Priya Menon Priya Menon Scientific Media Editor at Curetalk

Cure Talk’s Interview With Dr. Richard J. Ablin – PSA Test Recommendations for Patients – Part 2

We continue our conversation with Dr. Ablin (read part 1 here)…

Dr. Ablin

Dr. Ablin in the Division of Immunology Laboratories, Cook County Hospital and Hektoen Institute for Medical Research, Chicago, IL, in 1978. He was Director, Immunobiology Section, Division of Urology, Department of Surgery, and Senior Scientific Officer.

Me: What would you recommend men regarding the PSA test?

Dr. Ablin: PSA may be elevated in prostatitis, BPH (benign prostate hyperplasia) and cancer. In fact, anything that disturbs the prostate, be it infection, inflammation, can cause an elevation in PSA. Generally, beginning at the age of 40yrs, the prostate begins to enlarge. The problem with the way the PSA test was introduced was that, if a person had a PSA score of four or above, and/or the DRE was positive or suspicious, physicians ordered a biopsy, which may have disclosed prostate cancer. Prostate cancer is an age-related disease and a PSA-prompted biopsy may or may not, related to the age of the individual, find cancer, which according to some, may be related to “how hard it (i.e., the cancer) is looked for (Welch). However, we cannot determine whether it is an indolent (“turtle”) clinically insignificant cancer requiring no treatment or an aggressive cancer (“rabbit”) that may require treatment. The result in over a million cases, since inception of PSA screening has been overdiagnosis and overtreatment of prostate cancer and an unnecessarily drastic reduction in an individual’s quality of life.

Family history plays an important role where prostate cancer is concerned, the chances of you getting prostate cancer, if your father had prostate cancer is twice, while the risk increases three times if your brother had prostate cancer. Therefore, for a patient with a family history, getting a PSA test could be beneficial.

Ideally, the person should get a baseline PSA reading and then follow it up regularly every 6 months or yearly, with subsequent readings. A comparison of the readings can point out changes or elevations in PSA levels that can help the urologist make the right decision toward possible further evaluation for prostatic disease, be it prostatitis, BPH and/or prostate cancer…

However, if a man about 55 to 65 years of age goes for a physical and feels the need to take a PSA test, the doctor should inform him of the advantages and disadvantages of the test, so that he is able to make an informed decision.

“Cancer” is a word that frightens everyone. The moment you find you have cancer you want to cut it out! This is where prostate cancer is different than other types of cancer..  Relative to the stage and grade of the cancer, and the age and overall health of the patient, immediate treatment may not be necessary. The patient may opt for active surveillance, i.e., he may wait and follow with regular monitoring of PSA levels and a subsequent biopsy, if so indicated. The criteria of an individual for active surveillance vary. However, generally, a patient with organ-confined, non-palpable or with small nodules (T1c – T12b), a Gleason score of 6 or less, with the number of positive biopsy cores controversial, but perhaps 2 or fewer  positive cores, with <50% of each core positive for cancer suggested, and PSA <10, is considered a reasonable candidate for active surveillance.

Me: I would like to present a case study: A man of 65 years, with a PSA reading of 42, and digital rectal examination (DRE) indicating soft, squishy, enlarged prostate. What is your diagnosis and recommendation?

Dr. Ablin: PSA is high and he could have an acute case of prostatitis in combination with BPH and/or cancer. His doctor should prescribe about 2 weeks of antibiotics and then repeat the PSA and DRE. If the PSA decreases and DRE is normal, it was more than likely an infection.

Here the DRE is indicating a soft, squishy prostate; if the DRE was hard and lumpy, it could indicate prostate cancer.

Related to the outcome of the foregoing,  this person should get a biopsy and then depending on his Gleason score and clinical stage of disease, he should make a decision whether to treat it or watch it, i.e., follow a course of active surveillance.

If he decides to treat it, he should opt for a treatment depending on quality of life he wants with regard to possible incontinence, impotence and other factors.

Certain people have co-morbidities. In many cases, when older people are treated, they die from co-morbidity rather than the cancer. So, when a man is diagnosed with prostate cancer, he should take into consideration his age, the quality of life he wants, co-morbidities, etc. He needs to think about the whole picture.

Stay tuned to the third part of the interview with Dr. Ablin to know his advice to those who believe in PSA screening, his diagnosis of Warren Buffet’s prostate cancer and some prostate cancer statistics.

Related posts:

  1. Cure Talk’s Interview With Dr. Richard J. Ablin – Robert Benjamin Ablin Foundation For Cancer Research and More – Part 3
  2. PSA Test Controversy: Richard Ablin And William Catalona Present Views
  3. Dr. Richard Ablin, Discoverer Of The PSA Antigen Test Calls It The ‘Greatest Prostate Mistake’
  4. FAQs About The Latest PSA Screening Test Recommendations
  5. Cure Talk Interview With Mike Baker, Lung Cancer Fighter, Journalist, And Media Trainer