Is a High PSA a Reason to Panic?

It is comforting to take a second, closer look at the findings from the Physicians Health Study. The study looked at deaths over a period of 30 years. Another way of stating the results of the data analysis is that 11 out of 12 men who have a PSA of 2.1 or higher before age 55 won't get prostate cancer and die of it before age 80. Also, six out of seven men who have a PSA of 3.9 or higher before the age of 59 won't get prostate cancer and die of it before the age of 85.

Prostate cancer is more often a disease men live with rather than die from. Because prostate cancer is seldom fatal, more and more doctors are advising watchful waiting rather than removing the prostate at the first sign of cancer. Once a man has his prostate removed, there is never again going to be an ejaculation. More often than not men who have radical prostatectomy lose erectile function and have to start wearing what are often called "man diapers" to deal with urinary and/or fecal incontinence. Other treatments may keep prostate cancer in check without the removal of the gland.

All of this being said, there are some aggressive forms of prostate cancer that require aggressive treatment. Men need to find doctors they can trust and work with them. Signs that there may be a need for a second opinion include:

• Pushing for treatment when your PSA is stable or declining.
• If your doctor recommends cancer-sensitive tests such as PHI or PCA3, make sure you are not part of a research study. You may be randomized to a treatment not optimal for your health for the sake of the study.
• If your doctor recommends annual prostate biopsies, also make sure you are not part of a research study. Annual prostate biopsies, which, as previously mentioned, are not without risks of their own, are often for the sake of research rather than for the treatment of the men who undergo them.

READ Prostate Health and Prostate Problems - What You Need to Know

The American Academy of Family Physicians has issued a statement that says "There is convincing evidence that PSA-based screening leads to substantial overdiagnosis of prostate tumors. Many tumors will not harm patients, while the risks of treatment are significant. Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by patients."

Look for a doctor who can maintain a long-term relationship with you in treating prostate cancer. Expect an explanation of why your prostate cancer has to be treated now and not later. Don't get it a hurry to have prostate cancer removed, and explore every option for staying as healthy as possible for as long as possible without surgery and radiation.