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The Prostate Cancer Testing Dilemma

Treating non-life-threatening cases risks lifelong incontinence and erectile dysfunction

Of course, sometimes treatment is necessary. Many men, including a close friend of mine, swear that PSA testing saved their lives — even if it cost their erections and necessitated underwear pads.

In 2012, the U.S. Preventive Services Task Force, an expert panel that advises the Department of Health and Human Services, recommended against routine PSA testing. The American Urological Association initially expressed "outrage" but has since modified its position, saying PSA testing should depend on men's "values and preferences." Of course, most men simply do what their doctors say — and most doctors recommend annual PSA testing.

So what's a man to do: Test PSA or not?

I get screened, but I've also taken steps to reduce my risk. The best-known risk factors — age, family history and race — cannot be changed. (African American men are at unusually high risk.) But many studies show you can substantially reduce your risk of prostate cancer by:

  • Eating at least five — but preferably eight to 10 — daily servings of fruits and vegetables;
  • Cutting back on meat, cheese and whole-milk dairy.

After my own PSA reading came back elevated a few years ago, I found myself bent over and being probed with what felt like a baseball bat. Sure enough, the biopsy showed worrisome precancerous cells, prompting my doctor to schedule another biopsy six months later.

During that interval, I swilled tomato juice; vitamin A-rich tomatoes are the food most closely linked to reduced risk of prostate cancer. I also gobbled salads and reduced my (already-low) consumption of meat, cheese and ice cream. The second biopsy was negative, so I didn't have to make the tough choice. But in fact I had already made it: Had my doctor discovered prostate cancer confined to the gland, I would have opted for a course of watchful waiting; only if it threatened to spread beyond the gland would I have considered seeking treatment.

Michael Castleman, publisher of the website GreatSexAfter40.com, writes about sex for AARP.

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