The Pros and Cons of Testing PSA Levels for Prostate Cancer
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- Опубликовано: 18 июн 2024
- Given the clear harms and the small and uncertain benefits, most men would presumably decide to decline PSA testing if they knew all the facts, but that’s up to each man to decide.
If you do get diagnosed with prostate cancer, what can you do with diet in addition to whichever other therapies you might choose? See:
• Prostate Cancer Survival: The A/V Ratio (nutritionfacts.org/video/pros...)
• Cancer Reversal Through Diet (nutritionfacts.org/video/canc...)
• Changing a Man’s Diet After a Prostate Cancer Diagnosis (nutritionfacts.org/video/chan...)
• Treating Advanced Prostate Cancer with Diet: Part 1 (nutritionfacts.org/video/trea...)
• Treating Advanced Prostate Cancer with Diet: Part 2 (nutritionfacts.org/video/trea...)
I detailed the issues with mammograms in my 14-video series, starting with 9 out of 10 Women Misinformed About Mammograms (nutritionfacts.org/video/9-ou...) and ending with The Pros and Cons of Mammograms (nutritionfacts.org/video/the-....
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-Michael Greger, MD FACLM
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I am a Urologist and psa testing and treatment have evolved. There is less screening for older patients and some with prostate cancer are watched and not treated unless there are signs of aggression. One can die of prostate cancer, and there are huge differences in the high grade vs low grade disease. I tell them all to avoid dairy and consider a plant based diet.
Yes! Finally! A doctor who recognizes the risks of dairy, especially for older men. My PSA number was concerning high, and I had issues: night-time peeing or nocturia, urination hesitancy and the like. My doctor had no helpful advice, except to suggest we check and re-check every year to see if my number was rising. I read extensively on this subject, especially research papers at the NIH website, and learned that dairy is a significant risk factor for both BPH and an aggressive form of prostate cancer. That was that. I gave up all dairy. We already ate a diet that was more plant-based but went on to reduce animal products to just an occasional thing. Over a period of perhaps six months, my PSA number fell to the point where my doctor said "You're good!" She confessed she knew nothing about the risks of dairy.
Very sad. Since meat is the best source of nutrition . Why is this avoided for this patients sir?
Meat is bad for you. The protein causes spikes in TMAO which damages blood vessels and joints. The saturated fat is also detrimental. Plant proteins are healthy. Humans like all primates evolved eating mostly plants much of which is starch like potato, rice and beans. @@ignaciosevil2157
@@ignaciosevil2157 The peer reviewed Adventist Studies revealed that those who ate meat were significantly more likely to develop the most common chronic and deadly diseases of developed countries, and died about 8 years sooner.
How is one suppose to know if they have prostrate cancer? What are the signs that would not be confused with BPH? Wait until you pee blood? It's too bad Dr. Greger didn't tell us this. People are being treated for prostrate cancer, right? After what symptoms does a doctor recommend a biopsy?
Both my grandfathers died from prostrate cancer and my dad might have too if he didn't die from pancreatic cancer. Neither was treated. It was too late.
70 yr old male here. I was diagnosed with PC (Gleason 7) last year, had SBRT (5 radiation treatments in 10 days), with no residual issues. PC treatment has evolved. No longer are they recommending treatment for Gleason 6, which is 50% of those diagnosed. Certain groups have a higher likelihood of PC, including factors such as family history, African American, etc. I have known three men who have died from PC, and none of them were tested, and by time it was discovered, it was too late. Cheers!
I think this is one of your most important videos, Dr. Gregor. Every man and woman should view it before making a decision on mammography or PSA testing. In the absence of a FULL explanation of risks and benefits, and a discussion of absolute risk reduction, we are NOT making informed decisions.
The American Academy of Family Physicians recommends against both PSA tests AND digital rectal exams? (1:50) I didn't know this. As I explain below, I debated long and hard regarding the risks and benefits of PSA testing, went ahead, didn't like the results and successfully lowered my number entirely via dietary changes. For me, it was a good-news story. For a close friend, it wasn't: he endured multiple biopsies, radiation, chemotherapy only to be told by his doctor that the cancer was indolent and should have been left alone. Now he suffers from fecal incontinence.
A screening test cannot cause overdiagnosis. Doctors are responsible for overdiagnosis. A PSA number is a number. It can't hurt you to know it and many men are actually able to cure prostate cancer because PSA catches them before it becomes deadly. Dr. Gregor, who is not an oncologist, failed to mention that.
New and better tests are what is needed. Not fewer tests, but BETTER tests.
I had slightly increased PSA at the age of 48 values between 4-5.5 went WFPB and stopped drinking coffee, which made a difference, now 5 years later my values are constantly below 1.0…..
Likewise, my dad's PSA has gone down after he shifted towards WFPBD.
My went from 0.9 to 0.65 after going plant-based
Plant based droppe psa
@@erusso4441 yes it does, best is whole food plant based
@@erusso4441 Yes! That's awesome! Happened to my dad, too. 🙂
Wow. I have been recommending PSA screening to my primary care patients as I have been taught to do. Thank you, Dr G. I will now change that to a discussion of risks and benefits.
You should read “The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster,” by Richard J. Ablin. Albin discovered the PSA yet is against its use.
Isn't this part of the problem - "been taught to". Who generates what is taught, is it the medical system or the profit system?
an deeply regrettable combination that has perverted our understanding and approach to human health?@@danherrick5785
Dr Greger is not an oncologist. Please continue to recommend screening. Screening does not cause overdiagnosis. Sloppy oncologists cause overdiagnosis. Give your patients the benefits of knowing their PSA and a referral to a reputable cancer center if it is high, and trust them, not an internet doctor, to do the right thing. If my husband's doctor had not ordered a PSA test a year ago he would be dead now. Thank you for considering.
I prefer getting the PSA. Mine is very, very low and it makes me feel better knowing that is the case.
Thank goodness my father got his PSA tested when his first cousin was dying OF prostate cancer in his early 70s.
Seems that they both had that ASHKENAZI gene linked to greater risk of prostate cancer.
My Pop's PSA at 66 was 11 !
No operation was needed. He was treated with radiation to shrink his 3 tumors.
A year later, he had radiation proctitis bleeding. NJ proctologist (a true A-hole doctor) told my father, "Good news and bad news. Good news: It won't kill you. Bad news: You'll have to live with it." (I was with my father at that appointment.)
When we got to the parking lot, I told my father: "You're going to Florida. Call 3 proctologists there - they've seen tons of A-holes. If they don't say that they can stop it, I'll come down with my curling iron and I'll cauterize it for you!"
First office he called, the receptionist said, "Oh, yes, radiation proctitis, very common. Seven to 10 laser treatments and you'll be fine."
He called me to ask if he should bother to call any other proctologists. 😂
I told him: "No. If the receptionist knows the procedure, the doctor is a specialist at it."
Anyway ... 11 years later, after his wife died from colon cancer, his PSA was down to 7.4 at the age of 76.
That's when I took over the food shopping and meal prep. Having learned the dietary relation to her colon cancer, I turned his diet to 90-95% plant-based. He preferred almond milk with his Cheerios to the "blue water" [skim milk] he previously used. He never knew that meatloaf and meatballs I made were mostly smashed beans. He was no wiser about it, but all the healthier for it.
By 85, his PSA as down to 4.3!
If he hadn't had his PSA checked, would he have died from prostate cancer like his cousin? Most likely.
So, suggesting that one shouldn't get the damned blood test is irresponsible.
"To save one life is as if to save the world entire."
I love this channel!
Me too
Great info...everyone should watch this and your mammogram series
Say what you want, it saved my life. Just a blood test you don't have to do anything else unless you choose to. Hopefully pursue more than one opinion as well.
Absolutely. Why see a doctor for anything? Out of sight, out of mind, right?
The point here is even IF your test indicated risk, pursuing your "treatment" introduces MORE risk for zero actual benefit. More died or have complications that if it were ignored... Look at the numbers, not feelings...
Thank you for this heads up, as this is very serendipitous as I just got a doctor that wants me to get a PSA. I eat a Vegan diet and I'm only 48, and it seems odd she wants me to get a test for something that I'm not at especially high risk for. I was unaware of the risks of over-medicalizing prostate cancer. But I've experienced over-treatment in the past from a neurologist, and I don't want to go down that route again.
PSA tests are very easy and so are the biopsies. My friend died of prostate cancer with the "watch and see" situaion. He was only in his mid sixties. Regardless of the studies and recommendations, it's up to you. It used to be the glove treatment and by the time the doctor can feel a tumor, it can be too late.
It's ALWAYS up you you as to whether you undergo any test or procedure. I generally agree with your comments, but biopsies themselves carry with them significant risks. Friends tell me that the pain was the worst they had ever experienced, and none went back as a result. All were OK, luckily.
Thank you. They have new procedures for biopsies. Now, they numb the area. I had one and it didn't bother me at all. Of course, I've had a few kidney stones and I guess there was no comparison to that compared to the biopsie. My biopsie indicated cancer and it was in the initial stages. I had the prostate removed and 17 years later, everything is OK. No side affects from the operation. I was the music teacher of the doctor's children and wife. That's a hard way to get students!@@paulmaxwell8851
What did he ate?
Thank you so much for sharing
This video ignores the more recent advances in PSA testing. I'm referring to PSA Velocity & PSA Density. I'm told these metrics can give a better indication of who would genuinely benefit from prostate cancer treatment & who would not.
READ THIS: If PSA is high, next step is the "4Kscore" test - another easy blood test. Most doctors (like the one in this video) don't know about this newer "4Kscore" test so you have to research it yourself and tell your doctor about it.
This is dated. It's not simply a case of elevated PSA, it's how elevated and how fast. Sometimes it's elevated due to prostatitis or other issues which can be managed. If these treatments don't result in improved then an MRI is scheduled to look lesions, if any. Only after lesions are seen on an MRI are biopsies performed. My BFF just went thru prostate cancer treatment, his brother died of prostate cancer 20 years ago. My other BFF has severe BPH and it's been quite a journey over the last 15 years and we've seen how monitoring and treatment standards have evolved. But the new standard is MRI before any biopsies.
So far I haven't found anything better drinking than copious amounts of a mix of six or more dark leafy green vegetables, steamed and blended with water (like apple sauce) three times a day, for excellent recovery, bar none. But it must not be a one-time thing. It's astounding how effective this is over time. And for anyone claiming how bitter it can taste, just add honey to the mixture and warm it a bit before drinking; it just works wonders for your health.
Prostate cancer treatment guidelines have been changing. I think most PCPs do PSA screening after a certain age. I was diagnosed with Gleason 6 and doing active surveillance but several friends had aggressive cancer. I'm pretty sure they're glad they were screened. Hopefully, cancer research will lead to a better understanding and treatments.
My PSA was slowly rising through out my 40’s topping out at 6.35 at age 52, I went to 2 different urologists who screamed at me there was no way to lower the PSA and that I needed a biopsy! FF 2 years doing low carb and fasting it was 3.0, last year at 57 years young it was 2.9! I asked my doctor how this could be, she ran out of the examination room!
Congrats! I have a friend with I think similar psa numbers. How many grams of carbs per day is your average, and how off do you fast?
@@DashingPartyCrasher I took about 6 weeks making my eating window smaller and smaller to OMAD but as I was doing that I was cutting carbs to make it easier popping up my fat content (do not calorie count at this point, eat to satiety), get a good zero calorie electrolyte to avoid lightheadedness. While I did that I made sure I had a really good workout routine that was sustainable long term, then I started doing longer and longer fasts. It’s definitely harder to workout when over 24 hrs fasted so be careful there. I never counted carbs, it’s too much brainwork for me so it’s just eating salads (oil and vinegar), steamed veges, get off anything that comes in a box with a bunch of ingredients you cannot pronounce or know what they are. Dairy also seems to drive the PSA up so while you’re getting to OMAD get off milk and cheese.
What I believe is causing our cancer epidemic is years and years of chronically high insulin and glucose (prostate cancer loves high insulin and sugar) from excessive sugar/carb consumption along with frequent meals and now these synthetic preserves and seed oils are all contributors. Sorry about the extended rant but just tell your buddy to read every ingredient list of items you usually buy at the grocery store and if that doesn’t convince you our food supply is poisoned I’m not sure what will. Good luck.
I’m currently carnivore OMAD so I’m as close to 0 carbs as I can get, my wife and I do 48 hr fasts when ever convenient, occasional longer ones and we do 2 cheat meals a month but still do OMAD no matter what.
Sounds like if you go so extreme with the high meat and low grain intake, you'll get athlerosclerosis.
But I understand we're all just giving our desperate shot at living confortably as long as possible.
@@BoogieBoogsForever it’s also chasing these “ideal numbers” weather is PSA, lipids or whatever put out by the medical industrial complex who are now getting it more and more wrong looking back ie the Standard American Diet SAD as our rates of obesity, cancer, atherosclerosis, dementia/Alzheimer and metabolic function go through the roof. Hyperinsulinemia is behind ALL of modern day health problems, excessive carbohydrate consumption coupled with multiple meals a day…
In the U.K. you get the digital examination up the rear end, a psa test, then biopsy. Treatments range from radical prostate surgery, radiation, to hormone therapy and now focal treatments such as nanoknife, ultrasound, and cryotherapy. Survival rate in the U.K. is 95%. It’s alleged that the 5% are those that are diagnosed too late when its become metastatic.
In the U.K. there is NO national PSA screening program. The N.H.S. found that the risks outweighed the benefits, so recommended against setting one up. Those men who do start with a digital rectal exam do so because they present with symptoms.
@@paulmaxwell8851 Try to understand, that I didn’t claim there was a national screening program. If you present with a problem down there, then this is what they do. I guess reading and comprehension are not your strong suit, or English is not your mother tongue.
@@akula9713i think writing clearly is your problem, not the readers. Its very easy to infer from your comment that all those things are standard practices but you miss out the key point about needing symptoms first.
@@Gazzaroo never assume or infer. That is your interpretation. Standard practice? Never mentioned, national screening? Never mentioned. The context of the video is the psa test and the treatments. FFS.
@@akula9713No need to get so testee, friend. 😂😂 You let people wind you up so easily, you'll have a heart attack!
I wonder what the metastases rates are though?
It might interest you to know, that Glasgow University is adding Ivy's cousin, Mebendazole to Docetaxel for PC and it's not for nothing. On another note, City of Hope is adding Ivy to TNBC treatment. Take that as you will.
You don’t have to talk me out of going to the doctor. Done and done.
The other consideration to the cancer data is that they are based on large populations and with probably 90% of people making poor lifestyle choices and 75% of the population being overweight or obese (I am assuming that men and women are pretty close to 3/4 being overweight or obese), that the risk for those that don't drink or smoke, add exercise to their lives and eat lots of whole plant foods (or entirely a whole plant diet) are at much MUCH lower risk than the numbers found in the studies that have been done regarding this cancer and risk.
16 years ago, I had an elevated psa reading of 13. I ignored it. Then 6 years later, I had a reading of 33. I had the biopsy showing a gleason score of 7 to 8. This all happened 10 years ago. I decided on the "robot" style prostectomy. My removed prostate was lab examined and found to be 65% cancerous. Today I have almost no aftereffects from the surgery. Amongst my friends, 4 of them have died from prostate cancer. I personally advise to get a psa test.
You knowing 4 friends who died from it seems like an abnormally high number.
Dr. Greger mentions getting a transrectal biopsy but a transperineal biopsy is much more accurate and it drastically reduces the risk of infection.
I have a PSA test and ultrasound every year.
Biopsing prostate cancer, aka poking holes in the capsule, seems like a great way to get cancer to Metastasize, aka spread. Are there any stats on this?
I think it is believed that prostate cancer may metastize before it's detectable by any current means of testing.
It runs in my family (according to 23andme, and the fact that the older generation all had it), and my father's life was probably saved by a PSA test. Zero side effects post surgery. Biopsy showed it was an aggressive type but never came out of the prostate.
Right. My father had it also, that's the main reason why I get tested. The video doesn't mention anything about family history being a risk factor.
This video is about SCREENING programs. If you have a family history you're not participating in a screening program. You're at risk.@@everlight1
But, but, the medical industry needs your business!!!
👍
However, an important detail - sex, or more importantly your amount of sex as a biological male. Males who have a high volume and frequency of sex (alone or in pair) will generally have a low PDA score even if they have early stages of cancer and those who are sexless, can show a high score without any cancer.
Interesting. Do you know why that is?
I think logic dictates that you should get the blood test screening, but hold off on the biopsy until you get more evidence of cancer. NEVER forgo the blood test as its only an eye into ur problem. But the biopsy is the problem not the screening blood test. 😊
I think one of the points of the video is the problem of false positives. Also that even if you have it most are not going to die from it.
@@RoughNeckDelta Not really, it sorta glazes over the importance of PSA blood testing and groups the whole blood test and biopsy together into one event that's not needed. It should be clearly stated blood testing are one tool in the over all picture of your health. It's very easy for most people to hear this and say " oh then there is no point getting either "
@@jujjuj7676 He doesn't gloss over it, he states clearly the blood test leads to alot of false positives, which can lead directly to unnecessary, and risky procedures.
If something has alot of risks to do something about, and few benefits, you're better off not sniffing around after it in the first place. I learned the hard way years ago you don't want to go fishing for problems in medicine, and sometimes it's best to leave well enough alone.
@@Magnulus76 That's silly thinking, EVERYTHING happens for a reason. So your advice is to not even use critical thinking skills and just forgo the testing for the possibility of a false positive. Which makes my very point. You need to get as many blood tests as possible and see the accumulation of data. As false positive in this context is seeing a spike in PSA numbers and then it dies down. But with my solution more blood tests will accumulate the data needed to make a more accurate decision. We do know prostates leak PSA when damaged. So if you have high PSA you DO have damage which needs to be addresses, it may not be cancer but it is an indicator. Don't build a bias on one test which this video does. Also when you get blood panels, you don't just check PSA lvls, you check other indicators when you put them all together you can see a more clear picture. Hope it makes sense..
My neighbor died unexpectedly last year to protrate cancer. It surprised everyone. I still miss him. It turns out his dr. Never did PSA tests.
How do you know it wasn't the you know what
If you’re African American, disregard this video since we are 4 times more likely to test positive for PC. Diet and lifestyle are the most likely reasons
I wonder if all the other animals have tests every year
Even the inventor of the test no longer recommends it; says it is "little better than flipping a coin". Dr. Mercola adds that a subsequent biopsy (based on PSA) can be very damaging to a man's health. But most doctors still recommend the test. They should be wholly ignored; this is best left as an individual choice.
This analyisis is out of date and as the wife of a Stage 4 prostate cancer victim who would be dead now without PSA screening, I cannot state strongly enough that this video is sloppy and dangerous. It is utterly illogical to state that screening is the problem. Screening does not and cannot create overdiagnosis. Doctors who don't do their homework are responsible for that, not a blood test. Screening saves lives. Dr. Greger, I have read your first book and respect your work on diet and health but please stick to your area of expertise.
Mmmmmm, sounds like an interesting business model for certain organisations...
From my own experience, MRI screening before any biopsy would be better.. …unnecessary biopsies are too common … and if cancer is throughout the prostate, biopsies can cause leakage, I.e. metastases…
I wonder how many guys are watching this while they're getting a prostate exam
Nah thanks! I’m sure a urologist would disagree. Next thing are you going to say to skip colonoscopy? You already told women to skip mammo’s. If I had done what you suggested I would have prob had stage 2 cancer by now. My friend did what you had suggested and that test never picked up her very aggressive cancer! She ended up having to do chemo and then treated for HER! She eats stupid healthy too, not fully plant based though, I bet you guys will blame that too! Yeah this for me is very irresponsible! If I were in my 20’s I would listen to some of the bs you are suggesting! Most men don’t like going to the doctors to begin with, never mind getting their prostate checked and now it’s just a simple blood test for them! Saying something dangerous such as this sort ok’s them not bother getting checked at all. For a doctor this is utterly Irresponsible! Sorry but 😑….
Did you watch the entire video? Did you understand the discussion around absolute risk reduction and the analysis of risk and benefit? My urologist, and the urologist before him, freely admit that PSA testing is questionable at best. As for mammography, nation after nation (Scotland, Switzerland, Italy, Australia) is abandoning screening mammography, and others (Norway, Canada, the USA) are debating the issue right now. Yes, anecdotes are interesting, but billion dollar health care policy cannot be based on anecdotes.
You are slightly missing the point. The point mostly is how the information can be misapplied. I think the test and knowledge is the best route for all