No major scientific or medical groups (including The American Cancer Society) recommend routine testing for prostate cancer at this time. These groups (too many to list here) have concluded that studies completed so far do not provide enough evidence to know whether the benefits for testing for early prostate cancer outweigh the possible risks. (ACS: Can Prostate Cancer be Found Early?)
Many frequent Forum readers and contributors are familiar with the above statement. It is not new. Still, it angers many, including me. The American Cancer Society and other organizations recommend "that health care professionals offer the option for testing for early detection of prostate cancer to all men who are at least 50 years old (or younger if at high risk)." Simply put, the PSA test is not included in any of the standard blood tests. It is not considered all that reliable. There is no "magic" number, such as 4.0, that is guaranteed to detect prostate cancer. And it is not recommended before the age of 50.
In a July, 2003 issue, The New England Journal of Medicine goes on to say, "If the threshold PSA value for undergoing biopsy were set at 4.1, 82 percent of cancers in younger men and 65 percent of cancers in older men would be missed. Dr. Peter Scardino in his Prostate Book goes on to say"...in 70 to 80 percent of cases, an elevated PSA that triggers a biopsy uncovers no evidence of cancer...20 percent of existing prostate cancers would be missed if doctors relied on PSA results alone."
Now it is easy to cherry-pick quotes knocking the PSA test. But what is the answer? Dr. Scardino continues: "The PSA test properly used remains the best indicator of a cancer's presence." Doctors have to learn how to interput the test. Dr.Scardino goes on to talk about PSA velocity, (the rate or speed of PSA rise or doubling time). "If a PSA level increases more than 0.75 nanograms per milleter per year, there's an increased risk of finding cancer.
This is practical, but how about the man with a low PSA taking his first PSA test? What number do we use to measure against?
Dr. H. Ballentine Carter MD and Professor of Urology at Johns Hopkins Brady Urilogical Institute says the key is to look beyond the cutoff numbers and establish a baseline at a younger age. "Test when the other confounding benign conditions (like BPH which cause PSA to rise) do not exist...about 35 to 40 years of age. This will provide a baseline upon which other measurements of PSA can be compared for the rest of the patient's life. Change for PSA over time is the most valuable tool we have for interperting the PSA.
This year, 234,460 men in the United States will be diagnosed with prostate cancer. about 30,000 will die of it. Source: American Cancer Society
So why should anyone still want a PSA test? Well Dr. Patrick Walsh in his book, Guide To Surviving Prostate Cancer, may have the strongest and most compelling quote of all, "Because it is saving lives." I know it saved my life. How about yours?
Diag: 12/03/05, Biopsy, Gleason 10
Hormone Therapy: 12/15/05
EBRT: May thru July '06
Current PSA .03, 09/21/07
Diag: T3b Seminal Visicle Involvement, Gleason 9 both lobes
Post Edited (veteran1) : 12/6/2007 2:40:29 PM (GMT-7)