ASK, ANSWER, LEARN
Should I get a PSA screening test for prostate cancer, or is that no longer recommended?
J. Bruce Robertson, MD answered:Medical professionals have been using PSA blood tests and prostate exams to diagnose prostate cancer for more than 20 years. Recently, use of PSA in the U.S. has come under fire, with the United States Preventive Services Task Force stating that PSA testing in the general population actually does more harm than good and that we should, therefore, curtail our use of PSA as a screening test.
Prostate cancer is the second most common malignancy in men, and also one of the leading causes of cancer death among men in the U.S. Prior to 1980 we had no good way to detect prostate cancer at an early stage. In the 1980s researchers found a protein called Prostate Specific Antigen (PSA) in the blood stream of men. Further research revealed PSA comes from the prostate (and, as far as we know, only from the prostate) and that it was often elevated in men who had prostate cancer.
It is very true that PSA is not a perfect screening test for prostate cancer. Many other prostate problems can cause an elevated PSA. For example, ordinary enlargement of the prostate (BPH) that affects most men as they get older is probably the most common cause of an elevated PSA. As a result, many men undergo a prostate biopsy for an elevated PSA only to find that they just have BPH.
We would, be much better off if we had a blood (or other) test that was more specific for prostate cancer and could help us avoid “unnecessary” prostate biopsies. Unfortunately, a better test for prostate cancer does not presently exist. However, the death rate from prostate cancer in the U.S. has decreased by about 20% since we have been using PSA. This is a strong statement that PSA has been helpful. Until a better screening test is available, the American Urological Association and your urologists here in Bozeman recommend annual screening with PSA and prostate exam for men between age 50 and 75. For men whose father or brother had prostate cancer, screening should begin at age forty.
Perhaps the best approach is to have regular checkups and discuss with your family doctor whether or not screening for prostate cancer is good for you.
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