PSA Testing: When is the Right Time to Get Screened?
Just this week new evidence has been released that the PSA screenings conducted since the introduction of the test in the mid-1980s have reduced the mortality caused by prostate cancer by 31% and not the 20% originally reported. The most recent study producing these promising results was conducted by European Randomized Study of Screening for Prostate Cancer (ERSPC). Recent controversy surrounding the PSA Screening test has centered on the overdetection and overtreatment of low risk tumors. Discussion flared up again after the release last month of the Prostate-Specific Antigen Best Practice Statement: 2009 Update by the American Urological Association (AUA).
The AUA lowered the recommended age to 40 for a baseline PSA Screening Test in spite of the furor over the risks and possible harm of widespread screening. Some risks that may occur are the possible stress of a positive result and the possible overtreatment of a low risk tumor. A call has been raised for more informed testing and better dialogue between patients and their doctors to let patients know the possible risks and create more options for a positive result, such as monitoring or the use of cancer preventive agents such as finasteride. These sentiments were expressed clearly by Otis Brawley, MD of the American Cancer Society; however, as Dr. Laura Esserman, MD, MBA stated in an essay on rethinking cancer screening, "the bottom line is that screening isn't bad; it is what you do with the information that makes it good or bad".
"The AUA believes that, when offered and interpreted appropriately, the PSA test may provide essential information for the diagnosis, pretreatment staging or risk assessment, and post-treatment monitoring of prostate cancer," and that testing should be begin early. PSA screening won't find all cancers, but getting a baseline test will provide information that can be used against future screenings. Test results should be interpreted by an urologist in conjunction with many other contributing factors including overall health, family history, age, co morbidities, and rate of change of PSA value over time (PSA Velocity) and a physical exam. Additionally, positive results could be an indication of other health issues such as prostatitis, which can be treated with antibiotics, or benign prostatic hyperplasia which may not require treatment at all. PSA testing is a valuable tool for monitoring male health and can provide lifelong information when used appropriately.
