Is The PSA a Reliable Prostate Cancer Test? Yes And No

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10/01/2013
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Interviewer:  You mention a PSA test and we've talked to a lot of doctors and hear kind of both sides whether that's effective and accurate or it's not.  Where do you sit on that?

Dr. Phranq Tamburri  Wonderful question.  And you're going to get an interesting answer.  From my boots here, I'm from Arizona.  We're always getting in trouble in that state.  And I hang out with some physicians at a physician's shooting club there in Arizona.  And some urologists and we go shooting.  And one of the urologists made an analogy that really sums this up.  And that is that the PSA, you know, first, everyone threw all their eggs in one basket on the PSA is what you're referring to.

Interviewer:  Um-hmm.

Dr. Phranq Tamburri  Now, people take pot shots at the PSA for sport as if now it's horrible. So it goes from one extreme to the other in typical American fashion it seems.  But as my gun urologist friend mentioned, it's, the PSA's really like a loaded firearm.  If you saw a loaded gun on the table and you've never touched one before, back off, don't touch it.  You're going to hurt yourself or hurt others.  

Interviewer:  Um-hmm.

Dr. Phranq Tamburri  A PSA, by itself, is a loaded number.  And if you've never used it, if you don't understand how to use that number, then that PSA will trigger, pun intended here, an automatic biopsy.   And that biopsy, the system, will trigger usually an automatic surgery.  And therefore this one number that people don't know how to read, it's one number all by itself without context, will lead to damaging the patient and others, meaning probably their spouse.  Right?

Interviewer:  Hmm.

Dr. Phranq Tamburri  Loss of erection, incontinence, this sort of thing.  However, on the flip side, going back to the politically incorrect firearm analogy here, if someone winds up taking what we call a CCW, you know they learn how to use a firearm, they take the, they learn the laws and how to clean it and this sort of thing, the ins and outs, technically in theory, you're safer to use it.  

And that's the same idea with the PSA.  If you know how to use this test.  If you don't just take one PSA, you take multiple.  You track it over three or four years.  You get to see is it going up or down.  What's the pattern?  Is it slowly going up in a linear line like BPH?  Is it taking two steps forward and one step back?  That tends to be like cancer.  Or is it high and low, going up and down like the stock market?  That tends to be prostratitis.  

Interviewer:  Hmm.

Dr. Phranq Tamburri  You can infer more info when you have PSA's over time.  What is the normal PSA for them?  Do they have symptoms or not?  The more symptoms you have, typically that explains the PSA is there for non-cancerous reasons.  If you don't have symptoms and there's a PSA that's high, that's suggestive of cancer.  

So I can, obviously, add to that but you get the idea that a PSA by itself is damaging and is worthless, but the system puts so much weight on it because they don't want to pay for more tests and we're still in the old days with PSA.  

But if you have the ability to track it and get imaging and do an ultrasound or a Doppler or an MRI, or take a thorough history.  Find out if you own a motorcycle or not?  Find out if the patient engages in rectal intercourse or stimulation.  Any of these things can make that PSA go up and then you get more factual information to get sense of it. 

So the bottom line is, one PSA by itself, I agree, throw it under the bus.  But multiple PSA's, now you're talking another story and you very well can help and save men's lives.

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The PSA has long been a common test for prostate cancer. Dr. Phranq Tamburri discusses whether or not it's reliable and how you might want to use this test to help you get the most accurate answers.

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