Is Routine PSA Test on Its Way Out?
HEALTH Men, this might get a bit uncomfortable. Prostate cancer is the second most common cancer among men, after skin cancer. In 2010, nearly 220,000 U.S. men received a diagnosis of prostate cancer and an estimated 32,050 died of the disease. 
Yet, the U.S. Preventive Services Task Force recommends an end to routine Prostate Specific Antigen (PSA) testing for healthy men.  The concern is that the test does not accurately predict the presence of prostate cancer. Instead, it only suggests it is something that may develop. This is stirring controversy among some oncolologists. Is there a better way to detect prostate cancer in its early stages?
Assume the Position
Men who reach the age of 50 endure moderate discomfort as their doctor tactfully asks them to bend over while he gloves up. During the digital rectum exam (DRE), the experienced physician feels for abnormal prostate size and texture. The glove used for the DRE may also be sent to the lab to test for the presence of blood in the stool.  In essence, this is a dual-test for indications of colorectal and prostate cancer. A PSA test may be performed from a separate blood draw.
|What do the PSA scores mean? |
|PSA Value||Cancer Probability|
|What's your number? Most healthy men have levels under 4 nanograms per milliliter (ng/mL) of blood. The chance of having prostate cancer increases as the PSA level goes up. When prostate cancer develops, the PSA level usually goes above 4. Still, a level below 4 does not mean that cancer isn't present – about 15% of men with a PSA below 4 will have prostate cancer on biopsy. PSA levels are normally higher in older men than in younger men, even when there is no cancer. |
African American males and men with a family history of prostate cancer benefit from earlier screening. The recommendation to end routine PSA testing may be interpreted to mean that the PSA test has no value. Statistically, widespread testing has led many men with slow-growing tumors to be over diagnosed and over treated with aggressive therapies.
Whose Call: Government or Physicians?
Elimination of PSA screening would return healthcare to the ‘pre-PSA’ era when about a third of prostate cancers were… incurable.
Dr. Gerald Andriole, chief of urologic surgery concedes that "mass screening is not the way to go." However, there is a fear among oncologists that wholesale elimination of PSA screening would return healthcare to the “pre-PSA” era when about a third of prostate cancers were advanced and incurable at the time of diagnosis. So Dr. Andriole posits that the decision should be left between patients and their physicians.  On a case-by-case basis, patients can be monitored to see if PSA values steadily increase and if other symptoms exists. (Sidebar: Symptoms of Prostate Cancer.)
Task force recommendations are open to public comment from October 11 through November 8, 2011 before finalization.  In light of current controversy over prostate cancer screenings, some patients or even primary care physicians may conclude preventative screening is unnecessary. Informative prostate posters are available at Store.ClinicalPosters.com to help ameliorate the confusion.
- Recommendation against PSA test goes too far. Washington University in St. Louis. news.wustl.edu
- U.S. Panel Says No to Prostate Screening for Healthy Men. nytimes.com
- PSA test and digital exam. California State University Northridge. csun.edu
- U.S. Preventive Services Task Force. uspreventiveservicestaskforce.org
- What tests can detect prostate cancer? American Cancer Society. cancer.org
- Prostate cancer symptoms. mayoclinic.com