PSA Screening-Advice From A Doctor On the Front Line and In The Trenches

What are the symptoms of early prostate cancer? Answer: there are NO early symptoms of prostate cancer. At this time, the ONLY way to diagnose prostate cancer is the PSA test or prostate specific antigen blood test.
The PSA test, which measures the amount of PSA protein released into blood, is by far the best tool I have for detecting this dreaded disease. A high PSA reading is a clear red flag. Because this type of cancer is almost always asymptomatic at first, the PSA — to a much greater extent than the annual digital rectal exam — is my best way to find it.
With over 200,000 new cases of prostate cancer every year in the USA, and more than 30,000 deaths (this number is decreasing because of the PSA), prostate cancer is the second leading cause of cancer death among American men.
Two large long-term European studies showed a 30 percent-50 percent reduction in death from prostate cancer as a result of PSA screening. Even though not all studies showed the same dramatic results, to cast aside this test — seemingly on a whim — is bad public policy that appears to treat life with little regard. And mortality rates don’t tell the whole story: without the PSA, prostate cancer would often be detected at an advanced stage, leading to more suffering for the patient.
PSA screening is the way most prostate cancers are diagnosed today. Without the test, many men will learn of their prostate cancer well after there is a chance to cure the cancer.
This month, the U.S. Preventive Services Task Force said there’s no evidence that routine PSA (prostate-specific antigen) testing saves lives. For the vast majority of men, the panel said, it may cause more harm than good. And last Monday, a study by Dartmouth College cast fresh doubt on the value of mammograms in fighting breast cancer. I, as well as most of my colleagues, am outraged at the publicity given to a recent report that suggests that men should not be screen for prostate cancer.
Of course we will diagnose some indolent cancers and miss lethal ones, and perhaps some doctors and frightened patients will rush forward rather than proceeding with caution. But finding exactly how and when to react to a rising PSA is part of the art of medicine.
If we cast aside the PSA, fewer men will become impotent or suffer the discomfort of additional testing. But more men will die.

Bottom Line: So what is my recommendation and the bottom line? There certainly is a role for cancer screening including prostate cancer and breast cancer. This is a decision that each man needs to make with the advice of his\her doctor.

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