PSA Screening: What You Don’t Know Really Can Kill You
Real-Life Consequences of PSA Testing
The first key fact that no one can dispute: from 1992 to 2011 there was a 47% decrease in prostate cancer deaths with the start of PSA screening in the USA. Yet in 2009 and again in 2012, the Federal Government, embodied in the US Preventative Service Task Force (USPSTF), recommended against PSA testing to detect men with prostate cancer. There were claims by the USPSTF about over diagnosis and over treatment, yet it seems to me that the patients were penalized, not the doctors doing the over diagnosis and doing the over treatment.
In my own clinic, many patients still seemed to be surprised that prostate cancer can be deadly-second only to lung cancer in cancer deaths among Americans. In 2015, the American Cancer Society stated that over 220,000 men will be diagnosed with prostate cancer in the United States. And 32,000 men will die from their prostate cancer. That’s hardly a disease to be taken lightly.
More Men Now Diagnosed with High Risk Prostate Cancer
As I reported previously in my blogs, City of Hope Medical Center’s Dr. Timothy Schultheis found that from 2011 to 2013-following the USPSTF’s recommendations- the number of men found with intermediate and high risk prostate cancers increased significantly in the USA. And that study had big numbers-Dr. Schultheis looked at 87,562 men diagnosed with prostate cancer from 2005 to 2013.
Dr. Catalona, a urologist and recognized expert on prostate cancer from Northwestern University School of Medicine, said “There is a price to be paid for not doing PSA testing. We have learned from cancer statistics in the US and from randomized clinical trials in Europe that PSA testing can cut the prostate cancer death rate nearly in half. The strategy for success is to detect the prostate cancer early, when it is curable. If doctors and patients do not work together to ensure appropriate PSA testing and treatment in an organized and routine fashion, there will be more unnecessary suffering and death from incurable prostate cancer in the near future.”
So What’s A Man to Do?
The second key fact that no one can dispute: the majority of prostate cancer deaths are in men 70 years or older. So it may be even more important to screen our senior men. Now that the Federal Government issued its edict that PSA testing is no longer needed, it’s really up to men to advocate for their own health. Men need to stand up to protect themselves. Ask your doctor about PSA testing. Bring PSA testing up at your next check-up. There are even some laboratories, right here in Dayton, where you can pay $30 and have the test done on your own, without a doctor’s order.
I agree that as a stand-alone, one time test PSA screening is less useful than thought over 25 years ago. But when combined with physical examination, family history, and tracking any changes in the PSA level over time, it really can be useful and even lifesaving. In fact, a change in the PSA level of only 0.75 ng/mL over one year may be worrisome for prostate cancer, especially in men younger than 60.
What you don’t know about your prostate and PSA level really can kill you. Once again, the USPSTF’s latest recommendation seem to be extreme. They are watching out for the dollar and not for the individual man.