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Prostate Cancer Screening: The Low Down On Prostate Cancer Screening
If you're a man who has reached his 50th birthday, chances are your doctor has already checked your PSA level to determine the potential for prostate cancer. If you're one of the lucky ones, your PSA was normal. But if you're one of the truly fortunate ones, you have a doctor who knows the real value of the test and how to put it to its best use.
An editorial in the British Medical Journal last month sized up the value of the PSA test with this comment: 'At present the one certainty about PSA testing is that it causes harm.'
It's not the test itself that causes harm, of course, it's the reaction to the test. Because when PSA is elevated, in most cases it's not time to act, it's time to be more cautious than ever.
Once is not enough
PSA - or prostate-specific antigen - is a protein that's naturally produced by the prostate gland. Prostate tumours typically cause an over-production of PSA, so when a blood test reveals an elevated level of the protein, it's a red flag that warns of possible cancer. The next step most doctors take is to recommend a biopsy. And this is where the trouble starts. Prostate biopsies are painful procedures that can result in bleeding and infection. But recent evidence shows that a great number of these biopsies are completely unnecessary.
In a 2003 US study from the Memorial Sloan-Kettering Cancer Centre in New York City, researchers set out to determine if fluctuations in PSA levels would reveal a single PSA test result to be unreliable on its own.
Over a 4-year period, the Sloan-Kettering team collected five blood samples each from nearly 1,000 men whose average age was 62 years. More than 20 percent of the subjects were found to have PSA levels high enough that many doctors would have recommended a biopsy. Half of those men, however, had follow-up tests with normal PSA levels.
The Sloan-Kettering team concluded that an isolated PSA screening with an elevated level should be followed with an additional screening several weeks later before proceeding with further testing or a biopsy.
This research backs up another study I recently told you about in which doctors at the Fred Hutchinson Cancer Research Centre (FHCRC) in Seattle estimated that PSA screening may result in an over-diagnosis rate of more than 40 percent.
If your prostate test turns out to be positive, you shouldn't let your doctor rush you into surgery. Most cancers are slow-growing, and you need not panic into treatment.
Next week I'll follow up today's e-Alert with some information about prostate cancer prevention.
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