What to Ask Before Your Next PSA Test

Introducing “Questions for Your Doctor” — a new series

Richard Ablin discovered prostate-specific antigen in 1970. He has spent the decades since publicly calling mass PSA screening “a public health disaster.” The test he found has a false positive rate of up to 80%. Two landmark randomised controlled trials, reported in 2012, found no survival benefit from radical surgery compared to watchful waiting. Thirty million American men are screened every year regardless.

The fifteen-minute consultation doesn’t leave room for any of this. The system moves from test to result to biopsy to treatment — each step generating revenue, each step harder to refuse than the last. The information that should precede the test almost never does.

I’ve built something for that problem, and it’s the first in a series.

Questions for Your Doctor gives you the questions to ask at a specific medical decision point — a screening test, a prescription, a procedure — with enough evidence behind each question to know whether the answers you receive match what the data actually shows.

Each instalment contains ten questions. Each question is followed by a Key Fact — a single statistic that distils the most important data point — and two paragraphs of context drawn directly from the published evidence. A cascade guide at the front identifies which questions matter most depending on where you are in the process. A one-page Quick Reference at the back is designed to be printed and taken to the appointment.

The first instalment covers the PSA test.

It works through the full arc of the screening cascade: what PSA actually measures, what an elevated reading does and does not mean, the risks of biopsy, the difference between finding a cancer and finding a cancer that needs treatment, the evidence on active surveillance, the side effects of surgery and radiation, and your right to informed consent before any of it begins.

Here is one of the ten questions, with its Key Fact:

Question 3. How often does the PSA test detect cancers that would never have caused symptoms or shortened my life?

Key Fact: Autopsy studies show that 40% of men in their forties and 80% of men over seventy have prostate cancer that never affected them.

The full document — including two paragraphs of context for each question, the cascade guide, and the printable Quick Reference — is available for download below.

The evidence is drawn from The PSA Trap, which compiles research from Richard Ablin, Dr Anthony Horan, and Dr Mark Scholz, alongside clinical trial data, autopsy studies, and the U.S. Preventive Services Task Force review. Every statistic in the document traces back to a named source.

If you or someone you know has an appointment coming up, print the Quick Reference page and take it with you.

The series so far, and what’s coming next:

1. The PSA Test (available now)

2. Mammogram Screening (in development)

3. Colonoscopy (in development)

4. The Childhood Vaccine Visit (in development)

5. Statin Prescription (in development)

These five are the starting point. If there is a screening test, a prescription, or a procedure where you needed the right questions before you walked into the room, put it in the comments. The next topics will come from what you need most.

The Questions for Your Doctor series is available exclusively to paid subscribers.

The PSA Test: Questions for Your Doctor is available for download below.