To screen or not to screen is one of the hottest questions in men’s health these days.
For urologists at Chesapeake Urology, there is no doubt that the American Urologic Association has the right approach, which is to advocate that men begin PSA testing at age 40, provided there are no other health concerns that indicate the man has less than a 10-yearlife expectancy. This way, their doctors have a baseline to help monitor their prostate cancer risk in the future.
“If all men have regular PSA testing according to the AUA guidelines, we could virtually eliminate discovering prostate cancer when it is at an advanced stage and no longer curable,” says Dr. Bruce Berger, a CUA urolo-gist. “The lifetime incidence of prostatecancer for a man is 16 percent, which means that a lot of men are at risk for developing prostate cancer.”
In the 1980s, before PSA testing became standard, two-thirds of the men newly diagnosed with prostate cancer had an advanced cancer that was not curable. According to Dr. Berger, “PSA testing has revolutionized prostate cancer diagnosis and treatment.” Since 1990, there has been a 35 percent decrease in prostate cancer deaths. Between 1994 and 2004, the mortality rate from prostate cancer has decreased by four percent annually, even though the population is aging and more men are at risk for developing prostate cancer.
The PSA, which stands for prostate-specific antigen, is a blood test that measures a protein produced by cells in the prostate. “As the PSA goes up, the risk of prostate cancer increases,” Dr. Berger says. PSA screening can help detect prostate cancer five to 10 years earlier than it might be detected by physical exam. Early detection can lead to finding prostate cancer when it is confined to the prostate and more likely to be cured.
There is no specific PSA level that indicates cancer. Therefore, it is important for the doctor to monitor the rate of change of a man’s PSA from year to year. Many older men have higher PSA levels because their prostates have enlarged due to benign prostate hyperplasia (BPH). However, too rapid a change indicates an increased risk for prostate cancer.
“Screening gives us knowledge,” Dr. Berger explains. “Rescreening intervals are based on an individual’s baseline PSA and the patient’s age. The decision to proceed to a prostate biopsy should be based not only on the total PSA levels but also on multiple other factors.”
These factors include PSA properties, such as free PSA, PSA velocity and PSA density; rectal examination; the patient’s age and co-morbidities; prior biopsy history; family history; ethnicity; diet and lifestyle. African-American men and men with a family history of prostate cancer have an increased risk for the development of prostate cancer. “Cancer risk does correlate with an increased PSA level, but there is no PSA value below which a man may be assured that he does not have biopsy-detectable prostate cancer. We cannot give guidance concerning the best way to treat a man’s prostate cancer if we don’t know the cancer exists,” Dr. Berger says.
CUA’s urologists are very concerned about whether men are being discouraged from getting timely screening. There have been reports that the PSA is inaccurate or not reliable. This is not true. Recently, the American Cancer Society issued new guidelines on prostate cancer screening. Many urologists are not in full agreement with some of their recommendations.
“We concur that informed consent should be an integral part of a man’s decision to have PSA testing. We don’t agree that the first testing should occur after age 50 and that the decision to then do a biopsy be tied to a specific PSA level,” Dr. Berger says. “We feel that there is no single PSA standard that can be applied to all men. Education combined with PSA testing is the best way to find prostate cancer when it is still curable.”
There is a real controversy concerning PSA and biopsy evidence of early prostate cancer. As we use changes in PSA as one indicator for doing a biopsy, there is concern that we may find more low-grade cancers that are small in volume and that will not grow rapidly enough to threaten a patient’s life span. Therefore, there is the potential for overtreating cancers that may not ever cause a clinical problem. Some of these early cancers can be closely followed and do not need immediate treatment. Others can progress to more aggressive cancers. Unfortunately, our tools for distinguishing the incidental cancer from the significant cancer are not yet as accurate as we would like them to be.
“Currently, the only way to cure prostate cancer is to find it early. The PSA guides us. Early prostate cancer has no symptoms. By the time there are symptoms, the disease has advanced and is more difficult to treat and impossible to cure with our present treatment modalities,” Dr. Berger concludes.
Before the PSA test became standard, there were 40,000 prostate cancer deaths annually in the U.S. Now, that statistic has dropped to 26,000 annual deaths. “We want that downward trend to continue,” Dr. Berger emphasizes.
For more information on prostate cancer screenings, or to make an appointment, please call 877-422-8237.
This entry was posted on Friday, August 13th, 2010 at 9:16 am and is filed under Press Release. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.
