One of the most poorly understood aspects of American medicine today, especially in the realm of men’s health, is prostate-cancer screening. Indeed, the PSA — prostate-specific antigen — test, a blood screening that can detect early-stage prostate cancer, is one of the most hotly debated and misunderstood tests in the history of medicine.
Why? Well, although non-expert physicians have minimal comprehension of testosterone deficiency itself (see here for a previous posts on this topic), their lack of knowledge regarding PSA screening is mind-boggling. In fact, few physicians outside the field of urology truly understand the complexities of prostate-cancer screening. Add to the mix testosterone deficiency, which is a tricky diagnosis on its own, and things get downright mystifying, given that Low T can affect PSA results dramatically.
For once, I’m not even specifically condemning the charlatans and “anti-aging” quacks who infest men’s health like locusts. I’m talking about good primary-care physicians. To be blunt, many of them are downright clueless when it comes to PSA screening and other diagnostic tests. Urologists are the prostate-cancer screening experts, period. No physician in any other discipline can approach the subject with even remotely the same authority.
I of course intend no disrespect to my internal-medicine and family-practice colleagues. I don’t expect them to understand PSA and prostate-cancer screening to the extent I do as a urologist; after all, I spent six years studying the test during my urology residency, and for more than a decade since I’ve performed it, interpreted results and kept up with all the latest research and attendant controversies. Primary-care physicians understand PSA testing about as well as urologists understand high blood pressure. Different disciplines, different knowledge. And that’s OK.
Unfortunately, though, many American men get their Low T therapy from doctors other than urologists. A significant number of them aren’t properly screened for prostate cancer before beginning therapy — and if they are screened, their results might not be interpreted correctly, leading to false certitude about the efficacy of their treatment. Finally, many inexpert physicians fail to monitor their Low T patients correctly, misinterpreting subtle changes that might indicate cancer.
Testosterone deficiency is complex, and understanding PSA tests and other screening can be daunting even to legitimate medical professionals. Low T can increase a man’s risk of aggressive prostate cancer, while testosterone therapy itself can accelerate the growth of some prostate cancers. Combine the two in one patient and the care gets exponentially more tangled. Low T can be detrimental to your quality of life and overall health; prostate cancer can flat-out kill you. Don’t be tempted to short-circuit your own medical care — seek out a qualified urologist before you do anything else.
Posted on Wed, September 23, 2015
by Marc Richman, M.D.