TODAY’S COLUMN - Dr. Gupta talks about prostate cancer testing

Now is a great opportunity to review the recent changes in prostate cancer screening guidelines. The Prostate Specific Antigen test, or PSA, is a test that many men are used to getting at their annual exams. The test is meant to assist in screening for prostate cancer; however, its use has been scrutinized for many years.

In 2013 new guidelines for PSA testing were released by the American Urological Association. AUA recommends that testing be done every two years for man 55-69 years of age, rather than every year.

In addition, men with a 9-year mortality risk of less than 52% should not be screened.

Why not get tested? There are many reasons.

First, we need to understand the usual course of Prostate cancer. Prostate cancer is very common. In fact, it is the most common non-skin cancer affecting 1 in 7 men over a lifetime. Most patients experience no symptoms from prostate cancer, meaning it is often found when patients have complains due to other conditions, such as Benign Prostatic Hyperplasia (BPH), or from routine PSA screenings.

The majority of prostate cancers are very slow growing. Sixty percent of prostate cancers grow so slowly that the patients are likely to die from heart disease or other causes before the prostate cancer causes problems.

Second, up to 13% of men will have a false positive result, meaning the test is positive, but the patient does not have prostate cancer. For example, the PSA can be elevated in conditions such as prostatitis (inflammation of the prostate) or BPH, which is exceedingly common in this patient population.

Third, there is no set PSA level that confirms the diagnosis of cancer.
False positive results may lead to unnecessary biopsies, which are invasive and not without risk and complications including urinary incontinence and erectile dysfunction.

Finally, there is no way to tell which patients will die from prostate cancer and which patients will die with prostate cancer. This leaves many patients with a final diagnosis of prostate cancer the difficult task of deciding what to do about it.

For these reasons some are pushing for even more lenient screening guidelines than every two years.

One suggestion is that patients get a “baseline” PSA. There is a 3.5% risk of developing prostate cancer within 10 years when the PSA is less than 1 ng/ml. Furthermore, 90% of those cancers will be low-risk.

The U.S. Preventative Task Force has gone even further, recommending that healthy men should not be screened at all.

We suggest that all men educate themselves, know their family history of prostate cancer, think about what they would do if diagnosed with prostate cancer and talk to their doctor about the risks and benefits of prostate cancer screening.

For more information on prostate cancer and the debate on screening:

Prostate Cancer Foundation
http://www.pcf.org/site/c.leJRIROrEpH/b.5802045/k.6D36/What_is_Prostate_Cancer.htm

Early Detection of Prostate Cancer: AUA Guideline
https://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm

Experts explain why PSA test is not worth risk
http://usatoday30.usatoday,com/news/health/story/2012-05-21/psa-test-test-questions-answers/55120916/1

PSA Screening:New Approach Could Shift Risks/Benefits