Yesterday Ben Stiller announced to the world that at the age of 48 he was diagnosed with prostate cancer. His doctor first started testing him about two years earlier and when he saw his PSA levels rise, Ben had a surgery to remove the cancer. Since then he says, he has been cancer free. In a blog post he credited the PSA test as saving his life. This revelation has brought questions about the utility of a PSA test for screening back into the public spotlight once again. So here is what you may be asking and what you need to know.
What is a PSA test?
It’s a blood test that looks for a protein made by prostate cells; PSA stands for prostate specific antigen. If the levels are high in your blood that means that something could be going on in the prostate that causes this protein to leak out into the blood. It could be cancer, but also this can result from a benign condition like inflammation or prostate enlargement.
Should the PSA test be used routinely to screen for prostate cancer in asymptomatic men?
The PSA test was approved by the FDA in the 1990s as a screen for prostate cancer in asymptomatic men and it’s been a topic of controversy ever since.
At this time there is no major medical organization that recommends routine screening in asymptomatic men with a PSA test.
In addition, the US Preventive Services Task Force, an independent group of experts convened by the government to review screening tests like this, has looked at all of the data and they recommend that men not get this test to screen for prostate cancer, because they say the risks of this far outweigh the benefits.
That’s because the test is not perfect and it can’t tell the difference between a slow growing tumor that might never cause a problem and an aggressive one. Most men who get the test will go on to get treatment if they have an elevated number and over treatment can lead to significant problems.
According to the task force for every 1,000 people screened we will save one life—so that’s a good thing—but among those 1,000 people, 30-40 will develop erectile dysfunction or urinary incontinence, two will have a heart attack, and one will develop a serious blood clot due to treatment. For every 3,000 that are screened one man will also die from a complication of the surgery.
What is the argument for the test?
While neither the Urological Association of America or American Cancer Society recommend routine PSA screenings, they do recommend that if you are considered high risk or of a certain age you should talk to your doctor about the risks and benefits of the test. That’s because some people want to know and do everything they can to know if they have cancer. If you are that one person in a thousand whose life is saved by a PSA test, than that might be a good enough argument for you to do it. But it’s important that you understand the risks before you make this decision.
So what should I do?
What everyone agrees on is that there are serious risks to PSA screening and you need to be fully informed about them as well as the benefits before deciding what to do. Getting the test can give you some information, but you have to know how to use it. Everyone will react differently to the information, so deciding if you are going to have the test is a very personal decision. If you are concerned about prostate cancer talk with your doctor and together you can decide what the best decision is for you.
What if I have an elevated PSA?
If you have an elevated PSA your doctor will want to do further testing. Remember, an elevated PSA doesn’t necessarily mean that you have prostate cancer and you want to discuss all of the risk and benefits of next steps. If it turns out you do have prostate cancer, first don’t panic. Prostate cancer is typically a very slow growing tumor. One of the other issues with prostate cancer that is important to realize is that while it is pretty common–13 percent of men get it–most don’t die from it.
In September a study published in the New England Journal of Medicine found that there was no significant difference in mortality among men with prostate cancer who had either had surgery, radiation, or only been monitored with no intervention. While disease was more slightly likely to progress in men who were simply followed, the researcher found that they would have to operate on 30 men to prevent one man from having metastatic disease after 10 years.
So what to do if you are found to have prostate cancer again is a very personal decision and you need to discuss all of the options and risks and benefits with your doctor.
What can I do to reduce the risk of prostate cancer?
There are a lot of studies looking at how to reduce prostate cancer risk and some of the best data is around lifestyle. It even turns out that the same diet program that works to reverse or prevent heart disease may also help with prostate cancer. Dean Ornish and colleagues looked at men who had an elevated PSA and biopsy positive for prostate cancer and found that lifestyle changes could reduce PSA levels.
The best things you can do to reduce your risk are:
- Eat more fruits and vegetables.
- Eat less meat and dairy.
- Eat omega-3 rich fish.
- Eat whole grains.
- Eat less refined carbohydrates like sugar.
- Exercise: Shoot for 150 minutes of activity each week.