I find the arguments against testing compelling. I know that my prostate is enlarged, and together with all the biking, I'm guessing that my PSA score would be high, even if there's no cancer.
... but I don't want to head down the road to possible false positives. I'm 57 and have never had a psa test.
My problem is that I don't know whether to trust my doctor or not. Sometimes he says things that seem pretty kooky to me.
Everyone is fine now, but you can see how it influences my thinking, for better or for worse.
Maybe its because of my Post-Medical-Stress-Disorder that I see it as the same thing, just at a different end of the body. If you get a high PSA value, you may have a life-threatening cancer growing inside you. Or maybe not. So you have the biopsy, and wait by the phone for the results. Etc.
A lot of people "win" the PSA lottery, finding an aggressive cancer and getting cured. But stories from lottery winners don't mean that it makes sense to buy a lottery ticket.
Al, we come from different ends of the bias bell curve, but let me share this logic anyway.
First, you need a new doctor. They're everywhere and they keep making more of them. You, one of the most frugal people I've ever met, know how to shop for a quality product. You keep sampling them until you find one who thinks like you and makes you feel better. If you think they're kooky then go find another one. Life is too precarious to waste your time, energy, & emotion dealing with a guy who may or may not have your best interests at heart.
Second, your lottery analogy is flawed. Think of it more as a Russian Roulette analogy. By not having a PSA you do indeed remain blissfully ignorant, but you also limit (or even eliminate) your treatment options.
When my father's tumor was diagnosed, his PSA was part of a "routine" blood test that was ordered for another reason. (It was his first doctor's visit in over a decade.) His PSA was in double digits. The digital rectal exam was an "Uh-oh." The tumor was determined to be a stage IV. The radical prostatectomy was scheduled within a couple of weeks, so he felt he was scrambling to be logistically ready for it-- let alone mentally & emotionally. The word "radical" turned out to affect a couple other functions of that area of your anatomy that you'd prefer to preserve, although these days he's continent again. In other words, life-saving damage control was the priority-- not thoughtful reflection and a conservative treatment plan.
If you get a PSA (free DRE with every blood sample!) and it's 0.5 then you're done. If it's 25 then you certainly don't have to worry about false positives. Even if it's in an ambiguous range, further diagnosis (ultrasound or biopsy) can help-- or you can choose to come back next year to establish a baseline.
Most important of all, you can choose "watchful waiting" or "radiation therapy" instead of "cut this guy open because he's out of time".
When my father was diagnosed then I started the annual routine of PSAs and DREs. After five years of 0.6 or lower I stopped worrying about it, but I'll check it every couple years or so.
I'm just sayin'.
I wonder if Lance Armstrong's doctor said that his testicular-cancer symptoms were "Oh, that's just from all the biking"...
