New healthcare guidelines from the Canadian Task Force on Preventive Health Care recommend that men should not have a PSA test to screen for prostate cancer.
A PSA test is a simple blood test that measures the amount of prostate-specific antigen in a man’s blood. When the PSA is elevated, it can potentially indicate prostate cancer.
An elevated PSA can also mean other conditions such as an enlarged prostate or a prostate infection also known as prostatitis. For this reason, the PSA test is not perfect – it is not specific for prostate cancer. However, the PSA test can save many lives when used appropriately.
The Canadian Task Force claims that PSA testing does more harm than good. They suggest avoiding a PSA test until symptoms appear. Meanwhile, prostate cancer symptoms do not appear until the cancer has spread outside the prostate. At this point, treatment options are limited and there is no chance of completely eradicating the cancer. With a disease like prostate cancer, early detection saves lives.
The Task Force also strongly advocates decreasing over-treatment and using active surveillance as a way to monitor. Eliminating PSA testing does not solve this issue. If PSA tests aren’t around, how can we catch prostate cancer early? It’s true that prostate cancer occurs mainly in older men – the average age at the time of diagnosis is about 66. But what most people forget or do not realize is that younger men do get prostate cancer, and when they do, it’s more aggressive. Ethnicity matters too – African American men are 60% more likely to be diagnosed with an aggressive form of prostate cancer, and are twice as likely to die from it then white men. Men with a family history of prostate cancer have a two-to-three-times greater chance of being diagnosed with prostate cancer. That risk increases for young men with multiple affected relatives.
The current protocol for prostate cancer screening has long been a controversial issue. This is mainly because those who oppose routine PSA testing do so because they believe it leads to unnecessary biopsies and even treatment. A biopsy is usually the next step if a PSA remains elevated or continues to rise. These concerns are based on the fact that biopsies come with the risk of infection, while surgery comes with the risk of incontinence and erectile dysfunction. Neither of these risks are definitively true. While these are potential side effects, as with all medical procedures, there are also ways to mitigate these side effects. The solution lies in the hands of a prostate cancer specialist.
If your PSA is elevated and your clinical evaluation (including medical history, family history, ethnicity, age, etc.) points to possibly having prostate cancer, it is important to choose the right prostate cancer specialist. If your specialist recommends having a prostate biopsy, you can lower your risk of infection by taking the proper precautions. Your doctor should prescribe antibiotics which are to be taken before and after the procedure, as well provide specific post-procedure instructions.
If you are diagnosed with prostate cancer, it is even more important to select a surgeon who is affiliated with a hospital and has an outstanding track record for treating prostate cancer. Having your prostate removed is often criticized as leading to two major side effects: incontinence and erectile dysfunction. However, if you choose the right surgeon, a Robotic prostatectomy can be very successful and having extremely positive outcomes. Robotic prostate surgeons must perform thousands of procedures to become an expert in preserving urinary incontinence and sexual function.
It isn’t the PSA test itself that needs to be criticized – it is how the results are used by both the patient and especially the doctor. When used properly, the PSA test provides information that can be used to manage prostate cancer in its earliest stages to allow for the best possible outcomes. A PSA test should be used as a predictor of an individual’s prostate cancer risk. Based on my experience with prostate cancer, I strongly encourage men to get a baseline PSA test starting at age 40 and commit to checking their PSA once a year. Because every man is different, each will have varying risk factors. Therefore, the results must be considered in regards to those risk factors including ethnicity, family history, and age and should then be used to decide on the most appropriate course of action. This way, you are not screening just to screen, but screening based on an educated and joint decision made between you and your doctor.
A PSA test can save many lives when used identify prostate cancer that needs to be treated early. While the test is not perfect, there are two other tests that have recently been made available which are more specific and accurate for prostate cancer: Prostate Health Index (PHI) and 4KScore. Until these tests are more widely available, it’s a good idea to have an annual PSA test especially if you are at an increased risk. Choosing to have your PSA checked is ultimately in the hands of the patient. However, it’s important that the decision be made with the help of a prostate specialist who will appropriately take into account your age, general health, and risk factors. This way, you are providing yourself with the knowledge and expertise to make the right decision for you.