Prostate tests may cause more harm than good?

Q: I’ve just read this article titled ‘Prostate tests may cause more harm than good’. What’s your opinion on this? Thanks.

A: Good question. 

To test or not to test, it is up to the patient to decide. If a male patient wants PSA , digital rectal exam, transrectal ultrasound or a prastate biopsy(if the first 3 are abnormal), any normal professional doctor would comply with an added caveat that no lab test or tests is/are 100% accurate.
Dr Neil Fleshner’s opinion is that of the current Canadian MD thinking:
“Canadians physicians know screening for prostate cancer saves lives, he said. The preferred approach in Canada is to find the cancer but not necessarily treat it, an approach called “active surveillance,” 
It is the treatment like radical prostatectomy, orchidectomy (surgical castration), or estrogen therapy (chemical castration) which can do more harm than good.
If the doctor explains the test results and options to the patient well, it is highly unlikely that the patient would be harmed.
As the saying goes: “Ignorance is the worst cardinal sin!”
Here is additional reading for those who might be interested: .  As well  search under “Prostate”
or Stay Active to Reduce Your Risk of Prostate Cancer in the same Johns Hopkins’ website.

1 thought on “Prostate tests may cause more harm than good?

  1. Update on Prostate Tests:

    Does PSA Testing Hurt or Help?

    Although some experts — including those from Johns Hopkins — strongly disagree with its final recommendation, the U.S. Preventive Services Task Force (USPSTF) says that routine prostate-specific antigen (PSA) tests should be discouraged for all healthy men.
    The USPSTF asserts that the blood test for prostate cancer screening causes more harm than good. Elevated PSA scores can lead to unnecessary biopsies or overtreatment with surgery or radiation therapy, the panel says. The controversial guidelines were published online in May 2012 in Annals of Internal Medicine.
    About 90 percent of men with PSA-detected cancer undergo treatment — but without treatment, only a tiny fraction would die of prostate cancer. As a result, says the USPSTF, up to 70 in 1,000 men suffer needlessly from lifelong complications, such as urinary incontinence, erectile dysfunction and impotence.
    Overdiagnosed and overtreated. H. Ballentine Carter, M.D., director of adult urology at Johns Hopkins, agrees that prostate cancer is overdiagnosed and overtreated. But he doesn’t agree that the PSA test should be discouraged. “If one looks at the evidence, it’s possible to put emphasis on the harm or the benefits. The task force chose the approach of emphasizing harms and minimizing benefits. But it’s not so much the PSA test,” he says. “It’s what we do with the information we get from it.”
    The test measures PSA levels, which, if high, can indicate cancer — or a benign condition like an enlarged or inflamed prostate, leading to an unnecessary biopsy. If cancer is found, most tumors will likely not progress or progress so slowly that they’ll never cause symptoms. Therefore, most experts do agree that men with a life expectancy of less than 10 years or most men over age 75 forgo the PSA test.
    The USPSTF considered data from two major clinical trials and concluded that only about one in 1,000 men screened avoids death due to prostate cancer. Critics contend that the trials had inadequate or flawed data and at least one better study — which found a 44 percent reduction in prostate cancer deaths among men screened — was given little consideration.
    What’s needed, Dr. Carter says, is targeted screening instead of a one-size-fits-all approach. He and his colleagues are developing a tool to be integrated with electronic medical records to help doctors and patients make informed screening decisions. Meanwhile, he stresses the value of personalized care, advising men to discuss the PSA test’s risks and benefits with their doctors — and that doctors should not order the PSA test without discussing it with their patients.

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