Men have been harmed by routine PSA testing

Terry Dyroff's PSA blood test led to a prostate biopsy that didn't find cancer but gave him a life-threatening infection.
Terry Dyroff's PSA blood test led to a prostate biopsy that didn't find cancer but gave him a life-threatening infection. (JOSE LUIS MAGANA / Associated Press)
Posted: October 13, 2011

Terry Dyroff's PSA blood test led to a prostate biopsy that didn't find cancer but gave him a life-threatening infection.

In the emergency room several days later, "I didn't sit, I just laid on the floor, I felt so bad," said Dyroff, 65, a retired professor from Silver Spring, Md. "I honestly thought I might be dying."

Donald Weaver was a healthy 74-year-old Kansas farmer until doctors went looking for prostate cancer. A PSA test led to a biopsy and surgery, then a heart attack, organ failure, and coma. His grief-stricken wife took him off life support.

"He died of unnecessary preventive medicine," said his nephew, Jay Siwek, vice chairman of family medicine at Georgetown University. "Blood tests can kill you."

Since Friday, when a task force of independent scientists said routine PSA testing does more harm than good, urologists who make a living treating prostate cancer have rushed to defend the test, as have some other doctors and patients who believe it saved their lives.

Less visible are men who have been harmed by testing, as Dyroff and Weaver were. The harm is not so much from the test itself but from everything it triggers - biopsies that usually are false alarms and treatments that leave many incontinent or impotent - for cancers that in most cases were not a threat to begin with.

Once a PSA test suggests a problem, many men can't live with the worry that they might have cancer. And once cancer is found, most men feel they must treat it, usually at their urologist's urging.

"There are many men who have had serious consequences from treatment. Those stories don't get told and they are not uncommon," said Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, which thinks the task force reached "an appropriate conclusion" about the PSA test.

"I'm not going to criticize men who believe that their lives have been saved by this test," because that's what doctors have told them, Lichtenfeld said. "If you're sitting there and you wet your pants three times a day, you've got to believe it's worth it, that it saved your life."

Many men who agree to a PSA test do not understand what it is. It does not, for example, show cancer. PSA is just a measure of inflammation, and it can be elevated for many other reasons: normal enlargement of the prostate with age, an infection, even recent sex, a strenuous bike ride, or horseback riding.

The real message from the task force is that a better screening tool is needed, said Christopher Logothetis, prostate cancer research chief at the University of Texas M.D. Anderson Cancer Center in Houston. There may even be other ways to use the PSA - employing it as a baseline test and tracking its rise over time - that might prove better than annual testing.

"If the debate gets reduced to 'there's a right and a wrong,' we will lose what we are being told here, which is to search for the path forward," Logothetis said.

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