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Something missing in the three papers on PSA testing is the personality of the patient.
Can he live with uncertainty about the implications of a histological diagnosis of prostate cancer, or is he at the other extreme – someone who will be beside himself with worry that he might die 'soon' from a spread of the cancer? Where each man fits on that spectrum is surely something to be taken into consideration.
Culture, such as the acceptance of 'karma', might well determine a man's reaction. So might his experience of friends who have been told that they have prostate cancer.
My prostate cancer was diagnosed 15 years ago at the age of 67. One specimen out of eleven showed 'invasive carcinoma'. Knowing that so many men died with it, rather than from it, I decided to ignore that finding. My recent ESR was 4mm. My recent 68Ga-PSMA contrast CT scan showed no secondaries, My PSA is so high that I no longer have it estimated.
My confidence was boosted by Tom Stamey (J–Urol, 167: 103,–2002) and by Richard Ablin (the discoverer of PSA, writing in the New York Times of March 9, 2010).
I'm not suggesting that others follow my example. I am suggesting that the patient's personality and degree of risk aversion should be taken into account by his doctors.