Should PSA Screening be routine for Prostate Cancer?
After skin cancer, prostate cancer is the second most common type of cancer among men in the US. About 220,000 men will be diagnosed with prostate cancer per year. Fortunately, deaths from the disease are low with nearly 100 percent of prostate cancer men surviving five years or greater.
The US FDA approved PSA testing as a way of screening for prostate cancer around the early 1990s. Before PSA testing was recommended the five year survival rate was only about 70-75 percent. It is believed that routinely screening men with a PSA test accounts for the drastic increase in survival rate. Still PSA screening is controversial. The test can result in false positive test results, which can further lead to over treatment of the condition.
PSA stands for prostate specific antigen, a molecule made by prostate gland cells. This shows up in the blood and the PSA level is identified. Elevations in PSA levels can indicate the possibility of prostate cancer; a high level necessitates a prostate biopsy.
Unfortunately, a high PSA level can be found in prostate inflammation and prostate enlargement—conditions that do not require a biopsy of the prostate gland. The PSA test cannot tell the difference between non aggressive and aggressive prostate cancer. It is estimated that up to half of all men who carry the diagnosis of prostate cancer probably would not have had symptoms of their condition for the remainder of their life.
An elevated PSA level might mean that too many men are undergoing drastic surgery for non-aggressive prostate cancer. Surgery is not without its risks. Men can develop incontinence or erectile problems after such a surgery.
The US Preventative Services Task Force has gone on record as of 2012, saying that men should not have routine testing of PSA levels, largely because of the issue of over treatment. Men who are screened with a PSA test should understand the pros and cons of having such a test.
Other researchers believe that PSA testing helps identify the disease in its early stages and that, by not testing, only advanced cases of prostate cancer will be uncovered. The American Cancer Society doesn’t provide for the testing of a PSA level in asymptomatic men. It is said that a discussion about screening for prostate cancer should begin at age 50 for those at average risk and at 40 for those at high risk.
Many doctors still believe that prostate cancer can save men from prostate cancer deaths, citing the improved survival rates since PSA screening became routine. A European study is often cited, which showed a reduction in prostate cancer deaths by 21 percent of men are routinely screened with PSA screening. They note that prostate cancer screening is just as beneficial as breast cancer screening is for women.
Another study, called the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, showed that PSA screening did not affect mortality in patients any better than a digital rectal examination. The CDC is sitting on the fence, indicating that men should undergo informed decision-making when it is related to screening for prostate cancer.
Many experts on the condition believe that if a different test could be identified that would tell the difference between aggressive and non-aggressive, there would be no question that such a test would be done and would replace PSA screening. No such bio marker has yet been identified, however. Prostate Cancer UK is currently working on such a test that, if it works, could change the face of prostate cancer screening.
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