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Urology/Prostate Cancer Screening


Hello, I'm a 59 year old healthy male with a family history of prostate cancer. My Dad had it, had several TURPS, was castrated at age 70,  but lived to age 93 and died of CHF. All (3) of my brothers have had it and have had different treatments and all are doing well now.

I recently went to a new physician because my former one had retired. The new doctor says he no longer does rectal exams or PSA blood tests because neither are reliable. He says as long as I'm not having frequent urination/or pain or getting up mutiple times during the night, I shouldn't be concerned.

I would like your thoughts on this.




Find another physician.  This doctor has already made up his mind based on the recent US Preventive Services Task Force recommendations and he isn't interested in your input or suggestions.  If he was, he would say he doesn't recommend rectal exams or PSA testing but would consider it in your case given your history.  In my opinion, you will do better with someone who will keep an open mind and consider your requests especially since it's your life at stake.

The USPSTF recommended against PSA testing based on the controversial findings in two large studies that appeared to demonstrate little benefit in the majority of patients.  It's not that PSA doesn't find alot of cancers; it does!  The problem is that the majority of the cancers discovered are relatively harmless but we usually end up treating them with expensive therapies like radical surgery or radiation that result in significant side effects.

There is plenty of data and evidence to suggest that PSA testing does indeed save lives such as the 44% drop in prostate cancer death rate since PSA testing became widespread in 1992 and this cannot be accounted for by anything other than screening according to the National Institutes of Health (NIH).  There are also many studies showed a better than 50% cancer specific survival benefit such as the Labrie study from Quebec, the Tyrol Austria study and the Goteburg Sweden study which all showed a very substantial survival benefit to PSA testing and early treatment.

You have a strong family history for prostate cancer and in my opinion you should be screened regularly.  As an informed patient, you have that right.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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