Prostate cancer is the second leading cause of death of men in the US, with an estimated 1 in 7 men being diagnosed with the disease at some point in their lives.
Recently the news has been awash with celebrities, including Ben Stiller and Stephen Fry, speaking out about their battle with prostate cancer and the PSA test. This has been coined as ‘the Stiller and Fry effect’. With such high-profile celebrities advising men to take the PSA test, the NHS has actually reported an unprecedented 15 percent jump in urology referrals.
This creates a few problems.
While it is good news that celebrities such as Stephen Fry and Ben Stiller are raising awareness of the risk of prostate cancer, is encouraging PSA testing actually resulting in more harm than good?
Celebrity Influence – Helpful or Harmful?
Despite battling prostate cancer and effectively going through treatment, by no means are celebrities a medical authority. Raising awareness is one thing but instructing people to take a test is quite another.
Celebrity influence is powerful, and it could be suggested that the recent influx of men getting tested for prostate cancer can be attributed to celebrity coverage.
Let’s take a closer look at the PSA test.
The PSA test is one of the initial means of testing for prostate cancer.
PSA stands for “prostate specific antigen”. It is a protein produced by prostate cells. Prostate cancer cells also produce PSA.
It’s quite normal to have a small amount of PSA in your blood. But as you get older, the amount rises, and your prostate gets bigger. A raised PSA level is not always a medical concern but may suggest a problem with your prostate.
However, a number of factors can contribute to a rise in PSA and there has been much debate as to the reliability of the PSA test.
Research has shown the following:
- Two-thirds of men taking the test will have a positive result despite there being no cancer (‘false positive’). This could result in needless worry and unnecessary surgery.
- Those with an elevated PSA are likely to undergo a biopsy. Nearly 70% of men that are offered a biopsy will have no sign of prostate cancer.
- Conversely, 15% of men will have prostate cancer with very low PSA values. In other words, show a ‘false negative’ result.
- For every 1,000 men that undergo a PSA test, approximately 25 will suffer from erectile dysfunction. 3 will require pads for urinary incontinence. 1 will be hospitalized from sepsis, which is a life-threatening infection that can occur from a biopsy (2). This is not due to the PSA test itself but future procedures that a PSA test can lead to.
Is the PSA test a Reliable Indicator?
You see, a PSA test is unable to distinguish between different causes of a rise in PSA. Prostate cancer, benign prostatic hyperplasia (BPH) and prostatitis can all cause a rise in PSA.
Therefore, while there is no doubt that spreading awareness of prostate cancer is important, should men be following the advice of celebrities when it comes to health?
One review study recently published in the British Medical Journal found that PSA testing only slightly reduces the risk of dying from prostate cancer, but does not reduce the risk of death from all causes.
Statistical, the PSA test is by no means a 100% reliable indicator of prostate cancer. Yes, in the case of Ben Stiller and Stephen Fry, this test may have saved their lives by detecting cancer at an early stage. But would this be the case for every man? For some men, a high PSA may not be indicative of prostate cancer, yet based on the results of this test, a biopsy might be advised.
As discussed above, research has shown that biopsies can result in a number of nasty side effects. More often than not, these can be difficult to reverse.
Treatment for prostate cancer may reduce the risk of advancing and spreading to other organs. However, prostate cancer is a very slow growing compared to other cancers. The majority of men with prostate cancer do not die from prostate cancer.
This is shown in a study published in the New England Journal of Medicine. The study demonstrated that after 10 years, there were no differences in death rates in those that underwent prostate cancer treatments compared to those who elected to undergo active surveillance.
Unless you are suffering from an aggressive form of prostate cancer, active surveillance is the best option due to improved quality of life.
You will not have to suffer from long-term side effects of prostate cancer treatment.
Having a PSA test itself will not harm you, but having an unnecessary biopsy and aggressive surgery will. It’s important to bear in mind, whilst high profile celebrities are telling you to ‘get tested’, that the PSA test is not always a reliable indicator.
Speak to your Doctor prior proceeding with a biopsy. You can also discuss alternative non-invasive procedures which can help to determine if you do indeed have prostate cancer.
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