Are the benefits of screening oversold? Does screening lead to over-diagnosis and unnecessary treatments? Read more

A rapidly rising PSA (prostate specific antigen) level does not automatically mean men need to undergo a prostate biopsy, nor is it a good predictor of prostate cancer. These are the findings of a new study conducted by investigators from Memorial Sloan-Kettering Cancer Center. Read more about PSA levels and unnecessary prostate biopsies

Finasteride

- 18.4 percent of men who took finasteride developed prostate cancer over the study’s course

- 24.4 percent who took placebo developed prostate cancer over the study’s course

- Men in the finasteride group had a 28 percent reduction in prevalence in prostate cancer and a smaller prostate volume than men in the placebo group

However:

- The rate of high-grade cancers was greater in the finasteride group (6.5%) than in the placebo group (5.1%). The reason for this is unknown.

- Most cancers in the finasteride group were small and localized.

The incidence of high grade cancers in the finasteride group during this study is one reason medical professionals are reluctant in most instances to prescribe finasteride for prostate cancer treatment.

Since the PCPT, subsequent studies have reinterpreted the findings. Some research confirmed the reduced risk of prostate cancer (Thompson 2008), while others re-examined the increased risk of high-grade tumors and determined that finasteride actually reduced the risk of developing aggressive cancer when compared with placebo. (Pinsky 2008; Redman 2008)

However, two physicians from Johns Hopkins evaluated all the findings and noted that the decrease in prostate cancer related to finasteride was much smaller than originally reported and not statistically significant. Therefore, they believe finasteride will not significantly help reduce the risk of prostate cancer among men who are monitored regularly and who have a biopsy when they experience an elevated PSA or abnormal digital rectal exam. They recommend men not take 5-alpha-reductase inhibitors as a means to prevent prostate cancer, and warn that because 5-alpha reductase inhibitors reduce PSA levels by about 50 percent, men should multiply their PSA numbers during the first two years they use the drugs, by 2.3 for years 2 through 7, and by 2.5 for 7 years or longer to get a more accurate indication of their prostate cancer risk that may require a biopsy. (Johns Hopkins)

References

De Rosa M et al. Cabergoline treatment rapidly improves gonadal function in hyperprolactinemic males: a comparison with bromocriptine. Eur J Endocrinol1998 Mar; 138(3): 286-93

Johns Hopkins, Prostate Disorders, 2009

Redman MW et al. Finasteride does not increase the risk of high-grade prostate cancer: a bias-adjusted modeling approach. Cancer Prev Res (Phila) 2008 Aug; 1(3): 174-81

Sawada T et al. Effects of Oxytocin and Prostaglandin F2 on Androgen Production of Adult Rat Testis In Vivo. Prostaglandins 1998 Feb; 55(2030: 121-26

Takeyama M et al. Stimulatory effect of prolactin on luteinizing hormone-induced testicular 5 alpha-reductase activity in hypophysectomized adult rats.Endocrinology 1986 Jun; 118(6): 2268-75

Thompson IM et al. Does the level of prostate cancer risk affect cancer prevention with finasteride? Urology 2008 May; 71(5): 854-57

Tomlinson JW et al. Impaired glucose tolerance and insulin resistance are associated with increased adipose 11-beta-hydroxysteroid dehydrogenase type 1 expression and elevated hepatic 5-alpha-reductase activity. Diabetes 2008; 57(10): 2652-60

Van der Merwe et al. Three weeks of creatine monohydrate supplementation affects dihydrotestosterone to testosterone ratio in college-aged rugby players.Clin J Sport Med 2009 Sep; 19(5): 399-404

Let’s face it: people poke fun at the prostate (pun intended). And while it’s okay to make a few jokes, prostate cancer, like a prostate cancer screening, is no laughing matter. One reason people make jokes about the prostate test is that one part of the process involves a less than dignified but very brief examination called a digital rectal examination (DRE). If you’re a guy who has not yet had a DRE, I explain it below. For now, just let me say that if getting a DRE is your reason for not getting your prostate checked, then it’s time you took a deep breath and just did it. Hey, every guy who goes into the military has had to cough or strain while a doctor felt his groin, so if they can do that, you can get a DRE is all I’m saying. Forget the jokes, learn all you can about prostate tests and prostate cancer, and then make an informed decision about getting screened.

Prostate and Prostate Cancer

Despite the fact that prostate cancer is the second most common type of cancer among men in the United States and is estimated by the National Cancer Institute to kill more than 32,000 US men in 2010, prostate cancer screenings do not get the amount of press or respect–that breast cancer screenings do. Don’t get me wrong: screening for breast cancer is extremely important and every woman should discuss screening with their physician and heed his or her recommendations.

But prostate screening is critically important too. True, the prostate gland is not as glamorous or sexually appealing as breasts nor is it visible to remind us that it’s there, but it performs various important functions, including making some of the fluid for semen, keeping urine out of the semen, and enhancing pleasurable sensations of arousal and orgasm. You also want to keep the prostate healthy because if it become infected or enlarged, it can seriously impact urinary and sexual functioning. Therefore maintaining prostate health is of utmost importance, and undergoing prostate tests is one way to do it.

Do I Need a Prostate Test?

Doctors and other experts do not all offer the same recommendations for prostate cancer screening, although the Food and Drug Administration (FDA) has approved the use of the PSA test along with the DRE to help detect prostate cancer in men 50 years and older. Some say men older than 50 should be screened every year, while others recommend men who are at higher risk for prostate cancer to begin screening at age 40 or 45. (Risk factors include age, a family history of prostate cancer – especially a brother or father, being African American, a high-fat diet, obesity, lifestyle and other factors such as exposure to chemicals and toxins.) Other experts say routine prostate tests are not necessary.

The point is, every man needs to have a prostate test at some point, and that point differs for each man. Therefore you should work with your physician and consider your unique state of health, along with the risk factors already mentioned, and the fact that age is the most common risk factor, with nearly 63 percent of cases occurring in men age 65 and older.

Prostate Tests

Prostate cancer screening typically involves two procedures. One is the digital rectal exam, during which a doctor inserts a gloved, lubricated finger into the rectum. It takes about a minute or so for the doctor to feel the prostate through the wall of the rectum and to check for any suspicious lumps, as well as for any abnormalities in the glands shape or size. While it is not the most comfortable procedure you will ever experience, it usually is not painful and is over rather quickly. (By the way, women also have DREs to check for abnormalities in their reproductive organs. DREs are also used to check for colon polyps.)

The prostate-specific antigen (PSA) test involves taking a small blood sample and having it tested for the level of the antigen. PSA is a substance produced mostly by the prostate that may be present in elevated amounts in men who have prostate cancer. However, high PSA levels can also be an indication of noncancerous conditions, such as an enlarged prostate (benign prostatic hyperplasia, or BPH) or prostatitis.

Prostate tests are not foolproof, however, so you should have a discussion with a trusted, knowledgeable healthcare provider to determine the best time for you to be screened. During that discussion your healthcare provider should inform you about the risks of prostate screening.

Risks Associated with Prostate Tests

As with most tests, prostate tests run the risk of providing false-negative or false-positive results. If you receive a false-negative test results (one that shows you do not have cancer when you really do), then you may delay seeking treatment even if you have symptoms. A false-positive result means your test appears to be abnormal even though you don’t have cancer. Such results could send you on an unnecessary route of more tests, including a biopsy, and the risk of complications, which include fever, pain, blood in the semen or urine, and urinary tract infections.

A common risk associated with prostate tests is if your PSA test shows an elevated level, your doctor may recommend you have a biopsy of the prostate to help determine whether you have cancer. He or she may recommend a biopsy because a man’s PSA level alone does not provide enough information to distinguish between a noncancerous prostate condition and prostate cancer. A biopsy, however, is associated with complications, as I have already noted.

If the biopsy indicates that you do not have cancer, then that’s great news, and you can explore other reasons why your PSA levels are high, such as an infection, BPH, or prostatitis. But having had the biopsy, you still run the risk of experiencing the complications. If the biopsy indicates that you do have prostate cancer, then you and your healthcare provider will need to discuss whether you should undergo treatment. According to prostate cancer researcher Arul Chinnaiyan, MD, PhD, the SP Hicks Collegiate Professor of Pathology at the University of Michigan Medical School, the PSA test  is responsible for hundreds if not thousands of unwarranted biopsies a year, and ultimately overtreatment of incidental [cancers]. (WebMD) This is all food for thought and discussion with your physician.

Another risk factor associated with prostate tests is that thus far, there is no scientific proof that undergoing these tests improves your health or will help you live longer if you do have cancer. In fact, a multicenter study that included more than 71,000 men found no evidence that screening with PSA and DRE is effective in reducing the risk of death from prostate cancer. (Concato et al)

If the tests indicate you do have prostate cancer, then the good news is that you have identified it and you can now take steps to deal with it. Some prostate cancers do not cause symptoms or become life-threatening, and so doing nothing”except monitoring the situation regularly with repeat PSA tests, a process known as watchful waiting”may be all that is necessary. Prostate cancer tends to be a slowly progressive disease, and very slow-growing tumors are unlikely to threaten a man’s life. Therefore treating these men with surgery, radiation, or hormone therapy, all of which may cause serious side effects, would unnecessarily disrupt their quality of life.

What You Can Do Now?

If you’re a guy, or if you’re a woman who has a man in her life who has not taken any steps toward having his prostate tested, then it’s time to consider a few factors:

- One in six men develop prostate cancer is that one you? Talk to your healthcare provider about when you should have your prostate tests. Now may not be the time to have your PSA and DRE, but it is time to plan ahead.

- If you get prostate cancer, your life will never be the same, no matter what you read or people tell you. Research suggests that a healthful diet that is rich in antioxidants such as lycopene, quercetin, catechins, and procyanidins, may help protect against prostate cancer. (Konijeti; Jung; Reagan-Shaw) This is a step men can start at any age! You are never too young to reduce your risk of cancer through positive modifications to lifestyle, diet, exercise, stress-management, weight loss and nutrition as well as hormone and inflammation management, consuming limited dairy products and avoiding foods, additives and supplements that may contribute to prostate cancer. And while there is nothing that can “prevent” prostate cancer, this does not mean you shouldn’t do all you can to reduce your risk, no matter what age you are.

- Even if you think you’re too young to be tested, think again: prostate cancer can affect men in their thirties. Statistics from 1998 to 2002 found that the median age at diagnosis was 68 years, yet 0.5 percent of men between 35 and 44 were diagnosed with the disease, and 8.3 percent were between 45 and 54 at the time of diagnosis. (emedtv) And more and more evidence is showing that the positive effects of antioxidants is only being seen when commenced in your 20′s and early 30′s so it’s important to start eating healthy and taking positive lifestyle steps no matter what age you are.

- Think about adding to your diet and nutritional program with supplements like lycopene, quercetin, omega 3, mushroom extract, curcumin (turmeric), vitamin D, resveratrol, pectin, green tea, cayenne (capsaicin) that all have tier 1 and tier 2 clinical (human and animal) trials supporting their effectiveness in boosting immunity and causing apoptosis (self destruction) of cancer cells. And be cautious about supplements that may contribute to prostate cancer such as calcium and excessive folic acid/folate intake from supplements (as opposed to diet). Note also that daily multivitamin use has been linked to a higher risk of prostate cancer.

The bottom line. Talk to your doctor today and if it’s the right decision for you then “Man Up” and get tested. The earlier the detection, the better your treatment options and overall post-treatment quality of life.

References

Concato J et al. The effectiveness of screening for prostate cancer: a nested case-control study. Arch Intern Med 2006 Jan 9; 166(1): 38-43

Emedtv: http://prostate-cancer.emedtv.com/prostate-cancer/prostate-cancer-statistics.html

Jung YH et al. Quercetin enhances TRAIL-induced apoptosis in prostate cancer cells via increased protein stability of death receptor 5. Life Sci 2010 Feb 27; 86(9-10): 351-57

Konijeti R et al. Chemoprevention of prostate cancer with lycopene in the TRAMP model. Prostate 2010 Oct 1; 70(14): 1547-54

National Cancer Institute: http://www.cancer.gov/cancertopics/types/prostate

Reagan-Shaw S et al. Antiproliferative effects of apple peel extract against cancer cells. Nutr Cancer 2010 May; 62(4): 517-24

WebMD: Is prostate cancer screening still necessary? http://www.webmd.com/prostate-cancer/guide/is-prostate-cancer-screening-still-necessary

1. Prostate cancer. Research shows that pomegranate extracts can encourage prostate cells to commit suicide (apoptosis) and can also slow the reproduction of prostate cancer cells. (Albrecht; Rettig; Seeram) Components in pomegranates called ellagitannins can interfere with the growth of new blood vessels, which are necessary to nourish prostate tumors. (Sartippour) Other compounds, specifically punicic acid, delphinidin chloride, and kaempferol, can inhibit prostate cell growth stimulated by dihydrotestosterone (DHT). (Gasmi) Scientists have also noted that pomegranate can inhibit gene expression in androgen-independent prostate cancer. (Hong)

2. PSA. In studies, men with prostate cancer who had had surgery or radiation but whose PSA levels had climbed were given 8 ounces of pomegranate juice daily. While the average PSA level had doubled every 15 months before drinking pomegranate juice, it was taking 54 months by the end of the study. The juice also was associated with a 17 percent increase in cancer cell apoptosis and a 12 percent decline in the spread of cancer cells. (Pantuck)

3. Erectile dysfunction. Several studies provide evidence that pomegranate may have a role in erectile dysfunction. In one animal study, investigators compared pomegranate juice, red wine, green tea, and several berry juices and found that pomegranate juice showed the most antioxidant capacity. Long-term intake of pomegranate juice improved erectile function and reduced erectile tissue fibrosis. (Azadozoi) A study of men with mild to moderate erectile dysfunction found that pomegranate juice intake resulted in some improvement in erectile function. (Forest)

4. Breast and lung cancers. Studies in Israel report that pomegranate juice kills breast cancer cells without damaging healthy cells, and that it may also stop breast cancer cells from forming. (Kim) Other research indicates that pomegranate juice may inhibit the development of lung cancer. (Khan)

5. Osteoarthritis. Several studies indicate that pomegranate juice may prevent the deterioration of cartilage, which is characteristic of arthritis. A February 2010 study reported that pomegranate juice helped prevent cartilage damage in the knee joints of animal models with osteoarthritis. (Hadipour-Jahromy)

6. Rheumatoid arthritis. In a mouse model, pomegranate extract reduced inflammation and joint damage associated with rheumatoid arthritis. (Shukla) Another study reported that pomegranate extract and extract-derived compounds may be helpful in inflammatory diseases like rheumatoid arthritis by suppressing mast cells and basophils. (Rasheed)

7. Cholesterol and blood vessels. Pomegranate juice has been associated with both lowering cholesterol levels (the bad LDL cholesterol) and protecting blood vessels by preventing the buildup of plaque in the arteries and the development of atherosclerotic lesions. (Aviram 2002) A recent study found that 100% pomegranate juice and 100% black currant juice were superior to other beverages tested in inhibiting the formation of atherosclerotic lesions. (Rosenblat 2010) In another study, pomegranate had a positive impact on carotid intima-media thickness progression in some patients who had moderate risk of coronary heart disease. (Davidson)

8. Heart health. In patients with coronary heart disease, daily intake of pomegranate juice for three months improved stress-induced myocardial ischemia. (Sumner) Another study found that pomegranate juice can reduce cholesterol accumulation and the formation of foam cells, which contribute to lesion growth. (Fuhrman) Pomegranate juice also demonstrated several heart-related benefits in a study conducted in Israel, including reduction in lesion size in mice with advanced atherosclerosis, reduction in macrophage oxidative stress, and prevention of the development of atherosclerosis. (Kaplan) An analysis of both pomegranate juice and extract revealed that both have the ability to inhibit platelet activity, which is helpful in reducing cardiovascular disease risk. (Mattiello)

9. Metabolic syndrome. Pomegranate extract increased the actions of nitric oxide and supported arterial function in obese rats, suggesting it has potential clinical use in metabolic syndrome. (de Nigris)

10. Blood pressure. Research shows that adults with high blood pressure who drank 1.7 ounces of pomegranate juice daily lowered their systolic blood pressure by as much as 5 percent. (Aviram 2001)

11. Improves recovery from exercise. Researchers at the University of Texas at Austin found that supplementing with ellagitannins from pomegranate extract significantly improved recovery of isometric strength two to three days after engaging in exercise that had caused muscle damage. (Trombold)

12. Alzheimer’s disease. In an animal study from Loma Linda University, researchers administered pomegranate juice, which is rich in polyphenols, to one group of mice and sugar water to another. The mice given the pomegranate juice learned tasks more quickly than those given the sugar water. The pomegranate-treated mice also had significantly less (about 50%) accumulation of beta-amyloid in the brain. Beta-amyloid protein is believed to play a major role in the development of Alzheimer’s disease. (Hartman)

13. Supports healthy immune response. Pomegranate extracts and pomegranate juice are both rich in polyphenols. Experts note that daily consumption of these pomegranate products can support the immune system’s antioxidant, antimalarial, and antimicrobial capacities. (Reddy)

14. Type 2 diabetes. Pomegranate seed oil, which is a rich source of conjugate linolenic acid (CLA), was associated with an improvement in insulin sensitivity in one animal study, which suggests it may reduce the risk of developing type 2 diabetes. (McFarlin) Two other studies found that pomegranate juice and/or pomegranate extract had a positive impact on diabetic patients, suggesting daily use of these products could reduce their risk of developing atherosclerosis. (Rock; Rosenblat)

Whether you choose a fresh pomegranate, pomegranate juice, or a supplement, you will be treating yourself to a wealth of antioxidants and other nutrients, including vitamin A, vitamin C, and vitamin E, folic acid, fiber, potassium, and niacin and a boost to prostate and overall health.

References

Albrecht M, et al. 2004 Pomegranate extracts potently suppress proliferation, xenograft growth, and invasion of human prostate cancer cells. J Medic Food 2004; 7:274-83

Aviram M et al. Pomegranate juice flavonoids inhibit low-density lipoprotein oxidation and cardiovascular diseases: studies in atherosclerotic mice and in humans. Drugs Exp Clin Res 2002; 28(2-3): 49-62

Aviram M, Dornfeld L. Pomegranate juice consumption inhibits serum angiotensin converting enzyme activity and reduces systolic blood pressure. Atherosclerosis 2001 Sep; 158(1):195-98

Azadzoi KM et al. Oxidative stress in arteriogenic erectile dysfunction: prophylactic role of antioxidants. J Urol 2005; 174:386-93

Davidson MH et al. Effects of consumption of pomegranate juice on carotid intima-media thickness in men and women at moderate risk for coronary heart disease. Am J Cardiol 2009; 104:936-42

Forest CP et al. Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind crossover study. Intl J Impot Res 2007; doi: 10.1038/sj.ijir.3901570

Fuhrman B et al. Pomegranate juice inhibits oxidized LDL uptake and cholesterol biosynthesis in macrophages. J Nutr Biochem 2005; 16:570-76

Gasmi J, Sanderson JT. Growth inhibitory, antiandrogenic, and pro-apoptotic effects of punicic acid in LNCaP human prostate cancer cells. J Agric Food Chem 2010 Nov 10

Hadipour-Jahromy M, Mozaffari-Kermani R. Chondroprotective effects of pomegranate juice on monoiodoacetate-induced osteoarthritis of the knee joint of mice. Phytotherapy Res 2010 Feb; 24(2): 182-85

Hartman RE et al. Pomegranate juice decreases amyloid load and improves behavior in a mouse model of Alzheimer’s disease. Neurobiol Dis 2006 Dec; 24(3): 506-15

Hong MY et al. Pomegranate polyphenols down-regulate expression of androgen-synthesizing genes in human prostate cancer cells overexpressing the androgen receptor. J Nutr Biochem 2008; 19:848-55

Kaplan M et al. Pomegranate juice supplementation to atherosclerotic mice reduces macrophage lipid peroxidation, cellular cholesterol accumulation and development of atherosclerosis. J Nutr 2001; 131:2082-89

Khan N, et al. Pomegranate fruit extract inhibits prosurvival pathways in human A549 lung carcinoma cells and tumor growth in athymic nude mice. Carcinogenesis 2006 Aug 18

Kim ND, et al. Chemopreventive and adjuvant therapeutic potential of pomegranate (Punica granatum) for human breast cancer. Breast Cancer Res Treat 2002 Feb; 71(3):203-17

Mattiello T et al. Effects of pomegranate juice and extract polyphenols on platelet function. J Medicinal Med 2009; 12(2): 334-39

McFarlin BK et al. Pomegranate seed oil consumption during a period of high-fat feeding reduces weight gain and reduces type 2 diabetes risk in CD-1 mice. Br J Nutr 2008

de Nigris F et al. The influence of pomegranate fruit extract in comparison to regular pomegranate juice and seed oil on nitric oxide and arterial function in obese Zucker rats. Nitric Oxide 2007; 17:50-54

Pantuck AJ, et al. Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clin Cancer Res 2006; 12:4018-26

Rasheed Z et al. Polyphenol-rich pomegranate fruit extract (POMx) suppresses PMACI-induced expression of pro-inflammatory cytokines by inhibiting the activation of MAP Kinases and NF-kB in human KU812 cells. J Inflammation 2009; 6(1)

Reddy MK et al. Antioxidant, antimalarial and antimicrobial activities of tannin-rich fractions, ellagitannins and phenolic acids from Punica granatum L. Planta Medica 2007

Rettig MB, et al. Pomegranate extract inhibits androgen-independent prostate cancer growth through a nuclear factor-kappaB-dependent mechanism. Mol Cancer Therapeutics 2008; 7:2662 71

Rock W et al. Consumption of Wonderful Variety Pomegranate Juice and extract by diabetic patients increases paraoxonase 1 association with high-density lipoprotein and stimulates its catalytic activities. J AgricFood Chem 2008; 56: 8704-13

Rosenblat M et al. Anti-oxidative effects of pomegranate juice (PJ) consumption by diabetic patients on serum and on macrophages. Atherosclerosis 2006; 187:363-71

Rosenblat M et al. Consumption of polyphenolic-rich beverages (mostly pomegranate and black currant juices) by healthy subjects for a short term increased serum antioxidant status, and the serum’s ability to attenuate macrophage cholesterol accumulation. Food Function 2010; 1:99-109

Sartippour MR et al. Ellagitannin-rich pomegranate extract inhibits angiogenesis in prostate cancer in vitro and in vivo. Intl J Oncol 2008; 32:475-80

Seeram NP et al. In vitro antiproliferative, apoptotic and antioxidant activities of punicalagin, ellagic acid and a total pomegranate tannin extract are enhanced in combination with other polyphenols as found in pomegranate juice. J Nutr Biochem 2005 Jun; 16(6):360-67.

Shukla M et al. Consumption of hydrolysable tannins-rich pomegranate extract suppresses inflammation and joint damage in rheumatoid arthritis. Nutrition 2008; 24:733-43

Sumner MD et al. Effects of pomegranate juice consumption on myocardial perfusion in patients with coronary heart disease. Am J Cardiol 2005; 96: 810-14

Trombold JR et al. Ellagitannin consumption improves strength recovery 2-3 d after eccentric exercise. Med Sci Sports Exerc 2010; 42(3): 493-98

2. Avoid vigorous exercise and activities that stimulate or “jostle” the prostate, including bike riding, motorcycling, and riding a horse, ATV, or tractor, or prostate massage, for example, for 48 hours before your test.

3. Abstain from sexual a ctivity for 48 hours before your test. Ejaculation within this time period may affect PSA results, especially in younger men.

4. Wait at least six weeks after undergoing certain procedures including: prostate biopsy, transurethral resection of the prostate (TURP), urethral catheter, cystoscopy (procedure in which tube with a camera is passed through the penis to look into the bladder), or other procedures that involve the prostate. Consult your doctor before having your PSA tested if you have had any type of prostate procedure.

5. Have the DRE test. If you have a PSA test and a prostate examination scheduled (including a digital rectal examination [DRE]), make sure you have the PSA test done first. Although a DRE or other parts of a prostate exam should not affect PSA levels, doctors generally recommend doing the PSA test first as a precaution.

6. Stop taking certain medications before your test. Talk to your doctor if you are taking statins, nonsteroidal anti-inflammatory drugs, medications to control urinary problems such as finasteride or dustasteride, or other medications, natural supplements, and herbal remedies, such as saw palmetto. All of these substances have the potential to affect PSA levels.

In fact, roughly 80 percent of the 1.6 million men who undergo prostatic biopsy in the United States each year because of an elevated PSA level have negative results on their biopsy, according to Dr. Robert Getzenberg, MD, director of research at the Brady Urological Institute at Johns Hopkins.

Now, we are happy for those men who discover they do not have prostate cancer, but this is a very high number of men who are subjected to an invasive procedure that turns out to be unnecessary. What is needed is a test that is more accurate, that does not produce such a high number of false positives.

Now for the false negatives. Some cases of prostate cancer, especially those that grow rapidly, may not produce much PSA. This can result in a test result that incorrectly indicates that you don’t have prostate cancer when you do.

Overall, the downsides of PSA testing can be boiled down to the following:

• Concern about false-positive results that are caused by elevated PSA levels from something other than prostate cancer
• Having to undergo invasive, stressful, expensive or time-consuming follow-up tests
• Getting a false-negative result, leading to a missed diagnosis of aggressive prostate cancer that needs treatment
• Experiencing anxiety or stress caused by knowing you have a slow-growing cancer that doesn’t need treatment
• Having surgery, radiation, or other treatments that cause side effects that are more harmful than leaving the cancer untreated

As you can see, the simple act of getting a PSA test can result in many different scenarios. It’s important that you have a doctor who has lots of experience in interpreting PSA results along with any other information gathered from you and other tests in order that a proper and informative diagnosis is made.