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Subscribe to RSSA federal panel issued a grade of 'D' to the commonly used prostate cancer screening test, concluding that it does more harm than good. But the American Urological Association disagrees. NBC's Robert Bazell reports.
By Robert Bazell, NBC News correspondent
Today a federal health panel issued a report stating that routine screening for prostate cancer may lead to more problems for men than it's worth, including over-treatment, complications and side-effects, even as many cancer survivors say the prostate-specific antigen (PSA) blood test saved their lives.
For those who want more information on today’s decision, I've posted answers to some of the most frequent questions I've encountered while reporting the story. If you have a question that isn't answered below, ask it in the comment section, or visit my Facebook page. We will accommodate as many questions as possible and post the answers later this week.
What is this panel that made the recommendation about the PSA test?
This answer can be found on the panel’s website: Created in 1984, the U.S. Preventive Services Task Force (USPSTF or Task Force) is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, or preventive medications. The USPSTF is made up of 16 volunteer members who come from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics/gynecology, and nursing. All members volunteer their time to serve on the USPSTF, and most are practicing clinicians.
Do the recommendations have the force of law?
No. Though the USPTF is financed by the federal government, no federal agency, private insurer, or medical provider is required to follow the recommendations.
Why did the panel give a 'D' grade to the PSA blood test?
The panel concluded that on the basis of available evidence, the harms of routine use of the test to detect the possibility of prostate cancer in men outweigh the benefits. It gave the PSA test a 'D' grade.
What does this mean about my individual medical care?
The panel and almost all experts say the decision of whether a man should have the test should follow a conversation between the man and his doctor. The panel’s summary of evidence is intended as a starting point for that conversation.
How could a test for a common cancer end up being not recommended?
The heart of that answer is that prostate cancer is very different from other cancers. In some cases it can be a killer. But very commonly men have it and it is no threat to their lives. Doctors have little ability to differentiate between the two kinds. The panel found that 90 percent of Americans who are diagnosed (more than 240,000 this year) end up being treated with surgery, radiation, hormones or a combination. The reason for that is that when patients and doctors hear the world “cancer,” they often believe they have a life-threatening illness that must be treated immediately. But treatment often causes serious side effects, so millions of men have been treated who would have lived long, healthy lives without any treatment.
But I got a PSA test, then a biopsy and then treatment and I believe the sequence of events saved my life?
It may be true. Millions believe that, but in most individual cases there is no way to know what would have happened if you did not get treatment. The panel’s conclusions are based on studies of populations, not on individual cases.
Hasn’t the death rate from prostate cancer fallen since the introduction of the PSA test?
It has and most experts believe the PSA test has played a big role. But the questions is whether that drop in the death rate is worth all the men who the statistics show have gotten unnecessary treatment.
Wouldn’t the solution be for men to get tested and wait to see if they actually need treatment?
Many experts advocate such an approach which used to be called “watchful waiting” and is now called “active surveillance.” The problem is that experience has shown that the word “cancer” causes such anxiety that many men will not wait. Also doctors are often trained to – and benefit financially from – performing procedures.
More information can be found in the following links to papers published today in the Annals of Internal Medicine. The first is a summary for patients. The second is the entire report from the task force. The third is an article supporting the recommendations. The fourth is an article opposing them.
Summary for patients: http://www.annals.org/content/early/2012/05/21/0003-4819-157-2-201207170-00464.full.pdf+html
Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement: http://www.annals.org/content/early/2012/05/21/0003-4819-157-2-201207170-00459
Prostate Cancer Screening: What We Know, Don't Know, and Believe
http://www.annals.org/content/early/2012/05/21/0003-4819-157-2-201207170-00460
What the U.S. Preventive Services Task Force Missed in Its Prostate Cancer Screening Recommendation
http://www.annals.org/content/early/2012/05/21/0003-4819-157-2-201207170-00463
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I had a PSA test at 50 as part of my normal routine blood work for a heart attack I had at 43. If it weren't for that PSA test, it's findings, follow up biopsy, and seed implant treatment I would not be here to type this at 61 today. Screw these insurance companies trying to pad the CEO's bonus by denying tests to the average Joe. Greed has become rampant in the USA. Guys, trust me, a PSA test is worth having even if you have to pay for it out of your own pocket. Just what is a life worth today?
Truth be told, the "Panel" was probably staffed with divorced women...................................
I mean no disrespect but how do you KNOW that you would not be here today without the PSA test. Were they able to tell you with certainty that your cancer was agressive and would have killed you or did they just say you had cancer. The point of the article was that it is not possible to tell but there are real side-effects the patient may have to live with after treatement either way. That is why they made the recommendation and why guys like me are frustrated when deciding what to do.
What should bother EVERYONE really bad is that under the new healthcare Reform Act, INSURANCE companies are REQUIRED to cover those procedures which get a rating of A or B by the US Preventative Services Task Force.
This is this so called INDEPENDENT Panel established by the US Department of Health and Human Services. Now if an INSURANCE LOBBYIST "influences" a panels decision and recommendation from a A/B to a C/D,..then the INSURANCE company no longer has to pay for the PSA Test. Dr Bazell needs to ACCURATE REPORT THIS on the Evening News. He stated tonight that It's merely a recommendation and that people could still choose to have the test, however in the coming years this WONT be the case because of the new HEALTHCARE REFORM ACT!
"He stated tonight that It's merely a recommendation and that people could still choose to have the test, however in the coming years this WONT be the case because of the new HEALTHCARE REFORM ACT!"
And, because of the new HEALTHCARE REFORM ACT, since I have already had a high PSA test, I am safe to change jobs because a future insurance company will no longer be able to deny me coverage due to a pre-existing illness.
Elevated PSA scores are generally, followed with a biopsy and another test called a Gleason score which provides information on the likelyhood of the cancer being aggressive.
My husband almost did not take a routine PSA at his yearly physical. I told him to go ahead, the doctor told him to go ahead. Thank god. He had a high PSA. He was sent to an oncology urologist and a biopsy was done and his Gleason scores were 4 & 5. It was a very aggressive cancer however was contained in the prostate, so with consultation a prostectomy was performed. Had he not had that PSA he would have never known and very likely would not have been here 6 years later. Since he had a prostectomy, after a couple years, his PSAs started to rise again, and he underwent radiation treatment for 6 weeks. His PSA is now very low. He has not had any symptoms, pain, and we believe that it at least is in remission, if not cured altogether.
There are some prostate cancers that are not so aggressive. Once you are found with a high PSA, they do not just go in and yank it out. You are tested, biopsied, and have many different directions you can go, depending on the cancer. You can do nothing if you choose, if you have a slow growing cancer, a very low Gleason, or just because it's your decision to do nothing. Or you can have surgery, seeding, chemotherapy, radiation, or hormone therapy. However, at least you have a choice.
What you do not about, however, can kill you and kill you very quickly. I think this panel makes no sense at all. Why not care, rather than death, early or later, if finding it quickly can give perhaps a cure.
Society doesn't care of men live or die. If it was a test for women, it would be covered. There is a debate over mammograms. Wait, it'll get an A rating.
I agree with you Partly Cloudy. I called our Insurance Company a year or so ago and complained Loudly about the fact that my wife (or any other woman for that matter) could see any Gynecologist she wanted to without the necessary REFERRAL! I, on the other hand, had to jump through Hoops (beg) to see a Urologist for "Male" problems at 60 plus years of age. I finally called to complain about the huge disparity and threatened to call my state senator. They changed their procedures and now men can see whom ever they choose without a referral, but it took a LOT of complaining when it shouldn't have.
In 2005 I had an elevated PSA, a biopsy had indication of advanced prostate involvment. In Sept 2005 I had my prostate removed. Test indicated that I had an aggressive form of prostate cancer and was just starting to radiate out the nerves. Since then no indication at all of prostate cancer through the use of PSA test which indicate "not detectable". Good chance that I would be dead if I did not have the PSA test at age 62. A simple blood test which can be included in any annual physical workup. Even if it is not "fool-proof" it should be done on a regular basis of older men. When it was detected in me I was age 62. I am now 69. Thanks for the extra years of life.
I would still have the psa test done yearly.My thinking now is to have my colonosipy done every 5 yrs instead of 10.I still bend over every year.Doc says he hates it just as much as i do.Now I THINK ITS WORTH IT.
Being one who had PSA's annually and found the marker up to 7.8 or so at age 64 when the Doctor advised I needed a biopsy. COmbined with the PSA test info, the biopsy detected I I was 3+4=7 Gleason. This was Stage III. I am very thankful for the information the PSA provided so I could followup with the biopsy and subsequenst surgery. This decision makes no sense. What extent of lobbying went on by the you know who to cout this very important testing from the guides? I agree with macfan601 - very bad decision by the health panel.
"the harms of routine use of the test to detect the possibility of prostate cancer in men out weigh the benefits"........This logic totally escapes me. Does this really mean the test might save your life but we think it's too expensive? Try limiting the number of routine tests and if PSA values fall within normal range then restrict testing to say once every 2 years after a certain age. I am certain the insurance carriers will cash in on this one and quote the prestigious USPSTF. In my opinion not doing this test will result in many more deaths. They (USPSTF) should be focusing on what is the prudent course of treatment, not a tried & true test. Imagine the outrage if they take the same perspective on routine breast exams. Again, its not the tests that are the problem it's the current protocols of treatment that require serious reconsideration.
And the Health Care Panels begin to slowly show up...It was Mammograms first and now Prostate Exams..AHCA at its finest...
One of the problems with the PSA is false positives, usually caused by infection, or the result of BPH.
It beats the finger up the kazoo!
Seriously? I'm guessing you never had anyone in your family who has been diagnosed with this disease. I truly hope you never have to face this in your lifetime.
My husband would not be alive today if it wasn't for his first PSA test he took after
I read Hamilton Jordan's book: "No Such Thing as a Bad Day" back in 2002. My husband was 54 years old, a Vietnam Vet and had never had a PSA. It was elevated and his regular family doctor suggested he get it retested in 3 weeks and it was further elevated so he referred him to a urologist. By the time the urologist did a biopsy
his prostate had cancer in both nodules and by the time he had the surgery (approx. 5 months after his first PSA test) it had spread outside the prostate. He had radiation and hormone treatment and fortunately is still alive today.
Based on the task force's recommendations, fewer men will have a PSA and aggressive forms of prostate cancer will likely NOT be caught in time to save their lives before it advances and metastasis to their bones and becomes fatal.
I believe the US Preventative Services Task Force is doing a huge disservice to men of all ages because without the PSA test and tracking how fast it rises it will not be possible to determine if their form of prostate cancer is the aggressive form like my husband had.
The PSA test is a cheap, simple, non-invasive test - so why in the world would the task force recommend against using it unless they want more men to die of cancer?
In the summer of 2009, at the age of 47, I had a PSA test done as part of a physical. My doctor and I discussed it as I had been adopted as an infant and had no knowledge of my biological family's history.
The result was a shocking PSA of 62.7 when it should have been somewhere around 1.5 for someone my age at the time.
Follow-up tests and a biopsy a few weeks later showed Gleason scores of 7 (3+4) and 8 (4+4) indicating an aggressive and advanced strain of prostate cancer.
I had no symptoms of any kind that would have prompted any thoughts of something being wrong. The PSA test saved my life - and through the peer-to-peer counseling of other newly diagnosed men with PCa, I have learned that this is a very similar story.
In my opinion it's not the test that's the issue - after all it's just the first indicator in the process developing a diagnosis and treatment plan - as well as better informing the patients with what their treatment options are based on what stage their cancer may be.
This is truly a mistake.
sad as hell that money is more important than lives, i hope everyone of these fools that are against these tests get prostrate cancer, this is wrong
They are not making the recommendation soley on the basis of money but rather on the very real risks of unpleasant side-effects for treatment for a disease which may not cause a problem in the patient's lifetime.
Clearly, an intermediate cancer of 4 + 3 at the age of 45 will cause major problems for most men. My husband had no symptoms but asked for a PSA anyway. Thinking it would show nothing, it acutally revealed a 17.2 PSA. After ruling out BPH and infection, a biopsy revealed cancer. From what I understand, the test isn't too expensive to begin with. Why not get a baseline at age 40 and follow up every few years if PSA is within normal range. If it is not within normal range, follow protocol to see what could be causing an increase to first rule out BPH, or other type of infection. If once other infections are ruled out, and the PSA is elevated, go to biopsy. From there, if positive and cancer is indeed a low grade, don't rush to treatment, rather educate. If the cancer is an intermediate risk, or bordering on high risk, and you are young(er), it has to be dealt with.
The PSA test saved my husbands life. That test prevented my children's father from being taken from them far too young. Is this group saying that my husband's life is insignificant? Does his life not count for anything? I am left to wonder what this is really all about.
The organization I work with is pushing for a baseline to be done at age 40.
At least in my case . . . my cancer, or the possibility of it, would have been discovered years earlier.
These people (or the reporters) seem to be avoiding any mention of the Gleeson score from a biopsy. The PSA is just a preliminary test to see if further testing is needed and it's usually a biopsy that determines whether or not some action needs to be taken. How about clarifying this a bit for us MSNBC, hmmm.
BTW End the Daze, an elevated PSA will guarantee a finger test in your future. :)
How true.
After a positive diagnosis, as a result of a biopsy and subsequent clarifying Gleason score, which determines a person's individual degree of the aggressive nature and stage of one's cancer, the PSA test is now a moot issue.
However, a false positive PSA test can present a problem. A biopsy is the usual next step in the diagnostic protocol. If however, your biopsy is negative, your urologist, acting solely on your elevated PSA number, will usually order another, if not two more biopsies, to ensure that there is no cancer present in the prostrate. Yes, a biopsy is considered a procedure, but, believe it when they say that every procedure carries with it it's own inherent risks, let alone, pain/discomfort and period of recovery.
The bottom line remains, information is required to make informed decisions. And, as always, the choices of treatment are yours to make. Above all, take the time to educate yourself in order to make those informed decisions. The words "prostrate cancer" don't have to be all that paralyzing and generating an overwhelming sense of urgency. Seldom is an extra couple of weeks or even a month or two, deciding on a plan of action, going to make that much of a difference, as far as the progression of your cancer is concerned. Weigh the choices and side effects of each treatment option to suit your life and lifestyle. It's your life, not the doctors or surgeons.
I was diagnosed with prostate cancer 5 1/2 years ago, after my PSA doubled in one year; I was 53, and decided to have the prostate removed. Maybe not ideal, but I am cancer free and sleep like a baby every night. Who wants to go around knowing they might, or do, have CANCER in them. That panel is a bunch of idiots.
I feel like they are saying that my husband's life is insignificant. Without symptoms he approached his physican about a PSA test. We were shocked to find that his number was 17.2. After ruling out other possible causes of a PSA this high, a biopsy was performed and revealed an intermediate and very significant cancer, 4 + 3 gleason. How come this task force fails to talk about the younger men diagnosed with intermediate risk cancers? Are our husbands & father's lives worth nothing? To say that that this test does not save lives is a downright lie. Isn't just 1 saved life enough? What is this really about? I feel for the men that will follow this advice and not know about their cancer until it produces symtoms. I am thanking God hubby asked for that PSA test, because I know had he not, he'd be gone within 10 years or so.
The article did not say the test did not save lives. It said that many of those treated may well never had had a problem from their cancer but that some significan percentage would have unpleasant, life altering side-effects from the treatment. Depending on which bucket you fall into, that matters.
Very glad for you that your husbands cancer was detected.
Isn't DEATH an unpleasant side effect of no PSA test at all?
Possibly, but apparently it can also be a side-effect of the treatment. From another article on ABC ...
"Of 1,000 men who are screened, at most one man will avoid a prostate cancer death," LeFevre said. "Two to three will have blood clot, heart attack, stroke or even death from treatment of the prostate cancer. One in 3,000 men screened will die of surgical complications from the treatment."
Brad, it said rarely, if ever saves lives. I find that hard to believe. I also read that they said, the few lives that it has saved aren't worth the lives that were effected by the side effects of surgery. Excuse me?! Can they look my children in the eye and repeat that?! I'd take the side effects of surgery any day over the alternative.
My PSA was tracked for 3 years due to my Dad's history. At age 45 my PSA went over 4.00, I was red flagged and therefore went for the biopsy. Conclusion: I had a radical prostatectomy, the pathology result stating the cancer was smoldering and if left untreated it would be untreatable in 5 years and I would be dead in 10...here I am 14 years later with a continual PSA of less than 0.02. Get it early, live long... Voila it works!!!
my dad is a prostate cancer survivor. Was it hard-core? no, but he did the radiation and hormone therapy. Would it have killed him? probably not, as his doc even said that his cancer is generally the type that they find in an autopsy after something else kills you.
Why are those statements important to me? I'm 37 years old and the son of a prostate cancer survivor. That gives me a 50-50 chance of developing this cancer. (source: ). Thus, regardless of this panel's "recommendation", I will be starting my PSA tests at 40 without hesitation or concern of the costs involved
It seems that most commenters did not see the point trying to be made. Having been told that you have prostate cancer, how can you be sure that your cancer will indeed kill you or if it would not. If you have treatment on an ultimately non-fatal cancer and have significant side-effects to bowel, bladder or sexual function, is that counted as a success?
I have a PSA of over 10 now and am wrestling with this issue. A test which does not give you sufficient information to make an informed decision may not be a very good test. That is what they are saying.
Have you had any further tests to get more detailed information as to your actual condition? The point that is being made is that the PSA test is what is no longer necessary, as it raises unwarranted concern in patients. You're already beyond that step as you have actual test results, so wouldn't it be prudent to find out WHY you have such an elevated PSA?
Thanks for the concern. I actually already have had one biopsy (negative), multiple digital exams (negative). I, like many men my age do have BPH which can account for an elevated PSA. Now Doc wants to do another biopsy. I didn't enjoy the experience last time and, given that even that will not tell me if I actually have an aggressive cancer, I am unsure if I will do it since, even if it were positive, I might not accept a treatment which I might not actually need but which has a significant risk of side-effects I know I don't want. I am not advising others to follow the same course ... just expressing my own frustration about having to make a life-altering decision on suspect information.
The point is that the psa level is positive for cancer about one third of the time, but if you are in that third and it is an agressive cancer then early detection can save your life or at least prolong it with a healthy life style. It did for me and I would trade you your situation for mine.
Brad, hubby age 45 with a gleason 4 + 3 WOULD cause problems considering he has MANY more years of life left. Obviously, there is a big difference between a gleason 3 + 3, and a 4 + 3. I can see why some would consider active surveillance, considering their gleason, PSA, and age. That was not our case and the cancer had to be dealt with, period. Honestly, due to age, hubby is doing great. No bowel or bladder issues, whatesoever. We are effectively dealing with the sexual side effects, and hope to have a full recovery in that area. We don't regret our decision for 1 second. I have my husband, that's all that matters. Good luck to you!
Get ready. As Obamacare continues to take hold panels will continue to say the same thing about all kinds of tests so the government doesn't have conduct them once they take over health care. Sounds like a "death" panel to me.
Spare me the "deathpanel" nonsense. If I try to sell you ground up bugs to cure your bone cancer and a government panel says the available data indicates that ground up bugs don't cure bone cancer, should I still be able to sell it to you? Should insurance company's have to pay for it? Wouldn't it be better to spend our available healthcare dollars (and your insurance deductible) on something that really works?
Yes you should be able to sell it. The market will probably be small. Yes I should be able to buy to it. No insurance companies shouldn't have to pay for it if they don't desire to. That is the problem with a government controlled system. They will tell you what you can and cannot buy or sell. My point is more and more preventive care care tests will see the same fate because Obama REALLY doesn't care about your healthcare at all. He wants power over you and what better way than the healthcare system.
I am a one year cancer survivor. it was discovered through my yearly physical and blood tests, it showed an elevated psa level, rechecked it in 6 months with another psa test, which was higher, followed with needle biopsy, gleason 8 cancer, followed with a prostatomy, pathology report gleason 9, margin positive, direct beam radiation followed along with hormone therapy. As of today my psa is 0.01 I am off hormone therapy living from blood test to blood test, soon be 64 and am running the Canton Marathon in a month. I would have a different life if not for my yearly psa test. For the life of me I do not understand their thinking. This isn't a political thing it is common sense.( that is why its not a political thing, it makes sense)
As a physician, this is clap trap. Warren Buffett got his checked, but our insurance companies need our money more than we do. This is more simple hogwash, like not needing to teach women how to examine their own breasts (who doesn't know of a woman who found her own lump?), women not needing regular Pap smears. this is so anger provoking, you never hear how much the ceo's and other board members make from these companies. A doctor's group found out that in the top 24 medical insurance companies, the least paid ceo was $14,000,000. Now I am merely a provider of health care, but it's total bs that top brass gets paid millions while they tell us not to get tested...kinda like the Rainmaker, where the young lawyer forces the insurance company to admit there is a standing policy of automatic declines for initial claims. Wake up, America.
Yes, Doc, very anger provoking. I want to scream. Very frustrating.
Thor T---the recommendation could be a possible defense to medical malpractice claims in situations where no testing was ordered and the patient had developed statistically treatable cancer. If Dr would have ordered test, patient could have been cured!!! But, Panel of Experts, says not to test!! What is a Dr to do? Again the insurance companies win.....no payment of medical malpractice claim, no payment for test, no payment for treatment of early detection, limited treatment for late detection!!! No testing makes no sense to me in any context other than a predispostion to no treatment.
If it wasn't for the PSA screening test, I might very well have a terminal case of prostste cancer today. Three years ago, I had a routine physical with a blood test that included a PSA test. At the time, I was 52 and felt terrific. Little did I know I had four malignant tumors scattered throughout my prostate. The doctor could not feel them with the rectal digital exam. I ended up having surgery (prostatectomy). One of the tumors was very close to the inner edge of the prostsate gland and was within a couple of months of breaking out into surrounding tissue. Once the cancer escapes the prostate, it can end up many places, especially if it gets into the lymph nodes. My Gleason score of 7 indicated a somewhat aggresive growth rate for the tumors too. I feel very lucky in that all post operative PSA tests have resulted in zero antigens present, so far.
I have two younger brothers, in their forties. Since my cancer discovery, they've been getting annual PSA tests. There is no way they or anyone with a family history of prostate cancer should exclude this screening test from their annual checkup once they reach 40 years of age.
Sounds like another subtle, user-friendly introduction to Obama's Death Panels. Someday we'll all be Soylent Green.
Ah Sara, you're never really gone are you?
If a treatment or test is shown to be ineffective, it the government (or you by way of your deductible) still supposed to pay for it? Also, do you so trust your physician and the hospital he works at (who make their money on fee-for-service rather than outcome) that you will blindly do anything they say regardless of whether it has been proven effective? Are you so trusting of the drug company who developed the PSA test that you would continue taking it even if there was little evidence it's benefits outweighed the risks?
I'm not saying PSA is bad ... just asking why you don't have a little curiosity.
To Brad-2092941---Say you get the PSA test over a period of years and PSA level continues to get larger or spikes which leads to the medical recommendation to undergo further testing (such as biopsy). You get the biopsy and it indicates cancer is present in your prostate. You are otherwise healthy now and although you will certainly die some time from some thing, you can make a decision on treatment of this cancer now (or later, or never)--the point is YOU can make the decision as you best determine. You have alternatives for this treatment, but without the PSA screening you most likely would not have done the biopsy and not have known of the cancer which may have limited your choices for treatment (as bad as they may be).
I believe you are better being advised and informed. Why should the Panel of Experts, me or anyone else advise you not to conduct the preliminary screening test? Advice to remain ignorant of ones health situation makes no sense to me.
Once advised, I strongly believe I am more capable of making the best available choice of treatment for me than the Panel of Experts, you or my insurance company. Be it watchful waiting or other more agressive treatments--why deny me the information from the PSA test, unless you beleive the Panel of Experts is best suited to make treatment decisions for idividuals?
What are the "Risks" of the test???? They are drawing blood for other tests....its fast.. easy and inexpensive......
Obviously they are looking for more ways to not pay Social Security.... first Mammograms.... now this......
Pretty soon... we will be picking out our "going away" music and screenplay like Soylent Green........
Do the doctors who made this statement want to bet their lives on not having a PSA test. I would rather go through the tests and follow up and be wrong, rather than take a chance by forgoing the tests and be wrong.
Those who are convinced they were saved by a PSA test are subject to two levels of bias. First, we always try to justify our actions. Unless there is clear evidence we did the wrong thing, we always think we were rights.
More powerful is a similar bias affecting your doctor. Doctors have every reason to say they gave you exactly the right recommendation and probably saved your life. Sometimes that is true; but often it is not.
Taken together, these two influences reconcile the difference between perception and scientific fact.
Age 45, psa 17.2, gleason 4 + 3. We are convinced.
If it were not for a PSA test I would have never known I had protrate cancer. This type of cancer is very slow developing and may not have affected my life but I have a right to know what is wrong or right with my body. To hinder an individuals abilty to make intelligent, informed decisions pertaing to their own health would be just plain wrong.