Prostate Cancer Screenings

Using the prostate-specific antigen (PSA) to screen for prostate cancer has remained controversial among some patients. Now a new study says more men could possibly develop advanced cases of cancer if doctors did away with the blood test.

PSA is a protein produced by the cells of the prostate in which higher levesl can be an indicator of cancer.

“If we stop screening, and if we stop treating those cancers we feel are a threat to men, then what this study says is we’re going to three times the likelihood that men will develop metastatic prostate cancer,” Dr. Herbert Lepor of NYU’s Langone Medical Center.

The study was published in the Journal of Cancer and it comapared data from the 1980′s when there was no routine testing to recent yearrs of widespread testing. Researchers found PSA and early detection could help prevent the spread of cancer to other parts of the body in up to 17,000 men.

A federal task force recently recommended against routine PSA tests saying there is little to no benefit to them and that the screening leads to more tests and treatment that can be unnecessary and harmful.

American Cancer Society recommendations for the early detection of prostate cancer

The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information.

The discussion about screening should take place at age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African-American men and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).

This discussion should take place at age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

After this discussion, those men who want to be screened should be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.

If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the patient’s general health preferences and values.

Assuming no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:

- Men who have a PSA less than 2.5 ng/ml may only need to be retested every 2 years.
- Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.

Because prostate cancer often grows slowly, men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit. Overall health status, and not age alone, is important when making decisions about screening.

Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences.



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