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To PSA or Not To PSA? I’m As Lost As You

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(credit: ANNE-CHRISTINE POUJOULAT/AFP/Getty Images)

(credit: ANNE-CHRISTINE POUJOULAT/AFP/Getty Images)

Recent Blog Entries From Dr. Dave Hnida


Written by Dr. Dave Hnida, CBS4 Medical EditorIt’s kind of a rite of passage for us men: hit age 50, go to the doctor, get a rectal exam (aka finger wave) and a PSA blood test.

Even though women go through a lot worse, and worse things more frequently, us guys still whine about it.

But now we hear that the PSA blood test may do more harm than good.

That pronouncement comes from the U.S. Preventive Services Task Force, the same group who made the world angry a few years ago when they said mammograms for women in their 40s were a waste of time and money.

This time around, they looked at the effectiveness of having a PSA, and after weighing the evidence, gave it a grade of D. Not so hot.

But that grade made an awful lot of urologists hot, who argued today that the PSA is effective, and the task force was full of … ah, what you might step in on a horse farm.

Some cancer experts, on the other hand, said the recommendation is a good one. The PSA isn’t perfect, and may be even be a worthless test when you look at it in the big picture.

That’s because an abnormal PSA doesn’t mean deadly cancer. It only suggests there may be cancer — but doctors being doctors, and men being men, we like to put people through biopsies or have “drastic” procedures done to kill off any chance that we might die from a treatable cancer — even if it’s so slow growing we’d probably die from something else before the cancer actually hurt us.

The point here being is that a PSA doesn’t tell you if you’re in big trouble or whether you can ride it out for decades.

Plus it’s wrong 80 percent of the time — saying you have a problem, and you really don’t.

The Task Force says for every 1,000 men who have a PSA :

- 1 will have his lived saved

- 1 will develop a life threatening blood clot because of unnecessary treatment

- 2 will have a heart attack because of unnecessary treatment

- 40 will become impotent or incontinent because of unnecessary treatment

What’s my advice as a man and a doctor over 50?

I don’t like blood tests, and hate the finger wave. But at this point, I’m probably going to keep checking. Then if something comes back abnormal, at least I have the option of biopsy, treatment or just hanging out and seeing if I die in 20 years from being hit by a bus.

Life is about options. The PSA isn’t the best test, but its the only test we’ve got. Even though it’s not black and white.

And that’s the message of this whole thing. Keep your options open. There is no right or wrong answer to this puzzle … at least not yet.

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