4. A big prostate, high PSA levels or a vasectomy increase the probability of prostate cancer:
There is no scientific evidence that supports the idea that having a bigger prostate or having higher PSA levels is always correlated to the development of prostate cancer. Similarly, men who undergo a vasectomy do not have a higher risk of prostate cancer.
5. Prostate screening is worthless:
“Although the current method of prostate screening with the total PSA only may not be cost effective, evaluation of individual men with the PSA as well as the free PSA may be. Especially men in certain risk groups such as those with a family history of prostate cancer or those men with an African heritage,” explains the Florida Urological Associates. “Furthermore, prostate cancer is found in all age groups from the 30s on but becomes progressively more common as well as more aggressive with age.”
6. PSA is the only way to diagnose prostate cancer:
The PSA level is an effective method for physicians to evaluate if there is something wrong with the prostate. The prostate-specific antigen is a protein produced by the cells of the prostate and the PSA test evaluates the level of PSA in the blood. This is measured in nanograms of PSA per milliliter (ng/mL) of blood, and it can indicate numerous diseases of the prostate, not just prostate cancer. However, further examination is usually needed to confirm the diagnosis, including a digital rectal exam (DRE) and a prostate biopsy.
Read more about types of prostate cancer clinical trials here.
“total PSA only may not be cost effective, evaluation of individual men with the PSA as well as the %free PSA may be”
May be but no one knows yet.
So it’s still the same as PSA screening in general. No-one has ever shown that PSA screening, or even PSA screening of a chosen risk group, leads to an overall saving of lives.
It’s about time someone showed that PSA screening of any risk group at all leads to an overall saving of lives.
Regarding your statement:
“An imaging study including an MRI, CAT scan, or ultrasound is not used to diagnose prostate cancer. They may be requested by the physician to evaluate the presence of suspicious areas to be targeted during a biopsy or to evaluate the extent of the cancer. However, it’s a myth that an MRI can substitute a prostate biopsy.”
I would take major exception with your statement. Imaging before biopsy should become standard of care, the same as it is for women suspected of having breast cancer. What woman do you know who would submit to having 150 needles stuck in her breast to see if maybe they hit something and then go get a mammogram to see if they see something? Urologists have this entirely backwards. Random TRUS biopsies should be relegated to some dark closet of the past. TRUS biopsies regularly miss 40% of clinically significant cancer. Modern mp MRI scans have both a negative and positive predictive value of over 90% for prostate cancer. When a man is suspected of having prostate cancer the first step should be an mp MRI scan. If an area suspicious for clinically significant cancer is found, then an MRI guided biopsy targeting the suspicious area is warranted.
Standard TRUS biopsies regularly cause swelling and inflammation in the prostate which often results in a rise in PSA leading to more unnecessary biopsies. Erectile Dysfunction as a result of biopsy is not uncommon. The infection rate of TRUS biopsies is up to 4.5% and often results in hospitalization.
While a biopsy is the only way to diagnose prostate cancer, it should be a targeted, MRI guided or MRI/US fusion guided biopsy, not a TRUS biopsy.