Positively False Confidence in PSA Tests

From the July 2005 edition of Dr. Fuhrman's Healthy Times:

The use of the PSA (prostate-specific antigen) test has become widespread in the U.S. Based on results of the test, physicians establish detailed treatment recommendations—which typically involve surgery, radiation, and other invasive techniques—in an attempt to decrease the likelihood of a premature death from prostate cancer.

Prior to the widespread use of the PSA test, prostate cancer was detected only via digital rectal exam (DRE). Digital does not, in this case, refer to modern computer technology; rather it refers to a doctor’s finger, a digit. Unfortunately, once a lump in the prostate is detected via DRE, the prostate cancer is already at a later stage, and any potential benefits of early intervention are reduced. Currently, clinical practice guidelines recommend the use of both DRE and PSA in men over 50 years of age.

Incredible as it may seem, the PSA test does not accurately detect cancer. If you are over 60 years old, the chance of having a prostate biopsy positive for cancer is high, and the likelihood you have prostate cancer is the same whether or not you have an elevated PSA. More and more studies in recent years have demonstrated that prostate cancer is found at the same high rate in those with lower, so-called “normal” PSAs as those with elevated PSAs.1 An interesting study from Stanford University in California showed that the ability of PSA to detect cancer from 1998 to 2003 was only 2 percent. The elevations in PSA (between 2 and 10) were related to benign enlargement of the prostate, not cancer.

Remember, the pharmaceutical/medical industry is big business. Too often, treatments are promoted from a financially-biased perspective, leading to overly invasive and aggressive care without documented benefits.

If you want to have your prostate biopsied, radiated, and cut out, go ahead, but you do not need a PSA blood test first to decide. The PSA test is just an excuse to give men a prostate biopsy.

If you are a male over 60 who has eaten the Standard American Diet (SAD) your entire life, you should assume you have prostate cancer. If you are convinced (and if you are, it won’t be because of anything in the scientific literature) that you will enhance and prolong your life by undergoing treatment for prostate cancer, you might as well get the treatment without even bothering with a PSA test first. If standard treatment actually enhanced the quality of life and extended it, it would make sense to get the treatment before age 50, when your prostate cancer would surely be confined to the prostate. I am not seriously suggesting either of these approaches. But they make more sense than the present standard, especially since populations who get regular PSA tests, compared to populations who do not, show no reduction in prostate cancer-related deaths.2

My recommendations revolve around protecting ourselves from cancer with nutritional excellence, staying as far away from doctors as possible, and enjoying life without medical interference, testing, fear, and futile treatments. However, I recommend nutritional excellence for everybody of both sexes and of all ages, for overall disease protection and for the maintenance of youthful vigor, wellness, and mental acuity as we age. Nutritional excellence is not just for cancer or heart disease prevention or treatment. 1. Kobayashi T; Nishizawa K; Ogura K; Mitsumori K; Ide Y. Detection of prostate cancer in men with prostate-specific antigen levels of 2.0 to 4.0 ng/mL equivalent to that in men with 4.1 to 10.0 ng/mL in a Japanese population. Urology 2004 Apr;63(4):727-731.

2. Coldman AJ; Phillips N; Pickles TA. Trends in prostate cancer incidence and mortality: an analysis of mortality change by screening intensity. CMAJ 2003 Jan 7;168(1):31-35.
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