By Dr. Mercola
In a startling reversal of years of pressing healthy and symptom-free men to get routine PSA prostate tests, U.S. health officials now say these tests do more harm than good.
What's more, the United States Preventive Services Task Force (USPSTF) said they aren't recommending the tests for men of any age.
The task force is basing its new stance on research that shows that only zero to one out of every 1,000 men who are screened would actually benefit from the exam, while many others would suffer from the side effects of unnecessary treatments, ranging from impotence to death.
Task Force Rules PSA Test Not Worth the Risk for Most Men
The prostate-specific antigen test (PSA test), analyzes your blood for prostate-specific antigen (PSA), a substance produced by your prostate gland. When higher-than-normal levels of PSA are detected, it is believed that cancer may be present, even though other factors, such as age or enlarged prostate, can also cause elevated levels. A biopsy is often recommended at that time to determine whether cancer is, in fact, present.
While public health agencies such as the American Urological Association still recommend PSA testing, in 2008 the USPSTF recommended that men over the age of 75 no longer get PSA screenings and began reviewing data to make a decision about younger men.
Their review is now complete, and after reviewing published research to measure the benefits and harms of screening for prostate cancer with PSA testing, they gave the test a "D" rating, meaning that "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits."
"For men of any age, the USPSTF recommends that doctors and patients do not screen for prostate cancer because the potential benefits do not outweigh the harms. However, the USPSTF realizes that some men may continue requesting the PSA test and some physicians may continue offering it. The decision to start or continue screening should be an informed one that reflects an understanding of the possible benefits and harms and should respect an individual man's preferences."
PSA Levels Can be Elevated for Many Reasons
Many experts agree that PSA testing is unreliable at best and useless at worst for accurately diagnosing prostate cancer, because PSA levels fluctuate for a variety of reasons, one being age, which causes PSA levels to rise. According to the National Cancer Institute:
" ... there is no specific normal or abnormal PSA level. In addition, various factors, such as inflammation (e.g., prostatitis), can cause a man's PSA level to fluctuate. It is also common for PSA values to vary somewhat from laboratory to laboratory. Consequently, one abnormal PSA test result does not necessarily indicate the need for a prostate biopsy."
However, biopsy is typically what is recommended if a PSA test comes back high. Similar to mammograms (which the USPSTF ruled were no longer necessary for women under 50), the PSA screening has a high false positive rate, and the bulk of the harm is a result of the damage done by subsequent unnecessary treatments.
There are over one million prostate cancer tissue biopsy procedures performed annually in the U.S. Approximately 25 percent of these tissue biopsies are reported "positive," indicating the presence of prostate cancer. The remaining 75 percent are reported "negative." One-third of the men with initial "negative" results for prostate cancer actually do have prostate cancer that was missed by the biopsy.
A prostate biopsy involves inserting fine needles into the prostate gland. But specialists have begun to worry about a recent, significant increase in the risk of complications from the procedure. In particular, they are concerned about hard-to-treat bloodstream infections that can require weeks of treatment. Over the past decade, the rate of hospital admissions in Ontario, Canada, for serious infections caused by prostate biopsy increased four-fold.
Many men also experience pain, fever, bleeding, difficulty urinating, or other serious problems following a biopsy, not to mention the worry over the procedure and its negative results. If cancer is detected through a biopsy, which reportedly occurs in about 120 cases in 1,000, surgery, radiation or hormone treatment is typically offered, and upwards of 90 percent of men will accept. This, too, is problematic because the treatment itself can lead to complications, even death, whereas prostate cancer is often very slow growing, may never become invasive, and therefore is sometimes better left untreated.
"If a biopsy finds seemingly malignant cells, as happens to 120 in 1,000 screened men, about 90 percent of men opt for surgery, radiation or hormone-deprivation therapy. Up to five men in 1,000 opting for surgery will die within a month of the operation; 10 to 70 more will have serious cardiovascular complications such as a stroke or heart attack. After radiotherapy and surgery, 200 to 300 of 1,000 men suffer incontinence, impotence or both. Hormone-deprivation therapy causes erectile dysfunction in about 400 of 1,000 men."
Prostate Cancer is Generally Very Slow Growing
This is an important point, because you still might be wondering why the USPSTF would want to do away with PSA testing, given that prostate cancer is the most commonly diagnosed cancer among U.S. men (other than skin cancer). The answer is two-fold.
First, as mentioned above, the false positive rate is high, which means many men go through biopsies unnecessarily. Second, many prostate cancers end up causing no problems to the patient, who may have never even known it was there, if not for the screening.
"Good evidence shows that PSA-based screening can cause harm, including pain and complications from prostate biopsy and worry about test results. However, the more worrisome harms are related to treatment of prostate cancers found by screening when most of these cancers, if not detected by screening, would never have caused problems for the patient. The side effects of prostate cancer treatments include sexual dysfunction, bowel and bladder incontinence, and even death."
In other words, men end up getting highly toxic, dangerous treatments for a disease that probably would never have harmed them (PSA tests cannot distinguish between slow-growing and fast-growing prostate cancer). In fact, many of these cases are only defined as "cancer" based on outdated research from the 1800s. Dr. Otis Brawley, chief medical officer of the American Cancer Society, stated "As many as 70 percent of these lesions are cancer only by this antiquated definition and not in behavior," meaning that the "cancer" is not a threat to the man's life.ii
Of course, screening advocates immediately protested, saying the new recommendation will cost lives. But critics of PSA testing responded that, instead, thousands of men will be spared impotence and incontinence that occurs as a result of needless cancer treatment. Brawley continued:iii
" ... men are rendered impotent and put in diapers, and for what? They never really had cancer in the first place."
This is very similar to the issue of mammograms detecting Ductal Carcinoma In Situ (DCIS), the abnormal growth of cells within the milk ducts of the breast, in women. Although sometimes classified as non-invasive or "stage zero breast cancer," with some experts arguing for its complete re-classification as a non-cancerous condition, many conventional physicians view DCIS as "pre-cancerous" and argue that, because it could cause harm if left untreated it should be treated in the same aggressive manner as invasive cancer, often leading to unnecessary treatment and harm.
To be clear, USPSTF is not suggesting the PSA screening never be used, just that it shouldn't be offered to every man at his yearly visit. The test would still be available as individual cases dictate, such as if a man has a very high risk of aggressive prostate cancer or symptoms that may be cause for alarm.
Many men are responding with outrage at the news that the PSA test will no longer be recommended, and as a result may not be covered by insurance companies in the future. Many prostate cancer survivors credit the PSA test with saving their lives, even though they, too, may have simply been overtreated. Shannon Brownlee, author of Overtreated, wrote in Time Magazine:iv
"The trouble is most men who get treated didn't have a cancer that needed treating. So while a given man may believe fervently that early treatment saved his life, there's a better than even chance that he would have been fine even if his cancer had been left well enough alone.
We never hear from the men who died from their prostate cancer treatment or biopsy. And there have been plenty of them. The mortality rate during or shortly after prostate surgery is estimated to be 1 in 200, according to a study published in the Journal of the National Cancer Institute.v
We also don't hear much from the men who are suffering from incontinence, impotence, or both, the devastatingly common side effects of treatment."
Mammograms for Women Share Many of the Same Issues as PSA Tests for Men
In many ways, mammograms are the equivalent of the PSA test for women. In 2009, revised mammogram guidelines were issued by the USPSTF, which found that the benefits of mammogram screening do not outweigh the risks for women under the age of 50. Therefore, they recommend that women wait to get regular screenings until the age of 50, and only get one every other year thereafter. This caused a backlash from women and doctors who felt their "life-saving" screening tool was being taken away, and certain public health agencies, like the American Cancer Society, did not modify their recommendations and still recommend yearly mammograms starting at 40.
As is the case with the PSA test, mammograms carry an unacceptably high rate of false positives— up to six percent— which can lead to repeat screenings that expose you to even more radiation, as well as unnecessary medical procedures, including biopsies, surgery, and chemotherapy. A study published in the British Medical Journalvi confirmed that breast cancer screening may cause women harm, especially during the early years after they start screening. This harm is largely due to surgeries, such as lumpectomies and mastectomies, and other (often unnecessary) interventions. The study highlights losses in quality of life from false positive results and unnecessary treatment.
In September 2010, the New England Journal of Medicinevii published the first study in years to examine the effectiveness of mammograms. Their findings are a far cry from what most public health officials would have you believe. The bottom line is that mammograms seem to have reduced cancer death rates by only 0.4 deaths per 1,000 women— an amount so small it might as well be zero.
Put another way, 2,500 women would have to be screened over 10 years for a single breast cancer death to be avoided. This does not factor in the costs and unnecessary surgeries that are done from false positive mammograms. Remember, mammograms are unsafe (as they use ionizing radiation at a relatively high dose, which can contribute to the mutations that can lead to breast cancer), and they are NOT saving women's lives, as was commonly thought. For more information on mammography and tips for preventing breast cancer, read this past article.
Healthy Tips for Preventing Prostate Cancer
While prostate health becomes more important with age, particularly for men over the age of 60, it's worthwhile considering this issue far in advance. Although you may be able to reverse the damage, ideally you'll want to prevent these problems from ever occurring in the first place.
Men over 70 have a 50/50 chance of developing an enlarged prostate, known as benign prostate hyperplasia (BPH). This is not the equivalent of prostate cancer. However, you do need to address this issue, and unfortunately, the conventional route includes drugs. It's important to know that some of these drugs actually carry a warning label that if you have benign prostate hyperplasia, the drug may increase your cancer risk, and/or may promote a much more aggressive form of cancer.
For more information about this, please review this previous article on prostate health, which includes an informative interview with Dr. Rudi Moerck.
Total Video Length: 36:34
Download Interview Transcript
Diet is clearly a factor that can greatly impact your prostate health and help prevent enlarged prostate and prostate cancer. You'll want to eat as much organic (preferably raw) food as possible, and liberally include fresh herbs and spices, such as ginger. Make sure to limit carbohydrates like sugar/fructose and grains as much as possible to maintain optimal insulin levels, which will help reduce your cancer risk in general. Highly processed or charcoaled meats, pasteurized dairy products, and synthetic trans fats correlate with an increased risk for prostate cancer and should also be avoided.
There are also a number of more specific nutritional therapies that are particularly beneficial for avoiding and/or treating prostate cancer.
- Include prostate-healthy foods in your daily diet: Foods that support prostate health include vegetables and fruits rich in antioxidants, vitamins, cartenoids like astaxanthin and lycopene. One 2009 study identified tomatoes, cauliflower, broccoli and green tea as being particularly beneficial against prostate cancer.viii
- Try saw palmetto: The medical literature contains about 100 clinical studies on saw palmetto for prostate health and reduced incidence of prostate cancer. According to Dr. Moerck, saw palmetto in combination with pumpkin seed or lycopene may be an even more potent combination.
Beware that quality is very important when selecting a saw palmetto supplement. Most brands on the market are ineffectual because they use the inactive form of the plant.
The highest quality products are the organic supercritical-extracted saw palmetto oils, which are very dark green in color. Only one or two out of every 20 brands will be of this high quality. Dr. Moerck recommends a daily dose of 320 mg of saw palmetto oil (supercritical CO2 extract). Keep in mind that saw palmetto is a fat-soluble supplement, so it will not absorb well unless you take it in conjunction with a little bit of fat. I recommend taking it with eggs, which contain phospholipids that enhance absorption of fat-soluble nutrients.
- Consumed flaxseed: Something as simple as eating flaxseed may have a hugely beneficial effect in both benign and malignant prostate enlargement. In fact, a 2007 study published in the Journal of Medicinal Food found that flaxseed lignan extract was comparable to pharmaceutical 1A-adrenoceptor blockers and 5-alpha reductase inhibitors in reducing symptoms of benign prostatic hyperplasia.ix Even more remarkably, a 2008 study published in the journal Cancer Epidemiology, Biomarkers & Prevention found that the consumption of little over an ounce of flaxseed in the diet for 21 days before prostate surgery significantly reduced prostate cancer proliferation rates in those men.x
- Optimize your vitamin D levels: ideally by exposing your bare skin to natural sun light on a regular basis. Evidence suggests that vitamin D may be one of the most potent variables associated with a lower risk of prostate cancer, and you can learn more about optimizing your levels here. If you can't get regular sun exposure, you may want to consider using a safe tanning bed (one that uses electronic rather than magnetic ballasts and has less, not more, UVA than the sun produces). If these are unavailable you can opt for an oral vitamin D3 supplement. Keep in mind that when using a supplement, regular testing becomes even more important to make sure you're staying within the therapeutic range.
- Consider a vitamin K2 supplement: Another nutrient that has been found to offer significant protection against prostate cancer is vitamin K2. For more information about that, please refer to this previous article.
- Exercise your body, and your prostate: Having a well-rounded exercise regimen is essential for overall health, and is now becoming more widely accepted as a critical piece of cancer prevention and treatment. Having sex on a regular basis, which exercises your prostate specifically, is also beneficial.
- Check your testosterone levels: Contrary to popular belief, restoring testosterone levels in aging men does not appear to promote prostate cancer— on the contrary! According to meticulous research by Dr. Abraham Morgentaler, MD, author of Testosterone for Life, menwith low testosterone are the ones at greater risk. Unfortunately, this false assumption has led to a dogmatic belief that testosterone replacement increases your risk of prostate cancer— a belief that might now be preventing many men from experiencing optimal health.