USVI-On-Line

In the news today, just like the mammography testing a few months ago, the validity of PSA testing for men is now "in doubt�.

As all men of a certain age know, the PSA test is a cheap blood test that is a biological marker for prostate cancer that we�ve all been told we should get done, just like regular blood work for cholesterol etc.

However, now, �The American Cancer Society is warning more explicitly than ever that regular testing for prostate cancer is of questionable value and can do men more harm than good.�
Say what?

http://news.yahoo.com/s/ap/20100304/ap_ ... ate_cancer

However, in this age of glib bumper sticker mentality and politicized black and white talking points (no matter what the subject), it is important to look beyond the headlines and first paragraph of this news report.

Otherwise, the take away message for too many men will be �Oh, I don�t need that test anymore�, which may be the wrong message.

I believe the point they are trying to make here is that PSA screening shouldn�t be done willy-nilly
without knowing the limitations of the test AND that invasive testing (biopsy) and, most importantly, treatment shouldn�t be initiated based on a single PSA test.

Indeed, what is notable and can get lost in the fog of today�s news cycle is that the new guidelines still do say:
�Use past PSA readings to determine how often follow-up tests are needed and to guide conversations about treatment.�

Now, you can�t have �past PSA readings� if you never even have the PSA blood work done in the first place, so it seems logical to still at least get a baseline reading at age 50 (or even age 45). If that PSA number is nice and low, fine, you are good to go for another X number of years that you decide with your doctor works best based on family history etc. (by the way, another thing that can cause your PSA number to be slightly elevated above your �norm� is if you happen to have been, um, �active� within 36 hrs prior to testing, so its better if you keep it in your pants for a couple days prior to getting the PSA blood work done)

If do get a PSA test and have an above average result for your age, there are also other simple tests that could be done such as the �free PSA� and �PCA3� tests. These could be used in conjunction with the physical exam and multiple PSA test results taken over time to help make the decision with a urologist to biopsy or just do �watchful waiting� of what is usually a very slow growing cancer.

Also get a copy of that baseline PSA test result and keep it with your own personal medical files because another good reason to know that number when discussing PSA screening with your doctor is the issue of PSA �velocity�. That�s the rate of rise of the PSA number over time. If your PSA values double in 3-4 years, but are not yet over the �above normal� number of 4.0 ng/mL, that could indicate the presence of a faster growing cancer, and may warrant further investigation and consultation with a urologist who can run those additional tests noted above and in this link which has more information on PSA testing:

http://www.cancer.gov/cancertopics/fact ... ection/PSA

USeful info. Thanks for posting it. It's so hard to get some guys to go for regular checks as it is. I certainly hope they don't use some info they receive as an excuse to put PSA test off. I hope my hubby will always get regular checks. His father died of it.

A few more comments:

It seems misleading for the headlines to proclaim that the PSA (and mammography) tests “can do more harm than good”. It is not the tests that do more harm, it’s the over treatment (surgery, radiation, etc.) that results from the testing, especially of older men who are much more likely to suffer significant side effects.

You are always going to have surgeons that will recommend surgery and oncologists that will recommended radiation or chemo at the drop of a hat regardless of cancer stage, age, or overall health. And while it is prudent to question testing that can lead to over-treatment of cancer, and it is good that they are moving away from just “survival rates” as the end measurable and more towards quality of life issues when discussing cancer treatment outcomes, this comes off as a yet another ham-handed attempt to educate the public about these subjects. Seems there is enough blame to go around here for both the message maker (the American Cancer Society) and the messenger (media that is more polarized and knee jerk than ever).

Another thing that may be skewing the results of the long term studies they cite when they make these proclamations that the treatments “do more harm that good” is this:
it often seems like they include data from when the treatments weren’t very good, or sometimes they even mix somewhat different treatment protocols and/or different stages of cancer together when comparing end results. And in the case of prostate cancer, the advances made in the accuracy of radiation treatments and robotic laparoscopy in the last few years are reported to have much better results in reducing the risk of the potentially devastating side effects, especially for younger, fit men.

Having radiation or a prostatectomy 10 years ago to treat prostate cancer was a scary proposition that was probably more likely than not to result in you shopping in the adult diaper section of Walmart for the rest of your life. That’s a LOT less likely today with the advancements made in these and other treatments for prostate cancer that may not be well factored into these longer term studies. That’s just my take on it.