Dr. Jim explains the current rationale behind prostate cancer screening with the PSA or prostatic specific antigen test.
Dr. Jim here talking with you today about screening for prostate cancer with the PSA or prostatic specific antigen test. The United States Preventive Services Task Force recently released new recommendations for screening and I’m here to talk with you about them.
Prostate cancer is not uncommon. About 11% of men will develop prostate cancer in their lifetime if they live into their 80s. It’s also a deadly disorder. You can actually die from prostate cancer, so why not test everybody?
The United States Preventive Services Task Force has modified their recommendations considerably and here’s what they say.
Men age 55 to 69 should have individualized testing, which means a frank and honest discussion about their risks and likelihood of having prostate cancer with their doctor, then transitioned into testing.
If you are African-American, you are more likely to have deadly prostate cancer, so when you have an individualized discussion, you are more likely to get testing. If you have a first-degree relative – like your dad or your brother who developed prostate cancer, that is a risk factor – besides the fact that you’re male – so you need screening.
That said, why are they individualizing this? Why not test everybody?
The biggest problem is the PSA test is prone to false positives, which means that the test turns out positive, but you don’t have cancer. An enlarged prostate gland can cause an elevated PSA, so can riding on a bicycle. Infection in the prostate gland causes an increased PSA, the physician’s digital rectal exam will increase the PSA, as will anal sex, so there are lots of reasons why the PSA is elevated and you don’t have cancer. And then if you have a positive test and that triggers a prostate biopsy, you can have complications – infection, bleeding, needless worry and the like.
More importantly, if prostate cancer is over diagnosed by the PSA test, it can lead to unnecessary removal of the prostate gland through surgery and other means, which in and of itself is a hazardous procedure that quite honestly might lead to prolonged hospitalization or even death. But even more, if you recover from the surgery and now you’re incontinent and now you have erectile dysfunction, who wants that if they did not have cancer in the first place? Finally, after 70, the risks of prostate surgery and the complications associated with it often far exceed the gains.
So, for all these reasons the United States Preventive Services Task Force has individualized PSA testing, made it the name of the game and why asymptomatic men over 70 are not recommended to be routinely screened with the PSA.
References: United States Preventive Services Task Force, 2018. Final Recommendation Statement Prostate Cancer: Screening. Online [available at]: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening1 Accessed October 21, 2018.