpful and the treatments that are most appropriate, even if your own doctors don’t know about these advances or fail to inform you about them. In that case, also get a second or third opinion!
By the way, I never did require surgery and am now doing fine with a closely watched method called active surveillance. I check my PSA level every three months and obtain a color doppler ultrasound and parametric MRI every six. I describe all of these and more, step by step, in my new book, so other men will know the tests and treatments to ask about and obtain.