LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

PSA

PSA Testing: Is Medicine’s Idea of Prevention Falling Apart?

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IS MAINSTREAM MEDICINE’S IDEA OF “PREVENTION” FALLING APART?
While there is a clear distinction between early detection and prevention, mainstream medicine does not seem to recognize this.  Mammography, colonoscopy, PSA screening…these are all designed to catch disease in its early stage, but they are all catching the DISEASE (or at least the precursor to the disease like a polyp).
None of these actually address preventing the disease or condition in the first place.  Is it just me that seems disturbed by this?
Further confounding this issue is that we are beginning to find that mainstream medicine’s “prevention” is doing more harm than good.  Mammography’s effectiveness has come under fire (many lesions can resolve spontaneously, leading to high levels of overtreatment) and now PSA is under the same level of scrutiny.  The bottom line is that lifestyle changes NEED to be implemented instead of relying solely on early detection.

 

JUST HOW EFFECTIVE IS PSA SCREENING?

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It seems like all cancer screenings are coming under fire recently.  Rational, scientific attemps have been made to knock mammography off its pedastal, but emotions run very high on this topic and few see through this to the real story.  Interestingly, the mammography “debate” is not new and may have been started some 22 years ago in the medical literature, when well known researchers began to question whether we should be putting all of our hopes into mammography.

PSA testing is no different.  Not only are there questions about its effectiveness, but we really need to face the reality that some serious harms can come from overdiagnosis.  Again, this is not new news.  I had reviewed an article over 6 years ago looking at just how ineffective PSA screening was at saving lives.

This particular review article puts a more specific number on the effectiveness of PSA screening.  Overall, researchers found that, to prevent a single death from prostate cancer over the course of 11 years, 1055  men would have to be screened.  That’s basically a thousand-to-one odds.  If this is what we hang our hats on when it comes to cancer “prevention” in this country, we truly are sunk.

In this country, we continue to rely on early detection as a sick sort of prevention, despite the literally thousands of research studies finding lifestyle factors that promote and poor lifestyle factors that prevent many types of cancers.  It’s pretty clear cut.  Lifestyle prevents cancer in the first place so that we do not have to rely on screening to “prevent” cancer.

I have provided a more in-depth review of a variety of ways to lower your risk of prostate cancer in the past and will not go into it again here.  Just take this information and understand that cancer early detection tests (let’s not call them “prevention” tests) are a crap shoot at best, with massive levels of harm being done with false positives and detections of cancers that will likely never progress.  Go into your screening as well educated as you can be.

11 WAYS TO SKIP THE PSA TEST

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The United States Preventative Services Task Force has done it again. They have made the absurd claim that men should not be checking routine PSA levels. This recommendation is on the heels of recommendation against mammography for under 50s. What’s up?  Doesn’t routine PSA testing save lives?

I think I need to start this with a quick story. Last week I had a 52 year old patient who confided in me that he was diagnosed with prostate cancer 2 months ago. They plan on doing the daVinci robotic surgery in the next 6 or 7 months. The outcomes for these are generally good, but impotence is on the list of potential side effects.

Here’s the problem. He was completely unaware that prostate cancer was anything but luck of the draw. He’s not alone. Luckily, there are many things he can begin to implement in his lifestyle to change his trajectory. Who knows–maybe if his PSA changes in the next 6 months the surgery can be avoided.

Back to the USPSTF PSA screening recommendations.

Over 5 years ago we already had research strongly suggesting that PSA and DRE testing does not save lives. Obviously this research was brushed under the rug because and actually seems to have fueled an opposite reaction–I hear more of a push for men to get screened for prostate cancer then ever before. I don’t remember large POP (prostate on-site project) events or billboards promoting DREs a few years ago.

The problems with prostate PSA screening are much the same as those with mammography. (If you’d like the opinion of the doctor who first identified PSA, read more here)

First, prostate specific antigen (PSA), is not actually specific to cancer. Other factors like heavy exercise, prostatitis, BPH, age, large prostate volume and sexual activity can lead to elevated PSA. Some temporary, some permanant. Because of this, there is a heavy variation in what “normal” is. To confuse this issue, a little over 1/3 of prostate cancers have PSA levels within the “normal” range. This means that setting a value as “elevated” is going to catch a percentage of men who do not have prostate cancer and miss a large number of cases of prostate cancer. This weakens the value of the testing. 

Next, prostate cancer, by its nature, has a tendency to be slow growing. Because of this, many die with prostate cancer, not of prostate cancer. Many procedures are done as a result of PSA testing. These include surgery, biopsies, chemotherapy and radiation implants. So what happens when these procedures are done because of an elevated PSA due to non-cancer causes or procedures are done on slow growing cancers that would not have caused significant problems? The society costs are dramatic and result in no true life extension. If sure is easy to make it look like treatment is powerful at saving lives when the life was not at risk in the first place.

Third, and most importantly, PSA testing does not seem to trigger an educational process for the patient to lower their risk of progression. The factors that play a role in prostate cancer prevention are the same that can help with treatment. These include:

  • Increase your intake of non-GMO, unprocessed soy products (tofu, miso, soy milk, edemame)
  • Increase your intake of the omega-3 fatty acid ALA (pumpkin, flax, walnuts)
  • Avoid dairy products
  • If you drink juice, stick with darker juices like pomegrante and  cherry
  • Increase your intake of cruciferous veggies (broccoli, cauliflower, radish, bok choy, brussels sprouts)
  • Add Vitamin E in the mixed tocopherol form (NOT just alpha-tocopherol)
  • Increase intake of the red carotenoid lycopene (tomotos, grapefruit, watermelon)
  • Cut back on your calories
  • Avoid BPA in plastic water bottles and many canned goods
  • Maintain an anti-diabetic lifestyle and maintain an ideal body weight
  • Take a vitamin D supplement

So overall, there are many things we can do to lower our risk of prostate cancer. As always, I am not against cancer screening. I am, however, very strongly against using cancer screening as prevention. With all this knowledge about how to prevent prostate cancer, we should not rely on an uncertain test like the PSA to save our lives. Makes these changes to lower your risk of prostate cancer.