M07 — February 2012 — PSA: To Test or Not to Test
Intro: A popular early screening test for the second deadliest cancer in men is falling out of favor. The U.S. Preventive Services Task Force has concluded there is very little evidence to support routine screening for prostate cancer with a P-S-A test. Why? Here's Dennis Douda for Medical Edge.
One in six men will be diagnosed with prostate cancer, making it the most common internal cancer of adult males.
"Now, that's opposed to the lifetime risk of dying of prostate cancer, which is on the order of about 2 percent."
"So many people can — could live decades with cancer and not — not die from it, when it comes to prostate cancer."
It's an issue that has, at times, divided the medical community. How aggressively should we screen for a very common cancer, which is often not life-threatening?
The prostate is a sex gland that provides nutrients to sperm. It sits right below the bladder amid vital organs, nerves, blood vessels and the urinary system.
For more than 20 years, doctors have screened for cancerous tumors in the prostate by testing blood levels of P-S-A.
"Which stands for prostate-specific antigen, which is a protein that's actually secreted into the blood system by the prostate, and it can be abnormally elevated for numerous reasons."
Director of research at Mayo Clinic's Department of Urology, Dr. Jeff Karnes says such false alarms may subject men to unnecessary tissue sample biopsies or aggressive cancer therapies that may not be warranted. Recent, well-designed studies in both the U-S and in Europe have concluded that P-S-A testing shows very little benefit for men with no symptoms of prostate cancer. Dr. Jon Tilburt says that may seem surprising.
"But that's the general feeling right now, is that screening in the general population probably doesn't save a whole lot of lives based on what we can tell right now."
Using the same logic, Dr. Tilburt says some doctors are also rethinking the value of the dreaded rubber glove exam, in which doctors try to feel bumps or tumors in the prostate.
"There's a very limited role for the snapping of the glove in the asymptomatic man, in my opinion."
What's a health-conscious guy to do? You should know, advancing age, family history and African-American ancestry put men at higher risk for prostate cancer. Almost all guidelines agree that men should discuss the risks and benefits of P-S-A screening with their physician to make an informed decision about whether to be tested. Of course certain warnings cannot be ignored.
"So trouble urinating, or blood in the urine or other similar symptoms — and in those circumstances, you really just need to go see a physician and probably a specialist."
For Medical Edge, I'm Vivian Williams.
Mayo Clinic is a center of excellence for prostate cancer and will continue its current policy of offering screening. P-S-A's will continue to be used to help diagnose prostate cancer when symptoms are present and to monitor cases of slow-growing cancer.
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