Expensive Dr. Cocarach: I’m a 53 -year -old wholesome man, and I all the time request to confirm my PSA ranges yearly. My 57 -year -old’s new physician denied his request for a routine PSA management throughout his preliminary go to. She stated the check now produces extra false positives and pointless procedures and surgical procedures, so she stated “no” and didn’t order it.
Are the first care medical doctors discouraging the PSA check for older males now? I don’t obtain any setback once I request to confirm it. As well as, I heard that the digital rectal examination (DRE) is not so legitimate for detection. His new physician did not make a dre both. Are I curious to know that your ideas are within the present DRE and PSA detection tips for main care medical doctors? – CC
ANSWER: The particular prostate antigen check (PSA) is an evaluation of most cancers detection blood, and the advice for its use has gone to the many years because it was launched. Since detection and prevention are my areas of specialization, I’ve adopted the literature on using PSA and different detection assessments very carefully.
In my view, his brother’s physician was improper to refuse to order the check. He was proper that he produces false positives, which may result in pointless surgical procedures; Nonetheless, there are good methods to scale back pointless remedy and on the similar time order the check, which may save lives.
Nearly all of prostate most cancers is so gradual that it’s more likely to by no means hassle a person till he dies of one thing else. Subsequently, we don’t wish to function in these comparatively indolent cancers as a result of there may be the potential of a critical facet impact of surgical procedure, akin to urinary incontinence or erectile dysfunction (none of which any man desires).
Earlier than working, cautious assessments are carried out on prostate most cancers, together with photos (ideally by magnetic resonance), biopsy with a pathological examination and, usually, genetic assessments of the tumor. Along with the outcomes of the PSA, we will separate prostate most cancers into classes of very low danger and low danger versus intermediate and excessive danger.
As soon as we have now the prognosis, we will make good suggestions in order that we will determine the uncommon excessive -risk cancers unnecessarily handled low -risk cancers. With out projections, we can not forestall uncommon, small and aggressive tumors from spreading till it’s too late.
Now I’ve to inform you that the 53 years and 57 are usually not a lot “older”, at the least from the attitude of the detection of prostate most cancers. Crucial second for the detection of prostate most cancers is 50 to 70 years. There are some males who can profit from beginning detection at a youthful age (these with household historical past, black males and males with sure genetic dangers) and a few who profit from beginning to detect when they’re over 70 years previous.
The DRE doesn’t add a lot to the blood evaluation. Roughly 1% of males will get hold of prostate most cancers which are identified by the DRE as a part of the mixed detection. Many males will reject detection if it features a rectal examination. It’s estimated that 90% of irregular rectal exams will probably be false positives. Alternatively, I’ve had circumstances through which some males don’t really feel that they’ve projected correctly except they’ve the DRE.
I’ve an argument with every man concerning the PSA assessments, and I like to recommend it for many males on this age group. However I’ve hardly ever made a person say that he doesn’t need it as soon as he understands that we’ll not suggest surgical procedure except the mix of all research present that it is a excessive -risk scenario.
Dr. Roach regrets that he can not reply particular person letters, however will incorporate them within the column every time potential. Readers can ship questions by e-mail to toyourgoodhealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All rights reserved