PSA Screening-What You Need To Know Before Being Tested

Prostate cancer is the 2nd most common cancer in men in the US, affecting about 1 in 6 men in his lifetime. It is the 2nd leading cause of cancer death in men, and almost 2 out of every 3 prostate cancers are found in men age 65 or older.

Screening can help find prostate cancer early.
Most insurance providers cover annual PSA tests for men ages 50 and older. A PSA test is a simple blood test that may help find prostate cancer early before it has spread. Talk to your doctor about when you should begin screening. Some organizations recommended men who are at higher risk of prostate cancer, including African American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45.

The US Food And Drug Administration (FDA) first approved prostate-specific antigen (PSA) testing to screen asymptomatic men for prostate cancer in the early 1990s. In the decade prior to this approval, 5-year survival rates from the cancer stood at around 70-75%. By 1998, it had increased to 98.2%.

Although some health care experts have hailed PSA testing as the best available method to screen men for prostate cancer, there has been long-standing debate surrounding its use in routine testing.

PSA testing can lead to many false-positive results, meaning men can be alerted to cancers that are not actually present. Furthermore, critics argue that the test can lead to over-diagnosis, causing many men to undergo treatment they do not need.

September is National Prostate Cancer Awareness Month. So what is the evidence for and against PSA testing for prostate cancer?

PSA is a substance made by cells in the prostate gland. During a PSA test, a clinician will take blood from the patient and send the sample off to a laboratory, where levels of PSA are measured by nanograms per milliliter (ng/mL).

High levels of PSA – usually 4.0 ng/mL or higher – can indicate the presence of prostate cancer, and a man with such levels is likely to need a biopsy to determine whether he has the cancer.

However, high PSA levels can also be a sign of less harmful conditions, such as prostatitis or infection of the prostate gland – or enlarged prostate or benign enlargement of the prostate gland, a condition that can cause urination and bladder problems. Furthermore, the PSA test is unable to determine the difference between aggressive and benign prostate cancers. This is where concerns about the test’s accuracy come into play.

Past research has estimated that between 17-50% of men diagnosed with prostate cancer through PSA testing have tumors that would not have resulted in symptoms throughout their lifetime.

This means many men may receive treatment for prostate cancer – such as surgery, radiation or hormone therapy – that they do not need, which can lead to serious side effects, including urinary incontinence and erectile dysfunction.

Reasons Not To Test or Screen For Prostate Cancer
Such factors have fueled recommendations against routine prostate cancer screening. In 2012, the US Preventive Services Task Force (USPSTF) led the way by issuing a recommendation against PSA-based screening for prostate cancer for men of all ages who do not have symptoms.

Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms.

The American Cancer Society (ACS) does not provide guidelines that back routine PSA testing for prostate cancer. Instead, they state that “men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer.”

ACS suggest that a patient’s discussion with their health care provider about prostate cancer screening should start at age 50 for men who are at average risk of the disease and who are expected to live 10 years or more, while the discussion should take place at age 40 for men at high risk of prostate cancer.

The American Urological Association and the American College of Physicians have similar recommendations.
But despite recommendations against routine prostate cancer screening for men with no symptoms, many health care professionals believe PSA testing is crucial for preventing deaths against the disease.
Since PSA screening became routine in the 1990s, prostate-cancer mortality rates have declined by nearly 40%. I think PSA testing is the most likely explanation.

Without routine PSA testing, an additional 17,000 men every year would be diagnosed with advanced prostate cancer. We know that not all these men would be cured if detected earlier but PSA testing dramatically improves the odds that prostate cancer will be found before it becomes incurable.

Many men with prostate cancer feel that having a PSA test meant their cancer was diagnosed at a stage when it could be treated, and they would like all men to be able to benefit like they feel they have. As a result there have been calls for a screening program for prostate cancer using the PSA test to be introduced.

The European Randomised Study of Screening Prostate Cancer (ERSPC), launched in 2003 to determine the effect of routine testing on prostate cancer death rates.

Routine screening can lead to over diagnosis in around 40% of cases, which can lead to overtreatment and common side effects.

The results of another study – the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial – found that between 1993 and 2001, PSA-based screening for prostate cancer appeared to have no mortality benefits compared with a digital rectal examination.

With such conflicting studies on PSA testing for prostate cancer, it is no wonder that health organizations appear to be sitting on the fence when it comes to recommendations for such screening.

Dr. Otis Brawley, chief medical officer at the American Cancer Society stated that the majority of individuals are unaware of what the current recommendations are when it comes to prostate cancer screening.

Virtually every organization recommends men be informed of the documented harms and potential benefits of screening and be allowed to make a decision about being screened. Some may reasonably choose screening and make the decision about treatment after diagnosis. Even the USPSTF statement – which starts out recommending against routine screening – is consistent.

By looking at all available evidence for and against PSA testing for prostate cancer screening, it seems impossible to reach a firm conclusion about whether the test should be routinely offered to men or not.
If the test could distinguish between aggressive and harmless prostate cancers, routine screening would not be an issue, as the risk of overtreatment would be reduced. But of course, more research is needed to reach this point.

The US Food And Drug Administration (FDA) first approved prostate-specific antigen (PSA) testing to screen asymptomatic men for prostate cancer in the early 1990s. In the decade prior to this approval, 5-year survival rates from the cancer stood at around 70-75%. By 1998, it had increased to 98.2%.

Although some health care experts have hailed PSA testing as the best available method to screen men for prostate cancer, there has been long-standing debate surrounding its use in routine testing.

PSA testing can lead to many false-positive results, meaning men can be alerted to cancers that are not actually present. Furthermore, critics argue that the test can lead to over diagnosis, causing many men to undergo treatment they do not need.

I suggest that each patient being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.

They say a patient’s discussion with their health care provider about prostate cancer screening should start at age 50 for men who are at average risk of the disease and who are expected to live 10 years or more, while the discussion should take place at age 40 for men at high risk, i.e., if you have a close relative with prostate cancer or if you are of African-American.

The American Urological Association and the American College of Physicians have similar recommendations.

Bottom line: PSA screening isn’t for every man. However, every man should have a discussion with his doctor and see if PSA testing is appropriate for him.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


%d bloggers like this: