Liberty Planet Weblog

Men: Be aware of benefits, risks of PSA screening

Posted on: May 1, 2013

Back in 2005, I wrote a column about a test called PSA (prostate specific antigen) in which I said it was somewhat controversial.

Eight years later, the controversy continues.

Prostate cancer is a cancer that many men will develop without ever knowing it because it may not cause any pain or other symptoms. Men may go merrily along in blissful ignorance and die of something else.
Unfortunately, not every case of this disease is slow growing and silent. Some men will develop significant symptoms, including severe pain, and may even die as a direct result of prostate cancer.
The question is then not just who will have the disease, but who will have symptoms and who will not. If prostate cancer is detected in a man who will have no significant problems with it, the treatment will be worse than the disease. This is because the treatment involves expense and is likely to cause side effects that may decrease the quality of the man’s life unnecessarily.

On the other hand, if the man has an aggressive form of prostate cancer, early detection may save his life. In fact, before early detection tests were widely used, most men with prostate cancer were diagnosed with advanced disease, and most died within a few years of the diagnosis.

Keeping all of that in mind, we get back to the PSA blood test.

The practice of regular routine PSA tests has come under criticism in recent years amid concerns that it leads to over diagnosis and over treatment. It is now being suggested that just three PSA tests over the course of a lifetime is sufficient for many men.

This idea comes from a team led by Andrew Vickers, PhD, from the Memorial Sloan-Kettering Cancer Center, in collaboration with teams in Washington and Sweden. However, this proposal, which is based on a single study, is not ready for general endorsement by experts in the field.

In 2010, Vickers’ team reported that a single PSA test at age 60 is all that is needed for many men. That conclusion was criticized as being too simple and generally inadequate.

So the team offered a simple plan for prostate screening in a recent publication. For at least half of all men, it would mean only three PSA tests during their lifetime.

In their proposed strategy, all men with a reasonable life expectancy would have PSA screening in their mid to late 40s. The best age for this initial PSA test is around 45 years, unless there is a strong family history of prostate cancer. Age 40 might be too early, and age 50 might be too late to identify a man’s risk of developing an aggressive cancer. That single PSA test at age 45 could be used to predict a man’s long-term risk of developing an aggressive prostate cancer.

Men who were found to have a PSA level below one on the initial test would be advised to return for screening in their early 50s and again at age 60. At the age of 60, men who still had a PSA level below one would be exempt from further screening. This would probably be sufficient for at least half of men.
On the other hand, men who are found to have a PSA level of one or higher on the initial test are at above-average risk of developing life-threatening prostate cancer. These men should regularly undergo screening until around age 70, repeating the PSA test every two or four years.

For men 40 to 55 years, those with PSA levels in the top 10 percent of this age group should receive particular focus. This group contributes to close to half of all deaths from prostate cancer occurring before the age of 75.

Such an approach to PSA screening might improve the ratio of its benefits and harms. However, it is based on data collected from more than 20,000 white Swedish men in one city, so the conclusions might not carry over to other populations.

Therefore, the “right answer” about prostate cancer screening is yet to be clarified by further research. For now, all men should be aware of the benefits and risks of PSA testing as well as the pros and cons of treatment.

We men need to consult with our doctors and come to a conclusion that seems right to us, while keeping an open mind for future research results and conclusions.

Source: KPC News


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