Should Men get PSA Screening for Prostate Cancer?
The PSA test is a blood test that seeks out a specific protein that is produced only by the prostate. The higher a man’s level of PSA, the greater the likelihood he has prostate cancer. If it is determined that a patient meets this criteria, then it is often recommended that a biopsy be taken from the prostate. This procedure typically involves the insertion of 12 needles into the prostate using an ultrasound and retrieving a random sample of tissue.
According to Deepak Kapoor, M.D., of Advanced Urology Centers of New York, “Let’s look at, since the era of PSA screening, how far we’ve come with prostate cancer. Right now, since the last 20 years, we have reduced the death rate from prostate cancer by 42%. Twenty years ago, the 10-year survival rate for prostate cancer was 55%. Now it approaches 99%. So clearly we are doing something right. What we need to do now is take what we are doing and actually refine the process.”
The issue surrounding prostate cancer is that a large portion of tumors are not significant enough to warrant treatment. Earlier studies have indicated that as many as 40 percent of men who receive a positive test result have cancer that is growing too slowly to be a deadly threat. The ensuing biopsies, radiation surgery, and other treatments can incur serious adverse effects, including impotence, incontinence, and other complications – potentially even death.
That’s the argument behind why the panel advising the U.S. government on medical treatment guidelines, the U.S. Preventive Services Task Force (USPSTF), recommended against screening healthy, symptom-free men of any age. Previously, only men older than 75 were advised not to undergo PSA screening.
Dr. Kapoor adds his views on the guidelines, “The USPSTF issued guidelines that suggested that no man should be offered PSA screening. This type of one-size-fits-all approach makes completely no sense to the vast majority of practicing urologists. And from our perspective, this threatens to undo 20 years of progress in patient education and treatment.”
A number of experts strongly believe that the PSA test still plays a necessary role in prostate cancer treatment. Without the blood test, the only remaining option for seeking out prostate cancer is through a digital rectal exam, where a physician examines the prostate through the rectum using his or her fingers. Some tumors can be detected this way, but not others, and often this discovery is too late.
Dr. Kapoor explains his view on the controversy, “The only way we’ve been able to get the results that we have enjoyed is to catch the prostate cancer before it has become metastatic. Once prostate cancer has escaped the confines of the prostate, there is no probability for cure. So our emphasis has to be on early detection. And this is why we find some of these controversies to be bewildering.”
He concludes by stating, “A PSA is not an obligation to undergo biopsy, and if you’re biopsied, it is not an obligation for you to undergo treatment. It is simply a piece of information that a man can use to have a more educated discussion with their health care provider and their family about what approach is right for them. This is why I take significant issue with the USPSTF. A man has a right to know what is going on in his own body.”
Written by Stuart Diamond
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