Since May 2012, when the United States Preventive Services Task Force recommended against routine prostate-specific antigen (PSA) testing, patients have asked whether or not the PSA test is a good option for catching prostate cancer.
By the numbers
In 2011, there were 242,000 new cases of prostate cancer in the United States and about 28,000 prostate cancer deaths. In 2008, worldwide, there were more than 900,000 new cases of prostate cancer and about 258,000 deaths.
Prostate cancer screening started in the late 1980s and peaked in popularity in the early 1990s. Subsequently, the diagnosis of prostate cancer peaked in about 1992. Initially, this led to an increase in prostate surgeries and radiation treatments.
Since that time, we have learned we can do “active surveillance” of low-grade prostate cancers. As a result, the number of so-called “unnecessary surgeries” has dramatically dropped. And the number of patients whose cancers are simply being watched has increased.
There can be many causes for an elevated PSA. Benign prostatic hypertrophy, found in most men as they age, is the most common. This is followed by low-grade prostate infections. One of the strategies to combat a high PSA is a short course of antibiotics and a retest. Sexual activity near the time of the test may artificially raise the PSA, as well.
Other modalities to further define the significance of PSA include percent-free PSA and PSA velocity. Both determine if we are dealing with an aggressive tumor.
The definitive way to determine whether there is a prostate cancer is by prostate biopsy. The most common type is a transrectal biopsy in which access is gained through the rectum. If a tumor is found, these biopsies can determine the volume and aggressiveness, using a scale called the Gleason score. From there, it can be determined whether active surveillance or another form of therapy is indicated.
Our experience shows a dramatic improvement in quality of life with prostate screening, through PSA and digital rectal exam.
Considering the information, we recommend biannual (every other year) PSA and digital rectal exams for all males between 50 and 80. Additionally, for those who are African-American or have a family history of prostate cancer, we recommend starting this screening by 40 years of age.
If you have questions about PSA testing, do not hesitate to come in and talk to us.