PSA Screening

Menstuff® has compiled information on the issue of PSA screenings. While many organizatoins like the American Cancer Societey and Kaiser Permanente are not currently recommending screenings for all men 50 plus to help insure early detection, and only suggest to talk to a health care provider about the downsides of testing, articles like the following continue to suggest that the ACS advice may not be the best.

Studies Back Value of PSA Screening for Prostate Cancer
What's a Guy to Do? A different Perspective on PSAs

Studies Back Value of PSA Screening for Prostate Cancer

Evidence is mounting that a screening test helps save lives by catching prostate cancer at earlier and more treatable stages, researchers said here.

At the 95th Annual Meeting of the American Urological Association on Sunday, a new study out of Austria showed that widespread screening in a certain region of that country resulted in lower death rates from prostate cancer as compared to the rest of the Austrian population.

In 1993 in the Austrian state of Tyrol, a free, comprehensive PSA screening program was started. PSA tests monitor the levels of prostate specific antigen in the bloodstream. Elevated levels of PSA are signs of possible prostate-related conditions, such as cancer. In the first four years of the screening program, nearly two thirds of Tyrolean men between ages 45 and 75 (out of 65,123 in that age group) had been tested at least once. The incidence of cancer peaked in 1994, and then declined each year.

"We also saw an increase in organ-confined disease," said Georg Bartsch, M.D, professor of urology at the University of Innsbruck in Austria.

Starting in 1993, the number of prostate cancer deaths in this region began to decline, with a 32 percent downturn in 1997 and a 42 percent drop in 1998. During the same period, the death rate in the rest of Austria remained constant.

"This is what can happen when PSA is introduced into a population with high acceptance and accessibility," said coauthor Peter Boyle, M.D. "We're detecting more patients at a favorable stage, and we're also eliminating metastatic disease."

Although PSA screening is not yet considered a necessity in the United States, researchers from Washington University School of Medicine in St. Louis tracked men who followed AUA screening guidelines, which recommends that men with no risk factors receive a digital rectal examination (DRE) and PSA testing yearly starting at age 50.

The purpose was to see if the recommendations actually catch curable cancers. "There are limited data tracking men who follow AUA guidelines for the detection of prostate cancer," said Robert L. Grubb Jr., M.D., professor of neurological surgery and of radiation sciences at Wash. U.

They reviewed the records of more than 10,000 men who had been screened. Of that group, 103 were diagnosed with prostate cancer. After examining their records, the investigators concluded that the current guidelines were indeed effective, detecting the vast majority of cancers at a treatable stage. They conceded, however, that in 17 percent of the men the disease may have been medically harmless, and in 1 percent it had already spread.

We are catching more than 85 percent of prostate cancers at the curable stage with the AUA guidelines," Grubb said. "DRE and PSA screening should be offered to all men over the age of 50."


What's a Guy to Do?

Most men who get prostate cancer don't die from it. So why get tested? Good question.

Women having mammograms aren't the only ones getting mixed messages these days. Many men may be surprised to learn that questions have also been raised about whether the standard blood test to screen for prostate cancer does more harm than good. Some of the controversy surrounding the PSA (prostate-specific antigen) test will have a familiar ring to anyone who has followed the mammography debate. But there are also some important differences.

Two trials are under way to determine whether routine PSA tests save lives, but the results will not be in for five or 10 years. Until then, doctors must rely on reports like the study in last week's Canadian Medical Association Journal in which researchers take a close look at the drop in the death rate from prostate cancer across North America since the mid-1990s.

Supporters of the PSA test contend that the decline is due to the routine screening that began in the 1980s. If that were the case, the researchers from the University of Laval in Quebec City argue, the greatest fall in the death rate would have been recorded in those sections of Quebec where more men underwent screening. In fact, there was no statistical correlation between screening and death rates.

How could this be? For starters, the PSA test, like the mammogram, is a less than perfect cancer detector. Men may develop high PSA levels for many reasons: an infection of the prostate, the natural effects of aging, even bruising caused by a long bicycle ride. Or they may have cancer. Only a biopsy can tell for sure.

So far, so good. Now comes the part that seems illogical. You would think that early detection of cancer would increase a man's chances of being cured and therefore prolong his life. But not all prostate cancers are equally deadly. Indeed, most men, if they live long enough, will eventually develop prostate cancer. But most don't die from it. "Perhaps 10% to 15% of prostate cancers are very benign," says Dr. E. Darracott Vaughan, president of the American Urological Association. "Another 10% to 15% are very aggressive." It's hardest to predict what will happen to the middle 70%.

What's needed is a better way to figure out who will benefit from treatment and who can safely avoid it and its unfortunate side effects, which can include impotence and incontinence. That information may come in the next decade, as we learn more about the genetics of cancer.

In the meantime, if you are a man 50 years or older (40 or older for African Americans), you can start by familiarizing yourself with the pros and cons of PSA tests. After doing so, up to 70% of men decide to get screened. Who knows? The test may still save your life.

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