Do you know of any link between Peyronie's disease and PSA (Prostate-Specific Antigen)?

My question is, do you know of any link between Peyronie's disease and PSA?

Since I acquired Peyronies, my PSA has increased over a couple of years.

Dave

Greetings Dave,

In my opinion there is a possible link between an elevated PSA test and Peyronie's disease, actually two links, but only in an indirect way and probably not as you might expect.  I will discuss that association a bit later after a few preliminary remarks so all readers can be more familiar with the PSA test.

Every man needs to know that PSA (prostate-specific antigen) is a protein made by normal prostate gland tissue in the adult male.  A recent ejaculation, any inflammation of the prostate whether caused by  acute injury, benign (non-cancerous) enlargement (BPH or benign prostatic hyperplasia) associated with aging, or prostate cancer can elevate the PSA level found in the blood.

In the mid-80s the PSA test was approved by the FDA only to monitor the progression of prostate cancer that was previously diagnosed.  In the mid-90s the PSA test was approved by the Food and Drug Administration (FDA) to be used in conjunction with a direct digital rectal examination (DRE) to annually test men who did not have active prostate symptoms as a screening procedure for prostate cancer. 

However, due to recently becoming aware of the limitations of the PSA test and the potential harm that can arise with its use, it the FDA acknowledges the PSA test is not a dependable prostate cancer screening procedure; it yields a false-positive result in about 75% of positive tests (only one correct test result out of four positive tests) . This means that three men who do not have prostate cancer will receive an incorrect test result for every four positive tests.  Prostate biopsy operations are performed on a routine basis when a PSA test is positive, so this means that three out of four prostate biopsies are unnecessary and expose those men to unnecessary risks and side effects.

On the other side of the coin, a false-negative PSA test can also come back with a low or normal readying even thought active prostate cancer is present.  This does not happen nearly as often as a false-positive PSA test, but it does occur, giving a man and his doctor, as well as his family, a false sense of security that cancer is not present when in fact he might have prostate cancer that requires immediate treatment.

As a cancer screening test the PSA, when it is actually correct,  can help detect the presence of small cancers that do not cause symptoms.  However, simply locating a small prostate cancer does not result in a man living longer.   Several types of prostate cancer detected by PSA testing grow so slowly they are unlikely to be a cause of death.  Further, detecting cancer early might not help a man survive a fast-growing or aggressive tumor that often spreads to other tissues and parts of the body long before it is detected.   For this reason the FDA now takes a different position about the PSA detecting prostate tumors:  early detection of slow growing and non-malignant prostate tumors that do not threaten a man’s life can result in “overtreatment” of low-threat problems, and this routine screening use of the PSA test has been called “overdiagnosis.”

Active and aggressive treatment of a low threat and slow growing prostate cancer is called overtreatment because the side effects and complications that arise from this kind of cancer treatment are often far worse and more life threatening than the cancer itself.   Beginning with  suppression or weakening of the immune system that makes a man more susceptible to infection anywhere in the body and other diseases, urinary incontinence (inability to control urine flow), bowel and urinary dysfunction and erectile dysfunction are a common side effect of cancer treatment.

More commonly now only those men who report actual prostate symptoms will be given a PSA test along with a digital prostate examination to determine the cause of their symptoms. The exception to this more limited use of the PSA test is for those men who are who are at greater risk of malignant prostate cancer (black men or those men whose father or brother had prostate cancer).  For this group it is recommended that they begin to screen for prostate cancer in their mid-40s.

For these men in a high risk group, PSA testing spread out over a period of several years rather than several months gives the most accurate and revealing diagnostic information. One individual elevated PSA test may be a reason for only mild concern, because often the next PSA test will be normal.  But a series of slowly raising PSA tests over a period of a few years is another matter and warrants further prostate testing. 

PSA testing is also controversial for men 75 years old and above.  This age group is far more likely to have a slow growing cancer.  This type of cancer posses very little immediate health risk compared to the other cancers, heart, lung and kidney diseases, diabetes, degenerative neurological and vascular disease (that often occur as multiple health problems) in the elderly.  For this reason PSA screening is not recommended for elderly men with multiple health problems or a single major medical problem, or when life expectancy is less than 10 years.

So now, Dave, with all that on the table, allow me to offer my thoughts about a possible connection between Peyronie's disease and the PSA test. 

When a man has a PSA test and the results come back positive, the doctor treating doctor will do additional tests that will probably include a prostate biopsy.  After the prostate biopsy the man might be catheterized (a thin catheter tube inserted up his urethra – the urinary passage in the penis) to help him void urine. I have written in the past about the issue of abusive catheterization leading to PD in  Possible Peyronie's cause: Catheter and cystoscope trauma. In this sense, men who have had a PSA test can develop Peyronie's disease indirectly as part of the process of having their prostate gland treated.

As a second possible link of PSA tests and Peyronie's disease, please consider the man who goes to his medical doctor for symptoms of prostate enlargement (urinary frequency, urinary dribbling, difficulty starting or stopping the flow urine or pelvic and penis pain).  As these things often progress, this man could be given a PSA test to assess the condition of the prostate and subsequently be prescribed the drug Proscar (finasteride) to reduce prostate enlargement (benign prostate hyperplasia – BPH).   There are a growing number of lawsuits now pending which claim that Proscar can cause Peyronie's disease; for additional information please see Will the drug finasteride (Proscar) (Propecia) affect my Peyronie's disease in any way?

I would be interested to learn more about your situation, Dave.  In particular, if you have ever taken Proscar in relation to prostate enlargement; and if have, if your Proscar was taken before you knew you had PD.  Now that you have Peyronie's disease I believe there is no direct connection between your prostate gland or Peyronie's disease and the raising pattern of your PSA readings.     

For additional information please see Prostate screening and Peyronie's disease.   TRH

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Prostate Screening Tests and Peyronie’s Disease

 

Older men undergoing unnecessary PSA screening

A new study from the University of Chicago reports on the use of PSA-based prostate cancer screening in the United States, concluding that many elderly men could be receiving excessive and unnecessary prostate cancer screening tests.  This same study also determines that while elderly men are over-tested for prostate cancer, while a significant percent of men in the 50-60 age group are not being tested enough for prostate cancer.

The prostate specific antigen (PSA) test is used to help detect prostate cancer or other prostate abnormalities.

These same University of Chicago researchers report that data from two separate surveys conducted in 2000 and 2005 found that slightly less than half of men in their seventies received PSA screening tests within the prior year, a number almost double the PSA screening rate of men in their early fifties.  Consistent with this trend, men who are 85 years and older were given PSA screening tests about as often as men in the 50-60 age group.

Senior author of this study, Scott Eggener, MD, said, “Our findings show a high rate of elderly and sometimes ill men being inappropriately screened for prostate cancer. We’re concerned these screenings may prompt cancer treatment among elderly men who ultimately have a very low likelihood of benefiting the patient and paradoxically can cause more harm than good. We were also surprised to find that nearly three-quarters of men in their fifties were not screened within the past year."  In the active study group were 2,623 men age 70 years and older and almost 12,000 men between the ages of 40 and 69 served as the control group. .

Published online in the Journal of Clinical Oncology (March 28, 2011), Dr. Eggener and his colleagues evaluated test  results in 2000 and 2005 of health surveys from randomly selected households, as part of the National Health Interview Survey initiative.  Reviewing this survey data, Dr. Eggener was able to calculate the estimated 5-year life expectancy of each participant over age 40 who had received a PSA test.

The total PSA screening rate for all men (40 years and older) within the past year was 23.7% in 2000 and 26% in 2005. A breakdown of this total number into meaningful groups shows that the PSA screening rate was lowest in the 40 to 44 age group (7.5%), the PSA screening rate increased to 24% in men ages 50 to 54 years.  The PSA screening rate increased again with a peak rate of 45.5% for men  s 70 to 74 years of age. Screening rates then declined with age, with 24.6% of men age 85 years or older reporting being screened.

The study concludes with the suggestion that treating physicians should be more selective in recommending PSA cancer screening tests for elderly male patients who are less likely to receive benefit from the results of that testing.  Instead, they recommend that more rigorous prostate and PSA screening tests should be done routinely for those men who are in the younger and healthier 40-50 age groups, since it is they who will more likely benefit from early prostate cancer diagnosis.

How does this relate to Peyronie’s disease?  Well, it shows that as your medical doctor is recommending tests and procedures for you, he is also calculating values and factors that might  not be related to your direct benefit.  This is the aspect of modern government-managed and insurance company-dictated health care that is warned about.   Medical decisions are made for you and about you that are based on what is good for others.  Keep this in mind when health care options are being given to you.