Hi Dr. Mike, I'm studying to become a medical interpreter and I often have to watch various medical videos in order to get a better understanding of the human anatomy, various diseases, treatments, etc. I so appreciated this PSA Testing video. It was creative and fun to watch. So, thank you, I'll be watching more of your videos.

Dr. Mike - your videos have become a standard patient education resource in my practice in Michigan. Thank you!!

Excellent educational video. Every man with question about prostate cancer should watch it.

Hi Mike, This is a great video. Thank you for taking the time to do it. Your summary of the evidence is fair and comprehensive.\I will recommend it to my patients

Thank you sooo much for taking the time to provide this information.

I feel it's best to follow up a psa with a MRI or CT scan to see those anomalies. I feel that a scan of the groin area could view a multitude of areas in one go

So, this discussion and the comments amaze me. I am a 70 year old man who has been battling Advanced Metastatic Prostate Cancer since June of 2009. I had never heard of the PSA test and at age 59 my general practitioner chose to do a PSA test as part of my physical. In my case it turned out that I had a very aggressive form of PC with a PSA of 75. Of course then came scans and biopsies where a Gleason score of 9 was found. The cancer had escaped the Prostate gland and spread to distant lymph nodes also confirmed by biopsy. I understand where this is video and discussion is coming form but I and my whole family thank God I did not see this video before my diagnosis and prevented my doctor from doing the test. The real issue here is not "should we be doing the test" but what do we do with the information once we get the results. Don't blame the PSA test for the foolishness of people (including both doctors and patients) and their reactions to the results. Note: In all my years this is the first time I have ever commented on KZfaq but I thought

Will probably get my PSA test soon. Wonderfully explained Dr. Mike, thanks..

Been going to a urologist for over 10 years because my PSA is high.Have had biopsies and scans and all have negative. PSA has been in the upper teens for over 7 years.

I learned a lot, thank you Doc!

thank you DocMikeEvans. I appreciate this education.

Brilliant informative video!

THIS WAS A WONDERFUL PRESENTATION WOW MY GRANDFATHER DIED OF PROSTATE CANCER MY FATHER DIED FROM IT AND MY UNCLE ALL THE MEN SAME FAMILY MY BROTHER WHO IS 54 WENT TO CANADA AND HE'S OK NOW BUT HE HAS 3 SONS 17,15 AND 12 THEY ALL ARE WORRIED ABOUT THIS IM GOING TO SEND THEM THIS VIDEO IT WAS GREAT THANK YOU.

Thank you Dr. Mike!!! It looks like you made this video for me. I am 78 Y.O. and my PSA is 215!!! and I am in a panic state. In 2003 I had a indigo laser (waste of money) same year a TURP 10 grams (negative for cancer) in 2008 another TURP 53 grams negative for cancer. I'm afraid of all the treatments most of all biopsies with needle and radiation. Again thank you for your honesty. All I ever ask of a doctor is be honest no more.

This is very helpful, has more recent research moved the debate on?

Thank Dr Mike very helpful . any thoughts now in 2020 about to test /find the aggressive variant of cancer you described .?

Thank you so much!

Good video-I try to have an educated discussion re. pros/cons of this test at a patient's medical since the evidence isn't nearly as compelling as for screens such as mammograms for breast cancer-tough to be the rare bird with the aggressive type of prostate cancer...

Thanks for this. Especially pointing out that many men live fine with prostate cancer without them even knowing they had it. Is psa the same or better than a prostate exam?

Dr. Mike, How does mpMRI change the scenario?

I am looking at the connection between adrenaline and PSA. I was doing too much speed work and my PSA went up a bit from the previous year.

Excellent

Very good’ informative video. I’m a 75 year old male so it’s highly relevant and quite comforting. Although I’m fortunate to have access to specialists at a very reputable medical center(NYU) and am well pleased with the care I’ve received, well-done videos like yours are invaluable fir those of us who want to make informed decisions. Thank you( I subscribed).

Because of the blood PSA test I ended up with advanced prostate cancer. My GP ignored all the symptoms because my psa levels were normal. I found out from my oncologist that 15% of men are non secreters so the blood test was useless so if you end up in the same position as me seek a second opinion.

Age 77. PSA of 26 ish, rectal biopsy showed low cancer present. Recommend radiation but not hormone treatment as described as horrific! But next visit they recommended the hormone treatment to bring down the PSA prior to radiation... due for an MRI soon. CT scan came back as ok. I do not really want to go down the hormone treatment track. Your thoughts please. Or any feedback/ advice.

Very good. It was picked up by my Dr Oake when I was about 75 who told me it was slow and that something else would most likely kill me. He took a PSA about once a year and it has been higher each time and now about 20 and my age 93. I think I have TURTLE level cancer as Dr told me he may die before me and he seems to quit taking PSA. That was great article and my Dr very smart and honest

What did you use to do this presentation?

I am 83 years old. It is very difficult to doubt a test, but I truly think that is causing more harm than good. Your point is that 80& of men my age have turtle cancer. You can shoot your prostrate full of holes, and find nothing. Then you get endless prostrate problems. Then you find that it really was not necessary. Always a difficult choice. Thanks for your review!

I work in a doctor's office where I help with the gaps in care for testing and such among patients. Being relatively young and still in school I have heard there is much debate on the PSA screening test, and have noticed that of the many tests the PSA tests is one many men decline time after time. I have never really paid much attention or thought twice about why though beyond them just not wanting to. This video was awesome, and I feel like it gave me a much better understanding about the test itself and the results it may show. I LOVED the farm analogy. When I hear cancer I naturally think of awful outcomes and it being extremely dangerous. This video showed light on how although a male's PSA test may indicate cancer, they may not have ever known or had symptoms of it before, and the treatment and ways to go about the cancer may not be worth it. Although the test may be deceiving, if I were a male I still think I would like to have the test even if it indicated cancer and it was not aggressive or dangerous at least I would know and could take care of it because the chance of it being cancer would drive me crazy like this video says.

So after much research and debate i have decided to flip a coin

What a fantastic and well explained video 👌

My PSA - 0.7 ug/L,

Thanks for your video... I think I must be 1 of the 1000. PSA 48 at 50. After the swelling was gone I know I had my cancer for years. I mentioned to my oncologist that I thought people should get a test at 40, 35 if there is a family history. He mentioned I was not the norm and I was looking at it linearly. A few months after I was diagnosed a friend who had tested yearly had his levels jump into the teens. I guess he got the bird eh, he is in his 60s. Recently USPSTF released to only test in 55-69 without symptoms. Because I didn't have symptoms, and I guess because I'm 1 in a thousand, that infuriated me I would have been put off another 5 years. My oncologist seemed to think about my a statement I made that if someone tests at 40 and has a normal level then they get a base line that I never got. I don't know the right answer and I feel lucky to be one in a thousand. I believe the 45 radiation treatments and 6 chemo that I got has extended my life and with at least 2 enlarge lymph nodes I think I was on track to die from the cancer. I still recommend people get tested, but only if they know raised levels are not always cancer... and I hope they are one of 999 that get a good base line that I never got.

Makes a lot of sense. Does not explain the enlarged prostate having BPH. Did it effective my PSA? Have Kaiser too.

Brilliant video. Many thanks.

Question. Does an infection affect the psa result?

It’s sounds helpful

One additional problem with the PSA is that Life Insurance Companies test you for it--and don't tell you. In essence, they take the choice of having one or not away from you. To make matters worse, they don't tell you some of the things that might make a temporary rise in the PSA possible--like sex within 24-48 hours, riding a bicycle or motorcycle within 7 days, etc. That being said, I wish somebody would sue the pants off of these giant corporations to make them more accountable. But here in the U.S.A. they control the politicians who are only too happy to pocket the money given to them for their next campaigns. This is further complicated by the fact that too many urologists make money from biopsies and the false positives add to their coffers as well. So they like the PSA and don't want anybody to change it. Somebody like the New York Times or MSNBC really needs to expose these frauds.

My thoughts on PSA screening. The only accurate identification of prostate cancer seems to be based on an mri of the prostate where the cancer is visualized. In a way the PSA Test is a waste of resources. I had an elevated PSA of 5.0. Then the dreaded 12 sample biopsy. The Gleason score is important because it identifies and grades the cancer cells. My score was 3+3 based on 5% of one sample with grade 3 and 0 in the others. After having a PSA every 6 months it was determined I needed a 24 sample biopsy!!!. Yes, I was sedated for that procedure. 0 cancer in all samples. The urologist is still having PSA every six months and wants to do an fusion mri guided biopsy. My PSA is now 3.5 and I am over seventy. Does this sound like over treatment? The name of the medical system in my city is being withheld to protect the guilty.

Oh no. I just got the test done yesterday.

My Doc recommended watching this video. Glad I did! Very clearly explained. Now I just hope if I get Cancer, I get the "turtle" version! Russ: age 71

What about testing for free PSA? Wouldn't that be more accurate?

It seems to me that a rationale approach is to get a baseline PSA at an appropriate age based on your age and other risk factors. Then test again at what seems, based on discussion with your doctor, appropriate intervals so PSA increase, if any, can be monitored. If an elevated PSA at a concerning rate appears, then maybe consider the PHI test as a way to screen for aggressiveness (I think it's reasonable to assume that even better tests will come along eventually). If a biopsy seems warranted, I'd stop and find someplace where I can get a 3T mpMRI and, if that indicates a biopsy is in order, have an mpMRI guided biopsy. Doctors, particularly urologists, need to encourage this less invasive approach rather than just pushing for a biopsy. If the (hopefully mpMRI guided) biopsy shows a low risk cancer, open and frank discussions of AS/WW need to be held. Sticking our heads in the sand, primarily because statistics (slippery little devils that they are) say testing is useless, can put you in my situation in August 2013 (66 years old) -- a 25.6 PSA, high-risk, Gleason 8 cancer in 11/12 biopsy samples in a 58cc gland, with a DRE report of hard and nodular. I had only minimal symptoms that I attributed to "getting older." In my case, the mpMRI route wouldn't have changed anything, but nobody could know that at the outset. I sincerely wish I had had regular PSA tests so that, maybe, this could have been caught earlier (maybe at Gleason 7 in far fewer samples). I've since had an HDR brachytherapy followed by 5 weeks of EBRT after 9 months of ADT (pushing my PSA down to 0.17 and shrinking my prostate to less than 30cc). I get my first post-RT PSA test done next week. Hoping for an undetectable PSA. The problem is not too much testing. The problem is what urologists insist on pushing men into whenever a high PSA shows up.

im 34 years old and have a psa of 3.6, waiting for a mri scan and a biopsy to be taken, very very worried

Hi Dr My PSA level is increasing in 3 months 4.58= 10:45 what’s your advice please.? I am waiting for MRI and what is advance advice please..? What should I do? I am having herbal medicine too

If you have a 4.0, I wouldn’t be concerned. Mine was 74. I had Gleason 10 stage 4 cancer.

5years ago I had 30 prostate biopsy and was told no cancer was found now they tell me I have got prostate cancer if I refuse the treatment will I die I feel really fit and energetic I'm 79 years and don't want to be unfit with treatment help me please

34 Urologists down voted this video. They had a Ferrari payment to make.

I wish the VA hospital would have recommended this video to me. I spent 45 days getting radiation therapy that I probably didn't need.

What's an interesting fact about the PSA test, is why the value of PSA, that is the threshold for urologist recommendation, is 4. i.e. if you are above 4 your doctor will probably recommend you to have an appointment with a urologist. They 'arbitrarily' made this figure up. There's no scientific reason behind it, a mere wet finger in the air to detect which direction the wind is blowing. You can read this from the FDA transcripts when it was asked from the manufacturers of the PSA machine that required approval - it could have been 8 or whatever. Now, you can make up your own mind about that!

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From what I've read.. with my Gleason of 9+ (at age 65) ... I am possible the 1 in 1000 who benefitted from the PSA leading to biopsy leading to ADT/radiation therapy (with side effects) but possibly preventing or delaying PC growth and therefore gaining more longevity. BUT what I did not know is that there might be 2 in 1000 who actually die from complications with the biopsy. I believe I was fortunate to have the PSA test but I recognize the conclusions of the studies that suggest overall PSAs are counterproductive. A tricky bit of math.

I,m a 50 yr old male and have noticed I have even peeing more often. Was in really two minds about having a PSA test and the worry it would cause but after seeing this it really doesn't seem to warrant the hassle and worry.

It’s been 5 years and why haven’t they come up with a new better accurate test that doesn’t include the bhp men who face unnecessary stress every time their PSA comes out high.

Unfortunately you barely mentioned what it means for a person with a strong family history of aggressive prostate cancer at a young age and the need for testing. This disease kills a lot of men including my father and his brother. Testing should be encouraged in this situation.

Is psa a blood test

It would appear from this analogy, that one should bypass the PSA testing and hope that any cancer would be picked up from a rectal exam. and that information is FYI

After convid 19 and PCR false + I won’t be doing PSA test. I’ve seen elsewhere that you won’t live any longer treatment or not 😊

The American medical system won’t let you ignore a high PSA score.

Do not do a biopsy insist upon an MRI prostate test instead as it’s much less invasive much more accurate and the only reason urologist wants to do a biopsy is because he makes a small fortune on each patient and makes nothing on the MRI. the MRI is much more accurate and non-invasive!

I will not thank Dr Mike for this information because it makes me mad at Doctors who at psa of 12 done biopsy which infected my prostate with cancer. I had no symptoms of cancer presence. Post prostatectomy my life is ruined

Why do urologists continue to aggressively recommend PSA testing and invasive biopsies?

This is a very old video 2014?? It should be deleted from you-tube as things are much different now. We have new tests like the 4K and a 3T MRI etc

Easy answer: NO. Quite the opposite. The PSA causes far more harm (about 95% of the time) than good

what if a 45 yr old man has a level of 3.11?

mon frère comment

The PSA test is a very inaccurate test and doesn't diagnose cancer. As of 2023, the false positive rate is 70% and the false negative rate is 20%. The better option would be an MRI scan for those that can tolerate it. Another good option that is 94% accurate is a PSE (Prostate Screening Episwitch) test. It involves a urine sample and could benefit those that want an accurate test but can't have an MRI.

Please, ignore this typical NHS advise, and get tested! Keep repeating PSA after 45!