I attended the Annual Massachusetts Prostate Cancer Symposium on Friday, May 17. I listened to some great lectures. Especially interesting were the talks about PSA (prostate-specific antigen) testing. This blood test started being used in the mid 1990's. Since it's use began, we have seen a doubling in the rate of prostate cancer, but not much change in the number of men dying from the disease.
Many have taken a closer look at the PSA screening test and prostate cancer as a whole. It has been discovered that many cases of prostate cancer follow a slowly progressive course and men may even remain asymptomatic throughout their lifetime. For these men, the complications from treatment of prostate cancer outweigh any benefit of treatment.
So, last year the US Preventative Services Task Force released this recommendation: "The reduction in prostate cancer mortality 10 to 14 years after PSA-based screening is, at most, very small, even for men in the optimal age range of 55 to 69 years. The harms of screening include pain, fever, bleeding, infection, and transient urinary difficulties associated with prostate
biopsy, psychological harm of false-positive test results, and overdiagnosis.
Harms of treatment include erectile dysfunction, urinary incontinence, bowel dysfunction, and a small risk for premature death. Because of the current inability to reliably distinguish tumors that will remain indolent from those destined to be lethal, many men are being subjected to the harms of treatment for prostate cancer that will never become symptomatic. The benefits of PSA-based screening for prostate cancer do not outweigh the harms."
We need to determine which men are a risk for aggressive prostate cancer because these are the men who are dying from this cancer. We do know there are certain genetic mutations which are important (BRCA for example). Men who have any relatives with prostate cancer may choose to have a PSA test, or one of the newer (PCA-3) urinary screens.
All men need to have a discussion with their physicians to determine their individual risk for prostate cancer and whether screening will be of benefit.