The Test a Top Urologist Gives His Patients But Refuses to Take Himself

# The Test a Top Urologist Won't Take on Himself

A prominent urologist tells his patients to undergo a screening that he personally refuses. The contradiction sits at the heart of a debate about preventive medicine, risk assessment, and when aggressive screening does more harm than good.

The test in question is the prostate-specific antigen (PSA) screening. It measures levels of PSA, a protein produced by the prostate gland. Elevated levels can indicate cancer, but they can also signal benign prostate enlargement, urinary tract infections, or recent ejaculation. The test's inability to distinguish between these causes has made it one of medicine's most contentious tools.

The urologist's stance reflects a growing consensus among medical organizations. The U.S. Preventive Services Task Force recommends against routine PSA screening for men without symptoms. The American Cancer Society suggests shared decision-making conversations before screening rather than blanket recommendations. Even the American Urological Association emphasizes individualized risk assessment over universal testing.

Why the hesitation? PSA screening's track record reveals substantial downsides. False positives trigger biopsies, which carry infection risks and complications. Many detected cancers grow so slowly they never threaten life. Yet men diagnosed often choose aggressive treatment despite low personal risk, leading to erectile dysfunction, incontinence, and other side effects from surgery or radiation.

The numbers tell the story. Research published in major journals shows that for every prostate cancer death prevented through screening, roughly 30 men receive unnecessary treatment. A landmark study in the New England Journal of Medicine found that PSA screening reduced prostate cancer mortality by only 1 death per 1,000 men screened over 13 years. The harms accumulated far faster than the benefits.

This creates the uncomfortable position the urologist faces. Medical evidence suggests screening asymptomatic men without risk factors produces more harm than benefit. Yet patients arrive expecting the test, often believing it represents responsible preventive medicine. The doctor's refusal to undergo it himself demonstrates personal conviction about that evidence.

The shock patients express reflects broader confusion about screening. Many assume more testing always means better health outcomes. The reality proves messier. Screening works well for conditions where early detection genuinely changes prognosis and treatment options have clear benefits exceeding risks. Colonoscopy for colorectal cancer screening, for example, prevents cancer by removing precancerous polyps. PSA screening lacks this mechanism. Early detection of slow-growing prostate cancer doesn't prevent the cancer. It simply identifies something earlier that might never have caused symptoms.

Men at higher risk, including those with family history of prostate cancer or African American men who experience higher incidence rates, may benefit from informed conversations about PSA testing. The conversation matters more than the test. A doctor and patient discussing personal risk, family history, life expectancy, treatment options, and potential harms creates informed choice.

The urologist's refusal to screen himself represents professional integrity grounded in evidence. It also highlights the challenge of modern medicine: helping patients move beyond testing for its own sake toward decisions that align with actual health outcomes.