Prostate cancer is the second leading cause of cancer death among American men. Nearly 250,000 men will be diagnosed with prostate cancer this year. More than 32,000 men will die from prostate cancer this year. In Georgia, 7,360 men will be diagnosed and 1,080 will die. With statistics like that, we want every advantage possible in our fight with this disease.
Since the early 1990s, the Prostate Specific Antigen (PSA) test has been the primary screening tool used to detect prostate cancer. The PSA is a simple blood test, non-invasive and easy to administer and process. The US Preventive Services Task Force has recently recommended, however, that the PSA test no longer be offered to men as a screening tool.
This task force is a federally funded independent panel of experts in prevention and evidence-based medicine. It is comprised of primary care providers such as internists, family practitioners and pediatricians, but not oncologists or urologists. Their job is to evaluate the benefits of preventive services like screening and make recommendations about which services should be routinely incorporated into primary medical care.
Screening, or early detection, for prostate cancer is a complicated issue. Unlike the colonoscopy, which provides clear evidence of early detection and has been determined to have saved lives in multiple studies, the PSA test has been contradictory, with some studies showing a benefit, while others did not. There are many reasons, including the fact that most forms of prostate cancer are relatively slow-growing cancers. Generally, a man with prostate cancer may live for many years without ever having the cancer discovered. In fact, many men with prostate cancer will not die from it, but with it. In addition, high or increasing levels of PSA can indicate an increased risk for prostate cancer, but can also indicate an infection or an enlarged prostate. So, the USPSTF determined that because of these uncertainties, the risk of over treatment is greater than the benefit, and their recommendation states that PSA tests should no longer be offered as a screening tool.
The biggest issue in prostate cancer that confronts patients, their families and their healthcare providers is to delink screening with treatment. Not all forms of prostate cancer require active therapeutic interventions, but some do.
While the PSA test is imperfect, it is – at this time – the best tool we have at our disposal for early detection of prostate cancer. The Winship Cancer Institute of Emory University aligns with the American Urological Association, the American Cancer Society, American College of Physicians and the American College of Preventive Medicine and recommends informed decision-making. Our recommendation is that men at average risk should receive information, including a PSA test if they want it, at an appropriate middle age, although African American men or men with a family history of prostate cancer should receive information at an earlier age, such as 40, or 45 years.
So, what do we mean when we say “informed decision-making”? This means that doctors should discuss the potential benefits and harms of PSA screening with their patients and consider their patients’ preferences, overall health, and family history when making decisions regarding screening with a PSA test.
Unfortunately, there is no easy answer. Each patient comes to us with his own distinctive characteristics, and those characteristics must be taken into consideration when deciding whether to have the PSA test.
About Dr. Viraj Master
Dr. Master specializes in the treatment of adrenal cancer, bladder cancer, kidney cancer, prostate cancer, testicular cancer. He is also an expert in laparoscopic surgery. Dr. Master received his Medical Degree in the University of Chicago in Chicago, Illinois, in 1997. He completed his Internship at University of California, San Francisco in 1999, where he also completed his Fellowship in 2003.