Prostate Cancer: PSA Screening – The Controversy

By Virginia Carnahan, APR, CPRC
Director of Development

For more than 20 years (the “PSA Era”) physicians (family practitioners, GPs, urologists, etc.) have encouraged men to have an annual prostate cancer screening exam starting around age 50.  The exam includes two simple tests – a PSA blood test and digital rectal exam (not pleasant but of short duration).  Over these two decades, prostate cancer deaths have been reduced tremendously.

Now the tide has turned – we are saving many thousands of men from the painful, lingering death that untreated prostate cancer promises.  Screening and early detection has done the same for many other major cancer killers …  breast cancer, colon cancer, skin cancer.

So why does the Federal government now recommend that men STOP having these life-saving screening tests?  It makes no sense – except to the statisticians who gathered the data used by the U.S. Preventive Services Task Force.  The USPSTF published their 2012 recommendation based on the fact that abnormal findings from the screening exams lead to biopsies, and biopsies bring a level of “risk” with them.  Often the typical random sample biopsy will miss a cancerous tumor, and the “negative” result is really a false negative.  The patient will think he is in the clear until his next screening exam results in the same abnormal levels, triggering another biopsy.

All these biopsies are costly and bear a small risk of infection – even a very small risk of death!  (Maybe one man in 500,000 suffers a heart attack while having a biopsy – and the biopsy is labeled the cause.)

By eliminating screening exams, the task force succeeds in “throwing the baby out with bath water.”  What should really happen is that the task force should make recommendations that men having abnormal results at screening be counseled about the risk of going forward with a biopsy versus the risk of developing advanced prostate cancer down the road.

Wouldn’t you rather know you have the disease when it is in its early stages and potentially curable, rather than finding out when
it is difficult or too late to stop it?  If your doctor refuses to order the screening exams for you, look for another doctor who will.  Or
watch the papers for FREE screening events scheduled in September, which is National Prostate Cancer Awareness Month.

Those men who are particularly at risk for prostate cancer should seriously consider the annual screening exams.
They are men who have a family history of prostate cancer … a father, brother, uncle, grandfather who has previously been diagnosed
with prostate cancer; an man who served in Vietnam and was exposed to Agent Orange; and especially African Americans who
genetically stand a 6 times increase in prostate cancer risk.

Until there is a better way – we say “PSA is the Only Way!”  Be safe – get screened.  And in the meantime, adopt a heart-healthy diet, maintain your recommended weight, get regular exercise, get enough rest and reduce stress!

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