Prostate Cancer: What’s A Man To Do Following Conflicting Reports?

One finds that the prostate-specific antigen (PSA) test used to detect prostate cancer didn’t save lives. The other study finds it did.  

The conflicting studies have experts questioning whether prostate cancer screening provides enough benefit to offset the painful medical treatment that often comes following an elevated PSA finding.

PSA

Millions of men routinely take the PSA blood test.

An elevated PSA reading can indicate cancer or tumors that are benign. Doctors cannot yet tell the difference.  So they order treatment, such as surgery that can lead to impotence and incontinence. 

The American Cancer Society does not recommend PSA screening for all men on a routine basis. 

“We stopped mentioning screening in 1997, and since then have been for ‘informed decision-making,’” according to Dr. Otis Brawley at ACS, speaking to US News. 

Instead they recommend that men be told about the test and the potential risk versus benefit.

Men over the age of 75 do not need to have a PSA test unless past tests have shown a high PSA level, according to government guidelines issued last fall.

PSA is a protein produced by the prostate.  A reading of 4 is considered to be normal. Rising levels may indicate an aggressive tumor.

The PSA test was introduced in 1987. Since 1992, the U.S. death rates have declined about 4 percent a year from prostate cancer. 

PSA alone is not cancer specific.  A high reading requires a biopsy.

Since prostate tumors have a wide range of activity the question then becomes what to do.  Some grow slowly, so the term “watchful waiting” has been coined to just wait and assess the tumor's progress. You will likely die of some other cause before the tumor becomes a threat if it is slow growing. 

Other prostate tumors are aggressive and fatal.  Treatment can result in incontinence and impotence. 

The Studies

One NEJM studies followed almost 80,000 American men.

After seven years, researchers found the men who had regular PSA tests had no reduction in prostate cancer deaths versus those who didn’t have the routine screening.  

Critics say the U.S. test was flawed, become some in the control group were routinely screened, so it was actually a screening group compared to a semi-screened control group.

Another study of 182,000 European men , found there was a 20 percent reduction in prostate cancer deaths among men who underwent the PSA screening.   The results were based on a small number of deaths.

48 men had to be treated to save one life.  Compare that to 11 women who must be treated for breast cancer to save two lives, according to Brawley, speaking to the Los Angeles Times.

Recommendations

In a follow-up discussion in the NEJM, experts conclude that the benefits of testing outweigh the risks.

African American men and those with a family history have a higher risk of dying of prostate cancer and should have that regular screening discussion with their doctor at the age of 45 or sooner.

Current recommendations are that a man over 50 be offered the option of an annual test. It could tell if they have a life expectancy of more than 10 years.  

An estimated 186,000 American will get a prostate cancer diagnosis this year. More than 28,000 die from it annually, according to the National Cancer Institute.   

1 of 6 men in the U.S. will receive the diagnosis in his lifetime. #