PSAdynia

PSA_dynia

A 65 year old healthy man, with no family history of prostate cancer, had a routine PSA of 4.7 μg/L. His digital rectal examination was normal. He became anxious and depressed. A transrectal ultrasound guided biopsy showed a single microfocus of prostatic intraepithelial neoplasia. He remains dispirited. A new disease entity was identified and termed “PSAdynia”

Klotz, Urology, 1997

Test results so distressing that a whole new disease called PSAdynia has been identified!! PSA or prostate specific antigen test is a screening test for prostate cancer. It uses the concentration of a protein called PSA in the blood to detect prostate cancer. Prostate cancer can increase the PSA levels in blood. But the level of this protein can also be high for reasons that have nothing to do with cancer, like infection, trauma in the perineal region, or benign prostate enlargement. If your PSA test is positive, your doctor will recommend a biopsy of your prostate, and if the biopsy shows cancer, it will lead to surgery or radiation treatment.

So is the PSA test saving lives by catching cancer early? Studies have shown that the PSA test has led to overdiagnosis, meaning that many of the cancers detected by the PSA test may have been benign or harmless. That guy might have done just as well if the “cancer” was left alone. And he would not have lived through the hell of biopsies, surgeries, radiation and the fear of living with cancer. As a result, the American Cancer Society has recommended limiting the use of the PSA test.

All of this does not mean that the PSA test is completely useless and should not be performed. But like all nuanced medicine, it is a complex series of decisions that must be made by the patient with help of their provider as to when to get the PSA test, and what the test results will mean for them. Against this backdrop of worrying about positive PSA test results, the article by Klotz in the journal Urology goes on to explain

This condition usually occurs in the PSA-affected individual (proband); however, it is highly contagious and may infect his spouse or immediate family. Frequently an entire extended family may suffer from the condition…

Have you come down with a case of PSAdynia? Dr. Lawrence Klotz offers treatment options.

Many remedies are tried. Reassurance is sometimes successful in reducing the severity of PSAdynia. This is often ineffective, however. Muscle relaxants and hot baths may be of benefit in refractory cases.

There are also several related syndromes that could afflict you, for instance PSAosis:

…an obsession with the PSA, rather than emotional pain or anxiety due to elevated PSA. The individual thinks and reads about PSA during wakefulness; at night, he is woken repeatedly by thoughts of PSA. This is not to be confused with nocturia due to prostatism. Individuals affected by PSAosis usually have a comprehensive familiarity with the PSA literature.

If you’re the physician, you’re not immune, the PSAdynia bug bites you in a special way. Ahem…

[PSAdic is] restricted to health practitioners (particularly urologists) who have an interest in prostate cancer. A sense that the entire spectrum of intellectual development in their field has been reduced to various aspects of  PSA.

And of course, for those poor health practitioners who catch the contagious PSAdic bug, the recommended treatment is

Attendance at a 3-day seminar on urolithiasis or erectile dysfunction.

I couldn’t make this stuff up if I tried! What really tickles me isn’t that this paper was published in a seemingly respected journal. Though Urology offers open access options, it’s not one of the wild west open access journals spamming every scientist and physician. According to the Elsevier website, it has a respectable impact factor.

Urology_impact_factorThe author is the chief of the division of urology at Stonybrook Research institute at the University of Toronto and has published more than 500 papers, though not all of them are this entertaining.

WebOfScienceCitations

What’s really awesome is that this article has been cited atleast 22 times according to Thomson Reuters Web of Knowledge, including by this review article in the journal Cancer about the role of anxiety in prostate cancer. This has me wondering, do people really read the journal articles they cite or are they all in on the joke?

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  • Legalese

    The purpose of this blog is to share interesting bits from around the web and beyond. All opinions expressed on this site are my own, unless credited to someone else. The images and artwork have also been created by me, unless credited to the sources. Oh! And please don't hold me liable for your actions resulting from any information on this site. As with everything else on the internet, read with the requisite amount of skepticism.
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