Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand and writes about medical facts.
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Dear Martin,
I am 73 years old. I recently got my PSA blood test result back, it was 7.3. About 14 months ago, the result of this same blood test was 4.2. More than two years ago, my prostate was scanned and no cancer was found.
However, I was prescribed the drug Tamsulosin Retard 0.4 mg every other day to make it easier to urinate. Is the increase from 4.2 to 7.3 at my age alarming? I'm afraid that if I have an MRI scan made, the doctors will want to operate too quickly and too eagerly.
Pending,
G.
******
Dear G,
In my opinion you don't need to worry. The PSA can rise for many reasons, including lab error. as well as difficult bowel movements. In principle, you should never assume one result, unless there is a high urgency. If we assume that the PSA is a reliable marker, then nothing is wrong. 7.3 at your age is allowed.
Unfortunately, the PSA test is completely unreliable, which has resulted in millions of men being maimed (incontinence, impotence and many more misery) without necessity.
Indeed, many doctors would like to do a biopsy or operate, because they too are insecure. A Harvard study showed that you need to screen 1410 men, of which 48 are treated, to save 1 life in 9 years. That is usually a young man. If you have an aggressive cancer, not much can be done either, because it will have spread long ago.
My advice is to do nothing. Leave that Tamsulosin as well. It has never been shown to really help. Finasteride shrinks the prostate and promotes hair growth. Also lowers the PSA.
Leave the prostate screening for what it is. So don't do it anymore. If there's a non-aggressive cancer, it's not going to be a cause of death.
It is time for the urologist associations to speak out against all this screening. Let them look for something better instead of clinging to the not-so-great past.
The argument that there is nothing better yet makes no sense. The PSA test does not save lives, but destroys lives. The story that lives have been saved is easy to disprove through the probability calculation.
Don't let doctors make life sour, no matter how well they mean. On the contrary, enjoy it.
Yours faithfully,
Martin Vasbinder