Why the PSA test sucks, you still gotta get it, and a new gene screen could change everything

There are two kinds of prostate cancer —one will kill you, one won't.  Most of it won't. But doctors generally will recommend surgery and radiation for most cancer they see, even the non-lethal forms.  Why?  Because they don't know the difference.

"The biggest challenge we face in managing prostate cancer currently is determining whether someone with a newly diagnosed tumor will die or not," says Dr. Eric Klein, of The Cleveland Clinic, in an article in the Cleveland Plain Dealer, Cleveland Clinic researchers hopeful about study findings, promise of future prostate cancer test.

So what's the problem?  Why can't we separate the non-lethal from the lethal, and spare men unnecessary biopsies and life-altering treatments?

It starts with the PSA test—which sucks (non-medical term). Yes, it is the best indicator for prostate cancer that science has produced and every guy needs to get tested regularly. But it is terribly unreliable at identifying aggressive and non-aggressive forms of prostate cancer ... which, in an ideal world, should be the key to a treatment decision. Even biopsies, with their Gleason scores and in combination with PSA scores, can't predict better than 30-40% of the time which cancers are lethal.

Doctors tend to be predictably conservative and recommend a major treatment, just to be on the safe side.  And guys, scared to death with a big "C" diagnosis, become all-too-willing participants in their own mutilation.

Of course, the unreliability of the PSA test is old news. But at least more and more big, prestigious research groups (like Cleveland Clinic and Dana-Farber Cancer Institute, in the article above) are acknowledging the flaws of the PSA test, as they and others begin to zero in on new gene tests, perhaps available in a couple years.

What independent researchers seem to be close to identifying is a gene (or a number of genes acting in concert) that predicts prostate cancer recurrence. The goal is to have a new test available in 2013 that would tell if you need to treat the cancer, or you can just live with it.   

Until this new gene test comes along, however, guys are in a pickle about whether to treat or not to treat. Based on your Gleason score, cancer grade and age, can you wait on treatment and monitor the condition?  This may be a good question to ask MULTIPLE doctors before making a treatment decision.

Monitoring, or active surveillance, would include regular PSA tests and possibly multiple biopsies. So it's not an easy road.  But surgery and radiation is no picnic either, and the side effects can last a lifetime.