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Dr. Douglas Sutherland, right, talks with Physician Assistant Deo Perez in his Tacoma clinic.
Prostate test gives men chance to identify cancer early
In October 2011, the U.S. Preventative Services Task Force, a committee organized by the U.S. government to assess the value of preventative medicine, recommended that men no longer be screened for prostate cancer using a widely accepted blood test given to thousands of men each year. The task force gave the prostate-specific antigen or PSA test a “D” recommendation.
A “D” recommendation means: "There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits."
Despite this recommendation, many organizations and doctors (myself included) continue to recommend the PSA test to screen for prostate cancer.
So, what to do?
To be sure, prostate cancer is a highly variable “two-faced” disease. In most cases, the disease follows a slow-growing course without risking the health or life of the man himself. Prostate cancer can also be a highly aggressive and lethal tumor capable of causing great pain and suffering.
PSA was first used to screen for prostate cancer in the late 1980s. Prior to PSA testing most men with prostate cancer presented with advanced and incurable disease. With the PSA test, prostate cancer is found much earlier and, in most cases, before any symptoms occur. An impressive 44% reduction in annual prostate cancer mortality in the U.S. is attributed in part to PSA testing.
However, another story emerged along with this success. The number of men diagnosed with prostate cancer skyrocketed after the emergence of the PSA test. An estimated 240,000 American men will be diagnosed with prostate cancer in 2012. But only 30,000 are expected to die of the disease - just over 1% of the 2 million men currently living with a prostate cancer diagnosis in the United States.
In addition to finding prostate cancer earlier, which provides men and their doctors a chance to cure the disease, PSA identifies many thousands of men harboring tumors that will never risk their health or life. Not understanding this at the time the PSA test was introduced, several million men worldwide have undergone expensive and painful treatment for a disease that posed them little risk of harm.
So, I ask again, what to do?
It is important to acknowledge that the PSA test is not perfect. Unfortunately, a better alternative does not exist. Broadly categorizing PSA as “good” or “bad” is an extreme simplification. The better way to view the PSA test is to understand that it gives a man options. A simple blood test can offer a man an opportunity to identify prostate cancer early, before it becomes lethal. Performing a PSA test and a prostate biopsy provides a man with potentially life-saving information, at very little risk.
The most critical decision in modern day prostate cancer care is not whether or not to have a PSA test, but whether to treat, or not to treat, prostate cancer. Overtreatment of prostate cancer is the problem, not PSA testing. It is one thing to understand that most prostate cancers are not lethal, but choosing to observe prostate cancer that does not appear to be lethal is the challenge.
PSA can and does save lives, but we must acknowledge its limitations. A man with prostate cancer needs to understand his options, the risks associated with his tumor and available treatments before he makes the decision to undergo treatment. Until a better option becomes available, PSA remains the best test available to reduce the pain and suffering of prostate cancer.
Posted on Sep 10, 2012 in Cancer