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In just one year, the face of prostate cancer
screening - the Prostate-Specific Antigen test (PSA) - has gone from
screening essential to questionable test. Why? While the test has
revolutionized the ability to monitor prostate cancer, when used for
early detection it has both limitations and advantages. The Prostate
Conditions Education Council (PCEC) wants to arm you with the
information you need to make an informed decision about the value of
prostate cancer screening.
Early Detection and
Screening for Prostate Cancer
The goal of screening is to
detect cancers that could cause suffering and death, but screening may
also detect cancers that would never cause symptoms.
The PSA
Debate
The PSA debate should focus on when and how to use the test. On the one
hand, regular PSA testing has the ability to identify prostate cancer in
its early stages, when treatment is most effective and most
survivable. On the other hand, some believe that regular PSA screening
has led to the over diagnosis and subsequent over treatment of the
disease.
Two recent clinical trials, the Prostate,
Lung, Colorectal, and Ovarian (PLCO)
study and the European Screening Trial (ERSPC), found conflicting results on the benefit of
screening. Long-term
data from the ERSPC provides evidence that PSA screening can save lives. On the other hand, early data from the PLCO
found there was no early mortality benefit from annual prostate cancer
screening; however, many believe that additional data from the PLCO is needed
before the results of the study can be conclusively determined.
The PCEC's Council of renowned
oncologists and urologists believes the PSA provides men and their
physicians with important information about the risk for prostate
cancer, a disease that remains highly treatable if caught in its
earliest stages. Although the PSA test is not perfect, it is effective
in identifying men at high risk for prostate cancer and for detecting it
early. Moreover, a strong correlation exists between PSA and aggressive
forms of the disease. Moreover, a strong correlation exists between PSA
and aggressive forms of the disease. In
fact, since the PSA was incorporated as a screening tool, there has been as
much as an 85% decrease in the number of advanced-stage prostate
cancer cases (indicating that prostate cancer is being found earlier, in its
more treatable stages).
Some "over-diagnosis" and "overtreatment" do occur
with early detection screening. PCEC
works diligently and conducts significant research to help advance early
detection of the disease, but there is currently no validated test superior to
PSA as a screening device. Because of the limited ability to distinguish between
harmless and lethal cancers, most cancers are treated once it is diagnosed. It is not surprising that most patients and
their doctors would choose an early diagnosis of prostate cancer and
appropriate treatment rather than risking death. When used correctly, the PSA test can help identify an increased risk
for prostate cancer, allowing men to weigh the risks and benefits of additional
testing (such as biopsy) and treatment with their doctors.
Advice from our Experts The PCEC encourages men
to "Choose to Know - and Know to Choose." This means men should choose
to know their PSA values, just as they would their cholesterol, and
know that there are many choices and variables in determining if they
need a biopsy or treatment. The PCEC recommends a baseline prostate
health assessment, including PSA and digital rectal examination (DRE),
for all men at 35 years of age. Based on this initial assessment, the
PCEC recommends that men with a PSA less than 1ng/ml be screened again
in five years and men with a PSA between 1-2ng/ml be screened every
other year. For those who have a PSA greater than 2ng/ml, the PCEC
recommends annual screenings. However, the PCEC does not advocate for
screenings if a man's life expectancy is less than 10 years.
It is also critical for men to understand that
there are multiple risk factors that should be taken into account, and the
choice to be screened, biopsied, or receive treatment for prostate cancer is a
personal choice that should involve a discussion with their physicians.
To learn more about
the PCEC's prostate health recommendations and the value of prostate
cancer screening, visit www.prostateconditions.org.
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Resources and Links on Screening
Please find below a short list of links on articles regarding screening. Please visit our website for more at www.prostateconditions.org.
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7009 S. Potomac Street, Suite 125 - Centennial, CO 80112
1-866-4PROST8
www.prostateconditions.org
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PCAW 2010
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Watch It Now
Please visit the Healthy Body Healthy Mind iTV website to watch an excellent patient video on advanced disease, bone loss and early detection
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National Council Physicians
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E. David Crawford, M.D.
University of Colorado
David G. McLeod, M.D Walter Reed Army
Neal Shore, M.D.
Grand
Strand Urology
Frank
Staggers, M.D.
NMA
Nelson
N. Stone, M.D.
Mount Sinai
Allan Partin, M.D.
Johns Hopkins
Daniel
Petrylak, M.D.
Columbia-Presbyterian
Mark Moyad, M.D.
University of
Michigan
Mack Roach, M.D.
University
of Calif. SF
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