15 Questions to ask your doctor when checking for prostate cancer
Prostate Cancer is Not a Verdict
Consider the Anti-Cancer Stack
The lifetime risk of dying from prostate cancer is 3%.
Ninety-seven percent of men who have prostate cancer will die of something else — heart disease, stroke, another cancer, old age.
Autopsy studies find prostate cancer in roughly 40% of men in their forties, 70% in their sixties, and 80% of men over seventy.
Most of these men never knew. Most would never have been affected. The cancers were there, growing slowly or not at all, irrelevant to the lives being lived above them.
PSA screening finds these cancers. It cannot tell which ones matter.
In 1970, a researcher named Richard Ablin discovered a protein produced by the prostate gland. He called it prostate-specific antigen — PSA.
Its biological function is straightforward: it liquefies semen so sperm can swim.
Ablin identified it as a tissue marker, not a cancer marker.
PSA is present in normal prostates, enlarged prostates, and cancerous prostates alike.
There is no PSA level that reliably indicates cancer,
and no PSA level that reliably rules it out.
That protein went on to become the foundation of a screening industry worth $3 billion a year.
Ablin has spent the decades since publicly calling mass PSA screening "a public health disaster."
He wrote a New York Times op-ed titled "The Great Prostate Mistake." He testified before Congress. He published papers, gave lectures, sent warnings to anyone who would listen.
The medical establishment heard him and carried on.
Thirty million American men are screened annually. Many more world wide.
Over a million undergo prostate biopsies each year — twelve to eighteen needle cores fired through the rectal wall — and at least 750,000 of those biopsies find no cancer.
The test that triggers this cascade has a massive false positive rate.
The numbers that follow from those false positives are where the story turns from flawed science into something harder to forgive:
- A man receives an elevated PSA reading.
- His doctor recommends a biopsy.
- The biopsy finds cancer cells.
- The word "cancer" lands like a verdict.
- Most men — understandably, terrified — choose treatment.
- Radical prostatectomy. Radiation. Hormone therapy.
- The treatments carry consequences that reshape lives.
- 60 to 80% of men who undergo radical prostatectomy experience erectile dysfunction.
- Ten to twenty percent develop long-term urinary incontinence.
- Some wear diapers for the rest of their lives.
- Eight percent of incontinent patients report suicidal thoughts.
These outcomes would be tragic, but defensible if the treatments were saving lives.
They are not — at least not at the scale the industry implies.
Two landmark randomised controlled trials, reported in 2012, compared radical surgery to watchful waiting. Neither found a significant difference in cancer-specific mortality. The Scandinavian trial tracked men for over twenty years. The American PIVOT trial followed 731 men for up to fifteen years.
Both reached the same conclusion: removing the prostate does not extend life compared to monitoring the cancer without intervention.
A doctor may only have a few minutes with you.
A PSA test, a biopsy, or prostate-cancer treatment are decisions with life long consequences.
Make those minutes count by asking the right questions:
- Understand what a PSA test can and cannot tell you.
- Ask useful questions before the next step.
- Understand the possible benefits and downsides of testing.
- Take part in decisions about biopsy, monitoring, and treatment.
This information does not replace your doctor. It helps you have a better conversation with them in the time they grant you.
Plain words for medical terms:
- Prostate – A small gland below the bladder. It helps make semen.
- PSA – Prostate-specific antigen. This is a protein made by the prostate. A PSA test measures it in the blood.
- Screening – Testing someone who has no symptoms, to look for a disease early.
- Raised PSA – A PSA level that is higher than expected. It is not a cancer diagnosis even if it reads above 4.0 ng/mL.
- Benign enlarged prostate (BPH) – A non-cancerous increase in prostate size. It becomes more common with age.
- Prostatitis – Inflammation or infection of the prostate.
- MRI – A detailed scan that can help show areas in the prostate that need closer attention.
- Biopsy – Taking very small pieces of tissue to check under a microscope.
- Transperineal biopsy – A biopsy through the skin between the scrotum and anus.
- Transrectal biopsy – A biopsy through the wall of the rectum.
- Grade Group / Gleason score – A way of describing how prostate-cancer cells look under a microscope. It helps estimate how likely a cancer is to grow or spread.
- Stage – A description of where the cancer is and whether it appears to have spread.
- Active surveillance – Careful monitoring of a lower-risk cancer, with treatment if there are signs it is becoming more serious. It is not “doing nothing.”
- Overdiagnosis – Finding a cancer that would not have caused symptoms or shortened a person’s life.
- Overtreatment – Treatment that brings more harm than benefit because the cancer did not need treatment.
What a PSA test can and cannot tell you:
A PSA test is a blood test. It measures the amount of PSA protein in your blood.
Prostate cancer can raise PSA. But so can many non-cancer causes, including:
- an enlarged prostate;
- inflammation or infection;
- recent ejaculation;
- recent cycling or pressure on the prostate;
- urinary retention;
- old age;
- and some medical procedures involving the prostate or bladder.
There is no one PSA number that proves a man has prostate cancer. PSA also tends to rise with age.
- Any PSA result is only useful when it is considered with the full picture:
- your age;
- your general health and life expectancy;
- family history;
- ancestry and inherited gene risks;
- prostate symptoms and examination;
- prostate size;
- a series of PSA results; and
- other tests, if needed.
The possible benefits and downsides of PSA screening
PSA screening might find some cancers before they cause symptoms. Most of the time it does not.
A raised PSA may lead to worry, repeat blood tests, scans, and biopsy.
Often no cancer is found. Sometimes a slow-growing cancer is found that may never cause harm.
Treatment can affect urine control, erections, bowel function, energy, and quality of life.
A raised PSA says that the prostate needs more assessments. It does not say, by itself, that you have cancer.
It may be sensible to repeat the test, check for temporary causes, compare earlier PSA results, or make radical lifestyle and dietary changes before moving to a biopsy.
One of the lifestyle changes you might consider is our parasite cleanse or anti-cancer stack before moving to a PSA test or biopsy.