May 2014

To PSA or Not To PSA

The two common screenings for prostate cancer are either a blood test called a PSA, that calculates a secretion from the prostate gland, or the digital rectal exam (a healthcare professional uses a gloved finger inserted into the rectum to check for lumps on the prostrate).  When the blood test is done, high levels of PSA for men indicate a high risk for prostate cancer.  Other factors such as age and race, medications, infections and enlarged prostate can also affect the PSA level causing high results.

So what is the controversy?  A US Task Force made the following recommendations in 2012. The standard guideline for screening in non-symptomatic males has no benefit and that the harm outweighs the benefit.  This sent shock waves through the Urologic Community. The question is whether we are saving lives with this test or causing harm through unnecessary testing.

Benefit-The obvious benefit is early detection of prostate cancer and saving lives.

Harm-The blood test causes very little if any risk for harm.  Abnormal PSA may result in a biopsy which can cause bleeding or infection.  What we do next is the big step.  About 25% of all biopsies are positive for prostate cancer.  Once diagnosed with cancer, treatment options are watchful monitoring of your prostate, hormone treatments, or reduction type surgery.  Most men opt for treatment which is very successful.  Yet treatment can come with the risk of incontinence or impotence.

So now what?  The recommendation of some physicians is to still have the PSA testing done.  Then have a frank discussion with your physician as to what to do with the results.  Knowledge is power.  The more informed you are the better the decision you can make.

If you have any questions about PSA testing or Prostate Cancer, please set up an appointment so we can discuss your risk factors.

Dr. Steve