“Brethren, I wish above all things that thou mayest prosper and be in health even as thy soul prospereth.”  3 John 2

When Medical Tests Steer You Wrong

           By Jim Paupst, MD

Not long ago, a 53-year-old investment banker, concerned about his recent prostate-specific antigen (PSA) test, called his physician for his results.

His doctor belongs to the school of not sending patients a copy of their investigations. “If there is anything abnormal, we’ll call you,” is his reporting style.

The banker’s chart had already been filed away.  In a few moments, his doctor came back on the line and said, “Your PSA numbers are fine.  The upper limit of normal is 4, and your result was 2.97.”  He went on to say, “I have never seen prostate cancer while the PSA is in the normal range.”

Intuition is knowing without knowing why.  Our investment banker was still troubled, so he then asked a doctor friend to comment.

This was fortuitous, for he had indeed asked a lifesaving question.  The doctor responded that a single PSA reading was not sufficient.  What was required was an examination of his series of readings over the past three years.

In 2001, his PSA was 0.97...in 2002, 1.95...in 2003, it had accelerated to 2.97.  This acceleration of greater than 30% in one year made the diagnosis of early prostate cancer likely.  A biopsy confirmed this, and an aggressive but localized cancer was discovered.

The premise is simple:  The PSA is normal when prostate cancer first develops.  The acceleration almost always means early tumor activity.

This is then proven by a prostate ultrasound image and biopsy.  Even if the image is normal, a biopsy should be performed.  The cancer can then be detected in its earliest form, a form in which a complete cure is possible 95% of the time.

The banker’s former doctor had broken a fundamental clinical axiom:  “If you can see, look...if you can look, observe.”  Observation remains the best diagnostic technique of all.  He failed to observe the sequential change in the PSA assays.

The most important numbers of all—since prostate cancer is now occurring in one out of nine men, many of them in their 50s—are the PSA levels for the past three years.

A patient is entitled to a copy of all his clinical tests because it’s a good idea for him to be in complete charge of his own body.

Taken from The Medical Post by Jim Paupst, MD

“What? know ye not that your body is the temple of the Holy Ghost [which is] in you, which ye have of God, and ye are not your own?  For ye are bought with a price: therefore glorify God in your body, and in your spirit, which are God's.” 

1 Corinthians 6:19, 20

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Last modified: 04/25/05