Men and PSA: To Test or Not To Test?

Prostate cancer is the most common cancer and the second leading cause of cancer death among men.  The disease is most common in men over the age of 65, and African-Americans are at increased risk. One in seven men is diagnosed with prostate cancer.

Prostate cancer is a slow-growing cancer, meaning it may not cause any noticeable symptoms until the disease has reached an advanced stage. Once prostate cancer progresses or spreads outside the prostate gland, it’s usually more difficult to treat, which is why diagnosing the disease early, while it is still confined to the prostate, and still treatable, is key to survival. That’s why a prostate specific antigen (PSA) test is so important.

What is a PSA test?

PSA tests measure blood levels of prostate-specific antigen, a protein produced by the prostate gland. The higher a man's PSA level, the more likely it is that he has prostate cancer. However, there are other benign medical conditions that can cause a man's PSA level to rise, and some men who have prostate cancer have normal PSA levels. As with the decision to screen, Our team believes that physicians and men should make a shared decision whether to proceed with a biopsy to confirm the diagnosis.

A government panel questioned whether this test improves cancer survival. They determined that PSA screening leads to widespread over-treatment, unnecessary procedures, and complications like incontinence or impotence, which outweigh the benefits of testing. Recently, the U.S. Preventive Services Task Force recommended against routine prostate-specific antigen (PSA) screening for prostate cancer.

As a result, this has left many men confused and wondering how to defend themselves against a cancer that’s expected to claim the lives of more than 28,000 men this year.

Even with these limitations, the urologic community continues to recommend PSA screening in a large majority of men. That’s because there has been a measurable reduction in death from prostate cancer over the last three decades that can be directly correlated to the introduction of PSA as a screening tool.

Although the test isn’t perfect, the PSA, combined with a digital rectal exam, imaging if appropriate and a biopsy is the best way to diagnose prostate cancer. Rather than discouraging men from having a PSA test, we believe in a personalized approach based on each man's age, medical history, and other risk factors. We also feel that a discussion about the pros and cons of screening is the best strategy.

In fact, a confirmed diagnosis of prostate cancer may not require treatment. Because prostate cancer is relatively slow growing and some malignant tumors may not be life-threatening, “active surveillance,” or regular monitoring for cancer progression, can be the best course of action.  Treatment options may include surgery, generally considered the gold standard for high-risk disease.  Outcomes and recovery for the different surgical options (Robot-assisted laparoscopic radical prostatectomy, laparoscopic radical prostatectomy, and open radical prostatectomy) vary and are discussed more here. Other treatments may be chemotherapy, radiation, or hormonal therapy.

The real issue isn’t whether prostate cancer should be diagnosed, but rather when those cancers should be treated versus actively observed. Lives will be saved by selecting the appropriate men for screening and treatment and providing education so they can make informed decisions about their health care.

What’s most important is a discussion with your physician about the pros and cons of all your treatment options.

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