Many prostate cancer experts have challenged the recent U.S. Preventive Services Task Force's (USPSTF) recommendation against routine prostate cancer screening for healthy men using the prostate-specific antigen (PSA) test.
The task force has concluded that healthy men with no symptoms of prostate cancer should not undergo PSA testing, because the test does not distinguish between the aggressive prostate cancers that need treatment versus the slow growing ones that may never cause a problem.
The USPSTF recommendation has set off a firestorm, much the same way it did two years ago when the panel suggested that mammograms were unnecessary for women ages 40 to 49, and also recommended against teaching women to do breast self exams.
How a PSA is Test Used
"Screening tests, such as the prostate-specific antigen or PSA test, can help identify cancer early on, when treatment is most effective," explained Urologist Chris Stiff, M.D.
"The prostate-specific antigen is a protein produced by both cancerous and non-cancerous prostate tissue, and which can be measured through a simple blood test. Cancer cells usually make more PSA, which causes PSA levels in a man's blood to rise. However, PSA levels can also be elevated in men with enlarged or inflamed prostate glands. Therefore, determining what a high PSA score means involves a number of other factors to be evaluated by your doctor, including your age, the size of your prostate gland, how quickly your PSA levels are changing, and whether you're taking medications or supplements that may affect the PSA measurements.
"Detecting certain types of prostate cancer in its early stages can be significant in successfully treating this disease," Dr. Staff said. "Elevated PSA results may reveal prostate cancer that's likely to spread to other parts of your body, or they may reveal a quickly growing cancer that's likely to cause other problems.
"Early treatment can help catch the cancer before it becomes life-threatening or causes serious symptoms. The disadvantage to the test is that once a cancer is suspected, it is often biopsied or treated soon after it is identified. Most prostate cancers do not present an urgent threat to a person's life, but in some cases, identifying cancer early means you will need less aggressive treatment, reducing your risk of side effects such as erectile dysfunction or incontinence. If you are in a group of men at high risk of prostate cancer, you're even more likely to benefit from PSA testing."
PSA Screening Guidelines
Professional organizations vary in their recommendations about who should - and who shouldn't - get a PSA screening test. The American Urological Association recommends that men get a test at age 40, but if the PSA results are low, a retest can be delayed for a period of time.
The American Cancer Society recommends that most men should begin a discussion with their physician about the pros and cons of screening at age 50, or at age 45 in African-American men, or at age 40 in men with a family history of prostate cancer or who are deemed at high risk for prostate cancer.
The USPSTF recommendation of not screening men without prostate cancer symptoms has stirred up a controversy that caused the American Urological Association (AUA) to immediately issue a warning statement from AUA President Sushil S. Lacy, M.D., saying that the USPSTF recommendation might "ultimately do more harm than good to the many men at risk for prostate cancer, both here in the United States and around the world.
The AUA's current clinical recommendations support the use of the PSA test, and it is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer patients."
In addition, the USPSTF's recommendation against PSA screening was given a low D rating, which health plans consider when deciding to cover preventative tests. New legislation in the
Affordable Care Act requires health plans to cover without cost sharing only preventive services that are rated A or B by the USPSTF. PSA testing is estimated to cost around $3 billion annually in the United States, with much of it paid for by Medicare, Medicaid, and the Veterans Administration; so the D rating may become a factor in future payment determinations.
Even though the USPSTF suggests that men without symptoms should not be screened, urologists and other physicians know that by the time prostate cancer has shown symptoms, it is often in an aggressive stage.
"The benefit of having the PSA screening test is that a life-threatening cancer may be diagnosed in its early stages," Dr. Stiff concluded.
"The concern is that the new USPSTF recommendations may further confuse men and discourage them from getting screened or checking with their physician. Early detection is critical to the success of prostate cancer treatments. Ultimately, whether you have a PSA test is something you should decide after discussing it with your doctor, considering your risk factors and weighing your personal preferences."
Chris Stiff, M.D., is a board certified urologist affiliated with Salem Community Hospital's medical staff. His office is located at 2360 Southeast Boulevard in Salem, 330-337-1134; and at 885 South Sawburg Avenue, Suite 105 in Alliance, 330-823-1112.