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New Research Findings
USPSTF PSA Screening

Advanced Disease
Localized Disease
Metastatic Disease

Behind the Headlines-28

Behind the Headlines
(September 14, 2016)

September is National Prostate Cancer Awareness Month, reopening an annual remembrance of the husbands, dads, grandfathers, brothers, uncles, friends, neighbors and other loved ones who have been taken from us by this deadly disease. Annually, prostate cancer takes the lives of more men than any cancer except lung cancer. With such a statistic, many question the U.S. Preventive Services Task Force (USPSTF) finding, that due to PSA screening, prostate cancer is being over-diagnosed and over-treated and men should no longer be screened.
On the other hand, many expert urologists, the professionals who actually diagnose and treat prostate cancer, see the problem being underdiagnosis rather than overdiagnosis. Underdiagnosis occurs when the prostate cancer is locally advanced or metastatic at the time of diagnosis. How does it get that head start?
Most prostate cancer starts very stealthily, but not without usually dropping some hints along the way (as if seeing if anyone is paying attention). In most cases, that "attention" can be satisfied with a single PSA test. Better yet, accompany that PSA test with a digital rectal exam (DRE) and a complete risk assessment. Urologists have shown that a man's very first PSA test, which we refer to as his "baseline" PSA, is very predictive of prostate cancer risk 20-30 years hence. A recently published article in the Journal of Clinical Oncology provides information substantiating the effectiveness and accuracy of this baseline test in mid-life.
Getting that baseline PSA test around age 40 has one critical advantage for men - an accurate PSA score. At that age, young men seldom have the prostate problems of older men, problems which may affect a man's PSA results. Getting the test before those problems normally appear will give the urologists more confidence in the validity of the PSA number.
Fact: The most treatable and curable prostate cancer is diagnosed before it causes symptoms. Having that information means we must go looking for it while relatively young (around 40 years of age). That doesn't register very well with lots of men because at that age they feel great. However, the one primary reason over 2 million men are alive today following a prostate cancer diagnosis is because their cancer was diagnosed before spreading to other parts of the body. This is most often due to the man, his family and/or his doctor being pro-active about prostate cancer screening.
What we have seen, since the USPSTF recommendation that men no longer get the PSA blood test, is a 30 percent reduction in PSA screening, a reduction in diagnosis of localized prostate cancer and an increase in locally advanced and metastatic disease. No wonder the USPSTF is currently reviewing that recommendation!
Whether it is recommending against all PSA screening or limiting it from one age to another, such as age 55 to 69, we know some of the men who are not being screened are going to die of prostate cancer. In spite of that fact, each group seems to think it can come up with the "key" formula. All they are doing is fooling themselves.
In other words, the men being diagnosed with symptomatic prostate cancer, suffering years of very expensive medical treatment, reduced quality of life and finally dying a very painful death would have died even with PSA screening since it saves very few lives (they say). They prefer to sacrifice these men so other men will not suffer being diagnosed while asymptomatic, being treated for a cancer that (they say) would never have caused a problem and ending up living with incontinence and/or being impotent.
Here is the common sense approach: Oregon Urology Institute has held firm with recommending men get a baseline PSA during their 40s. Based on the results of the baseline test (and the DRE and risk assessment), they will establish the need for future PSA tests. This provides them with the information they need to catch those men who already have prostate cancer as well as those who are at risk of developing it in the future. And, they can put off retesting those men with excellent PSA and DRE results who have no other risk factors. This approach is all inclusive for the initial test, exam and risk assessment. From that point on, it is based on each man's personal risk. It is simply using the common sense "baseline" approach to screening for prostate cancer. Copyright © 2010 - 2024