by Thomas K. Slabaugh, Sr., MD | Commonwealth Urology
More than 200,000 men are diagnosed and more than 30,000 men die each year from prostate cancer, making it the most common cancer in men in the U.S. Prostate Specific Antigen (PSA) is a blood test that has been used for more than 20 years to screen for prostate cancer. Due to the sensitivity of this test, many thousands of men have been diagnosed with early stage prostate cancer, when the disease is most effectively treated. Studies have routinely shown that early detection significantly reduces prostate cancer deaths.
A recent recommendation from the United States Preventive Services Task Force (USPSTF) has called into question the appropriate use of PSA testing. The American Urologic Association (AUA) has issued a statement that challenges the USPSTF recommendation and upholds the current PSA testing recommendation as an effective screening method, along with digital rectal examination, in appropriately selected patients.
The USPSTF recommendation states that men have received treatment for low-grade, low-stage disease that might not have required treatment. Low-grade, early stage prostate cancer often progresses very slowly and can be followed for years without significant morbidity or mortality. Prostate cancer treatments do have significant side effects, most notably high rates of incontinence and impotence. However, high-grade prostate cancer may have a greater than 50 percent mortality rate in 5 years despite aggressive therapy.
Current recommendations for PSA screening include testing for all men once a year starting at age 50. African-American men or those with a family history of prostate cancer should begin at age 40. PSA testing is also recommended for men with abnormal rectal exams and increased risk factors. Routine screening of men over 70 or men with multiple medical problems remains controversial.
PSA testing has the highest validity of any serum cancer screening marker available. Approximately 30 percent of men with a PSA value more than 4 are found to have prostate cancer. Of these cancers, 85 percent are considered aggressive. A prostate biopsy is the only definitive test for prostate cancer. This biopsy is usually performed through a trans-rectal ultrasound probe. The biopsy is performed by a urologist after evaluating the patient and discussing the options for diagnoses and treatment.
The symptoms most commonly associated with prostate cancer are similar to the symptoms of benign prostate disease and include, trouble urinating, decreased force in the stream of urine, blood in the urine, blood in the semen, swelling in the legs, discomfort in the pelvic area . Many patients experience no symptoms until the disease has advanced; therefore, only screening patients with symptoms is not an effective way of detecting early stages of the disease. It is important to note that not all prostate cancers require aggressive therapy. Prostate cancer patients and their physicians must factor in the potential aggressiveness of their cancer, grade and stage of the disease, the patient's age, and other underlying health concerns when deciding on a treatment option. The AUA and other significant cancer support groups continue to recommend routine PSA testing accompanied by a digital rectal exam for all men in the appropriate age range.
For more information about PSA screening or to schedule an appointment, call Commonwealth Urology at (859) 277-2280 or Lexington Clinic at (859) 258-4361.