DEBATE ON USING THE PSA FOR PROSTATE CANCER RAGES ON

Prostate-specific antigen screening is linked with a considerable reduction in the risk of death from prostate cancer, suggests a new review.

The findings oppose current guidelines from the United States Preventive Services Task Force (USPSTF), which advise against prostate-specific antigen (PSA) screening for prostate cancer due to lack of evidence that it lowers the risk of death from the disease.

According to the review authors – led by Ruth Etzioni, Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle, WA – their findings suggest that guidelines for PSA screening may need to be reviewed.

Prostate cancer is the most common cancer among men in the U.S., after skin cancer. This year, it is estimated that around 161,360 new cases of prostate cancer will be diagnosed in the country, and approximately 26,730 men will die from the disease.

Men aged 65 and older are at greatest risk for prostate cancer, and the average age of diagnosis is 66 years.

The PSA test is one of the predominant tests used to diagnose prostate cancer. It assesses levels of prostate-specific antigen in the blood, which is a protein produced by cells in the prostate gland.

The American Cancer Society (ACS) state that the majority of men without prostate cancer will have a PSA level under 4 nanograms per milliliter. Men with a PSA level of between 4 and 10 nanograms per milliliter have a 1 in 4 chance of having prostate cancer, while a PSA level over 10 is associated with a 50 percent chance of developing the disease.

However, there are many other factors that can influence a man’s PSA levels, including urinary tract infections and certain medications. As such, research has indicated that PSA tests run the risk of yielding false-positive results for prostate cancer, which may put men through unnecessary stress and treatment.

The AAWP Point of View

Why the controversy over PSA screening? Because too often a high result triggers a cascade of diagnostic studies and/or surgery. When many of those men left alone would never be bothered significantly by the presence of cancer even if it did exist.

We stick with the recommendations that for men, especially African-American men between the ages of 40 and 70 should have PSA’s done on a regular basis. If results are high and considered significant by the primary care doctor then a biopsy should be done. If the biopsy is positive then several options should be considered to include surgery, radiation a watchful waiting.

For men over the age of 70 the recommendation that PSA’s be available to men who want them but not mandatory. This group most often suffers from unnecessary procedures to eliminate prostate cancers which either don’t exist or pose very little threat to the person over a lifetime. In addition the side effects of the diagnostics and treatment such as pain, erectile dysfunction and infection can dog them for the rest of their lives.

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