Prostate Specific Antigen (PSA) – A Tumor Marker? Justified or a Myth?
I confess that the title alone is biased and giving hints to my critical opinion when it comes to PSA Testing. So if you are convinced that PSA testing is a valuable way for detecting Prostate Cancer stop reading here.
The whole issue came up a few weeks ago when I consulted a urologist here in Germany. I had since about a year problems with urination. I had to get up often five times and more per night. During the day, I had built a network of cafes in town, which let me use their toilet. That is a vicious cycle by itself, as you drink coffee for being allowed to the men’s room only to pour more fluid into the bladder.
My urination problem was even more molesting when riding with friends and relatives in a car. The urge of using the bathroom came without warning and left hardly any time to find relieve. Sometimes it was nearly impossible to stop on a construction site of the Autobahn. So whenever I rode with somebody in a car, I gave a warning upfront about this problem. I am using for my traveling now much more often luxury busses or the railway that all have the relevant facilities.
So when I came back to my home country, the first thing I visited a urologist. I relied on a recommendation of a friend of a friend. But I believe that did not make lots of a difference.
After telling about my urination problem, the doctor did a DRE (Digital Rectal Examination) and took a Rectal Ultrasound Image of the bladder/prostate situation. While waiting for the final discussion his assistant draw a blood sample for a PSA Test.
PSA is standing for Prostate Specific Antigen, which is an enzyme the prostate produces to liquefy the semen.
Finally, we discussed the findings with the DRE and the Ultrasound. The checks clearly proofed that my prostate has a size of about 100 ccs, three to four times more than the prostate of young men. These have a prostate of a size of a chestnut measuring about 20 to 30 cc. The DRE found no irregularities like hard lumps that are an early indication of a prostate cancer.
So his indication was that I have a BPH, a Benign Prostate Hyperplasia (Enlargement).
As a first treatment, he prescribed DUODART, a combination preparation of a Reductase inhibitor and Tamsulosin belonging to the pharmaceutical class of Alpha-blockers. This medication worked promptly. After three days of taking it I was able to sleep through all night).
We agreed another consultation after about four weeks to talk about the effectiveness of the Medication and how to approach the BPH.
That happened on a Wednesday. Friday morning his assistant called me in for another PSA test as the laboratory had found a PSA value far over triple the value as what is supposed the “maximum normal” of 4 ng/ml.
Being a moderate hypochondriac, I got alerted and. I immediately searched on Google all the afternoon what I could find about prostate cancer issues.
I had heard a few times that PSA testing was controversy discussed in the medical community as well as by the health authorities. These have to decide who is going to pay for not only the testing but all the treatment like Biopsies and operations afterward. However, I did not know anything specific.
While I was busy with searching for more information on Prostate Cancer, I remembered that my Cardiologist Physician in Germany years ago did a PSA test on my request together with other Laboratory tests. I remembered that he called me after a few days and advised me to consult a Urologist as the PSA values were outside the normal spectrum. But I did not any more remember the range of PSA values. So I visited the next urologist. It was not the one I mentioned above.
This person was mad at me as he did not get the order for the PSA testing from me, but at the end he did a DRE. He wanted, based on his findings and the PSA Test results do an immediate Biopsy that I denied as I found the person and his clinic very unclean and not sterile enough to do any invasive procedure.
At this time, I was just at the start of traveling the world, so I forgot the prostate issue completely. Only years later visiting Argentina I got remembered that I had once a prostate concern when I found blood in my Urine. Being the Hypochondriac already mentioned I immediately consulted a Urologist in Buenos Aires who reassured me after a DRE and a laboratory test of my blood and Urine that all was okay with my prostate. I just had gotten a Bladder infection changing from the hot weather in Central America to the Argentinian winter. A treatment with Antibiotics cured that problem within a few days.
So now after I had learned that the urologist had found a high PSA Value I remembered the testing years ago in Germany. I wondered if my cardiologist had still laboratory records, so I sent him an immediate email. Despite the fact, that I only was able to give him only a time window of four years around the turn of the millennium he sent me back the laboratory data within an hour.
The test report he did in 2002 showed a PSA value of 8.1 ng/ml. That was more than double of the already supposed normal value of four Nano Grams per milliliter. I felt relieved that moment as the Test was done exactly 13 years ago. During this time, I traveled the world without any health problems.
It confirmed to me that the PSA test definitely could not be a useful cancer tumor marker. Otherwise, I would be already dead or at minimum weakened and not be able to do my travels.
I had found in the meantime some reports on the internet about the irrelevance of PSA testing indicating Prostate tumors.
Also, I have a healthy and critical distance on journalistic reporting. However, many of the articles I found were citing a book published by a Professor Richard Ablin. Dr. Ablin is researching at the medical department at the University of Arizona.
Dr. Ablin is not just a Pathologist and Biochemist who is giving his opinion on PSA testing: No, he is the man who found and determined the PSA Molecule in 1970.
His Book “The great Prostate Hoax” with the subtitle “How big Medicine Hijacked The PSA Test And Caused A Health Disaster.” He published it only in 2014. The content seemed updated, and relevant and easy to read.
I immediately contacted Amazon here in Germany, and I was happy they were keeping a few copies of the book in stock too. So I ordered it for shipping the fastest way. I was keen to read it before my visit to the Urologist following Wednesday.
For Monday, the supposed day of arrival I blocked or postponed all appointments and jobs to read the 260+ pages hardcover. It is normally not my way to react so swiftly.
But nothing less than more information to discuss important facts about my health was on its way, and I wanted to get my peace of mind as fast as possible.
As planned I read the book in the remaining hours of Monday after 10 am when the book got delivered.
Instead of writing my personal conclusion, I want to cite one of the reviews on the back cover of Margaret I. Cuomo, MD, Author of A World Without Cancer, it says it all:
“The Great Prostate Hoax boldly exposes the profit, politics, and fraud behind PSA Screening and the serious harm done to countless men. This is a must-read for every man and the women who care about them”.
The core information the book is concentrating on are Prof. Ablin findings what PSA is not:
PSA is not a Tumor marker
Most men, when tested on PSA, will show a positive PSA value higher than the 4ng/ml.The fear being tested positive for prostate cancer drives these men in the arms of an unholy alliance formed from Urologists, surgeons, the pharmaceutical and the industry providing diapers, etc.
This value of 4ng/ml is entirely arbitrary, as a representative of Hybritech, the firm applying for the introduction of the test before an FDA panel, confessed in the medical device approval process. “We could have changed the data and made it 6.0, 8.0 made it 10, anything we want”. Latest at this point, the approval already should have been denied. I want to mention here also that having a Zero value of PSA does not prove that there is nocancer at all.
After reading the book, I was getting calm again, and I did not spend more time pondering about suffering from a potential prostate cancer. Remember I had a PSA value of 8.1 more than 13 years ago and I am still feeling healthy all the time since. The fact that I heard now the PSA value was only arbitrary confirmed my dealing with the issue thirteen years ago was correct.
Now I was looking forward to the discussion with the urologist.
I had prepared many questions and hoped the doctor would be listening to my preparation.
As I had read the book in great detail I should have known better: He was not even prepared to listen to my arguments.
Finally, I said ok let us see what today’s PSA test will show I am better prepared for it now.
He was lifting his eyebrows, which preparation, which PSA test?
While last time I was doing a brisk half hour walk and I was a little out of breath arriving at the clinic. This time I took the tram, I had no sexual encounters the night before (as I did not last time). The DRE and the Ultrasound probe were not done before taking the blood sample. My prostate should be not stimulated to secrete more PSA.
He said this kind of irritations do not have any influence increasing the PSA count. And about what PSA test you are talking. He declared I am not called in for a PSA test but for a clotting status to find out if my blood coagulates well enough.
Now the question was coming from my side: What biopsy? He said as the laboratory found out my blood was clotting well he wants to do a biopsy now.
Sorry I said, you will not do any biopsy based on the PSA value found. I was turning down the procedure now a second time also out of a different reason.
He could not believe what he heard: Some lay person is turning him down on a medical procedure.
I had him already sent before the PSA value from 13 years ago and told him I lived very well and healthy without a biopsy, which would it have been positive had turned my upside down.
13 years ago I had not the time and resources like the internet to search and find out that the most prostate cancers are growing very slow. Most men who have prostate cancer die from other diseases with an underlying prostate cancer in high age and not because of prostate cancer.
So for what you think you are here now?. I told him that I was assuming as his assistant called me to come in for another PSA test. I reported being prepared now better than last time as my prostate gland will not be irritated through rough exercise and probing with the finger and the Ultrasound device.
Also, I wanted to discuss how good the prescribed medication worked in the meantime.
Additionally I had prepared for treating the BPE a few questions for example how the mostly applied procedure was a TURP ( transurethral resection of the Prostate ). Based on his findings during the last session I had a 3 to 4 times bigger prostate, which, by the way, alone was a strong reason for an elevated PSA value.
He became very impatient now saying I would hardly find any surgeon who would do a TURP without a biopsy done before. I contradicted that with a TURP they would get enough material anyhow for a cancer test chances were as good as taking a few samples with a needle biopsy on the outer area of the prostate.
He gave in on that point that in such a case a TURP would be considered only a palliative treatment only to relieve my urination problems. So he would assume it could be done.
I told him that I would like to discuss the TURP not earlier than three months from now. The medication is working great without potential side effects, so there was no urgency. I told him that I still needed to do some more research and consultations as I read that even TURP can lead to problems as impotence and incontinence if not done correctly. For the moment, my urination problem was well in check with the medication he prescribed and that I would be prepared to postpone a TURP or any other surgical procedure for the next three month.
He already had arranged some reading material on Biopsies as well as for the total resection of the prostate as well as about the primary radiation treatments.
We will meet again for a consultation four weeks after my first one as planned first. Another PSA test will be done, and he mentioned already that he is expecting a lower value because of the medication.
Medication, prostate volume and mechanical irritation alone prove to me the PSA test with so many variables influencing the results is at best unreliable to detect cancer.
I am not an MD, so I only can recommend that you read the upper mentioned book to build his personal opinion and visit more than one Urologist.
I had more or less the unintended luck that despite a very high PSA value of above 8ng/ml and denying a biopsy out of hygienic reasons.
Read Prof. Atkins book to learn more about the PSA issue and find from there a decision for yourself. Should you have “only” a urination problem, medication is out as a reliever. There is no need for hurry, even a full-blown prostate cancer is only growing slowly, so there is enough time to look for the best consultation. Remember only two out of thousand men die from Prostate Cancer but 60 % of men over 60 have one which is growing slower than the progression of their aging.
Health agencies are now alerted about the nonsense of PSA testing. They are supporting the search for more specific markers.
In the meantime stay alert.
I will continue this blog and let you participate in the further handling of my BPE treatment. My next appointment is the 30th of September for drawing blood for the next PSA test and on the 5th of October 2015 to discuss the result, the impact of the medication and the treatment of the BPE. For the TURP, I am considering to see another urologist.
Blog Version 1.2 of September 23, 2015