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Steve Lopez: A second opinion about the PSA prostate cancer test

  PSA%20screening%20has%20not%20been%20shown%20to%20reduce%20mortality%20rates%20in%20men%20with%20prostate%20cancer%2C%20a%20new%20study%20says.%20%28Adam%20Gault%20/%20Digital%20Vision/%u2026%29So the PSA test for prostate cancer should be abandoned, according to a government advisory panel?

Not in the opinion of highly regarded Santa Monica urologist Milton Krisiloff, who was my doctor in the late 1990s when I lived on that side of town.

Steve Lopez“I think the PSA is an excellent test when it’s used properly,” said Krisiloff.

As reported this week, the U.S. Preventive Services Task Force has concluded that few lives are saved by PSA screening. But when cancer is detected, 90% of men are treated with surgery or radiation even though most tumors are not life-threatening, and that can  lead to avoidable impotence and incontinence, among other problems.

That’s true, said Krisiloff, and doctors should  be more discriminating in recommending aggressive treatment for non-aggressive cancer, or for high PSAs, which don’t necessarily indicate cancer. But he said more and more urologists have changed their ways in the last decade and are taking what he calls “an active surveillance” approach.

With a high PSA, Krisiloff recommends doing a follow-up PSA after six months and a biopsy every year or two. “At a later date, if the tumor manifests as more aggressive,” the patient can still be saved with more radical treatment at that time, Krisiloff said.

Krisiloff is widely known for an anti-inflammatory diet he recommends to patients with urinary or prostate issues.

Are you ready for the bad news?

No alcohol, caffeine or spicy food. And he doesn’t mean you can have those things in moderation; he means you have to cut them out entirely.

When a patient has a high PSA, Krisiloff said, he recommends that they try the diet for a month and come back for another PSA.  Frequently, he said, the PSA number goes down significantly.

But whether you go on the Krisiloff diet or not, don’t give up on PSAs, the doctor said.

“The bottom line, and I’ve been quoted on this, is that if the PSA is thrown out completely, people are going to die.”

-- Steve Lopez

Photo: PSA screening. Photo credit: Adam Gault / Digital Vision / Getty Images

 
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