PSA Screening Guidelines Still Generating Confusing Opinions

June 19, 2012 by  
Filed under Prostate Cancer News

Prostate Specific Antigen (PSA) test is used to determine if a man likely to have prostate cancer of not. PSA is enzyme in the form of a protein that is found in the blood.

It is secreted by the prostate gland. During a blood test an elevated quantity of PSA in the blood may mean that the prostate gland has been affected by prostate cancer. Confirmations can be made with further tests like Digital rectal Exam and biopsy.

However, the US Preventive Services Task Force recommends that all PSA testing for men of all ages should be stopped because its risks outweigh the benefits. Since this recommendation was made, there have been supporting as well as opposing views on this. Some of these are even confusing as the following extract indicates:

Most football fans know Ricky Reynolds for his work on the field.  But this former pro is also known for something else—off the field, Ricky is a survivor of prostate cancer.

“I wouldn’t be here if it wasn’t for the PSA test,” he said.

That PSA test helped his doctor find his cancer.  At the time, he was only 37 years old.

“She said that I was too young.  I said, you know this runs in my family my dad was diagnosed at age 55,” Reynolds said.

But the same test Ricky credits for saving his life is now the center of a worldwide controversy.

“Regardless how passionate you may be about this test, the facts are the facts.  It’s no better than the toss of a coin,” said Dr. Richard Albin, the scientist who discovered prostate-specific antigen, or PSA, in 1970.

A leading governmental agency agrees.  In 2011, the U.S. Preventive Services task force brought screenings to a halt, recommending against routine PSAs for men of all ages.

It’s a recommendation Dr. Richard Ablin sees as a victory and vindication.

“I was jubilant. I was ecstatic, because for years, for 38 years, I’ve been trying to explain that this test can’t be used for what it’s used for,” Ablin said. “I’m mad as hell.”

Ablin said his discovery was not meant to be used in tests. That’s because healthy or not, all prostates produce PSA.  He says there’s no way to know how much is too much.

“The whole premise for the test is false,” Ablin said.

In a documentary called “The Second Opinion,” Dr. Ablin’s group warns men about the consequences of treatment, like incontinence and sexual dysfunction.

“Mainly being impotent for 13 years bothers me to no end,” one man said.

“I could have still functioned okay.  I could have still waited,” another man says.

Waited because many experts believe most men with prostate cancer don’t die from their disease.  Instead, something else kills them.

“To make it easier to understand prostate cancer, think of the children’s fable the Tortoise and the Hare.  Dr. Ablin says most prostate cancers are like turtles in a box growing slowly and never able to escape.   But other cancers are more like rabbits—they’re quick, and can hop out of the box, spreading to other parts of the body, increasing the chance of death,” Dr. Jo explains.

The problem?  Turtle or not, almost all men get treatment.

“That probably is not right. Many of these men are being treated unnecessarily,” says University of Florida urologist Dr. Philipp Dahm.  Dahm wrote a 2011 paper published in the British Medical Journal. His findings support the new guidelines.

Dr. Dahm concludes, “I think what we can no longer do is just add a PSA to the patient’s labs.”

While the PSA test might seem to be gasping for air, don’t expect it to die anytime soon,considering there are no new tests on the horizon.

“I think that it is important that a man knows what his PSA is,” said Dr. Julio Pow Sang, a prostate cancer expert at the Moffitt Cancer Center. He doesn’t support routine screening but, he says he is seeing less severe cases of prostate cancer less often.

“After being 20 years in practice, I used to see a lot of men with very advanced prostate cancer or locally advanced prostate cancer, and I see that less and less,” he said.

Dr. Pow Sang urges all men to discuss the test with their doctors.

“So if you ask my personal opinion, I would commit to say that PSA is a tool. It’s not a perfect tool, but it’s useful.”

Especially useful for younger men like Ricky Reynolds.

“I’m loving life and I’m glad I was tested and took care of my prostate cancer,” he says. Source.

There are still oppositions and supports for the recommendations of the US Preventive Services Task Force. In the above extract, the opinions and comments by the scientist who discovered the PSA is confusing ( at least for me).

I sincerely concur with opinion of Dr. Pow Sand that PSA is a tool and that it should be used correctly to give the desired result.

Men should really know the risks and benefits of whether to go for the PSA Test or not. The final decision will now be theirs to make. Having said that, the dominant confusion would be overcome.

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