Prostate Cancer Screening

Prostate cancer, and the test doctors use to detect it, has been in the headlines lately. Warren Buffett announced in April 2012 that results from his PSA test detected possible prostate cancer. After a biopsy confirmed the diagnosis, the 81-year-old billionaire scheduled a two-month radiation program.

Less than two months after Buffett learned of his diagnosis, famed NBA player LeRoy Ellis died of prostate cancer at age 72. Unfortunately, detection and treatment could not save the life of this basketball legend.

Amidst these sad reports, controversy boils over the tool doctors have relied on to diagnose prostate cancer in men like Buffett and Ellis for more than 30 years – the PSA test. Advocates say this test saves thousands of lives, but the U.S. Preventive Services Task Force maintains there is no evidence to support that assertion. In fact, the task force says that subsequent evaluation and unnecessary treatment based on false-positive tests causes more harm than good.

Prostate Cancer Statistics

Prostate cancer affects the prostate gland, a donut-shaped organ that wraps around the urethra, the tube that carries urine from the body. Prostate cancer is the most common non-skin cancer among men in the U.S., and the leading cause of cancer death in men over the age of 75. Prostate cancer is rare in men younger than 40.

Each year, doctors diagnose about 240,000 new cases of prostate cancer, which claims more than 28,000 U.S. lives yearly. Physicians detect prostate cancer through digital rectal exams or a PSA test and confirm the diagnosis with a CT scan, biopsy or an MRI scan. Physicians then recommend prostate cancer treatments including surgery, radiation therapy, proton therapy or alternative medical treatments such as brachytherapy and hormone therapy.

PSA – What Is It?

Prostate-specific antigens (PSAs) are proteins that are produced in the prostate. These proteins are present in every man's prostate, but levels become elevated when in the presence of prostate cancer. The PSA test measures PSA levels in the blood; a change in PSA levels can indicate cancer, especially in men over 50. It is important to note that medication, infection and medical procedures can also change PSA levels.

Medicare covers annual PSA tests for men over the age of 65. Many private health insurance companies also cover this procedure, especially for men who have already had prostate cancer and are concerned that it could be recurrent. In the event that this test is not covered by an individual's insurance (and he doesn't qualify for Medicare), the patient will pay for it out-of-pocket.

Ongoing Controversy

At face value, it seems prudent to do a PSA test on all older men during a routine medical exam to catch this common cancer in its earliest stages, when treatment is effective. However, the U.S. Preventive Services Task Force found that, statistically speaking, screening did not significantly reduce prostate cancer mortality.

Some medical professionals wonder if it is wise to test men over the age of 75. Prostate is a slow-growing cancer and many of the tumors discovered by PSA tests are so slow growing, they do not pose a danger to a man’s health. Treating harmless tumors cannot help men, but further testing and unnecessary treatments can cause harm in otherwise healthy individuals. For example, biopsies may cause serious infections or urinary retention. Despite this, most men who learn they have cancer choose aggressive action.

Is There an Alternative?

Advocates of dropping the PSA test recommend alternatives to widespread testing. Some of these alternatives include:

• Only testing high-risk groups and symptomatic men.
• Choosing watchful waiting and taking action only when the spread of cancer accelerates.
• Performing digital rectal exams and only ordering a PSA test for men with enlarge prostates.
• New tests, such as the A+PSA assay, may diagnose prostate cancer more accurately than the standard PSA.

[box type=”note”]Based solely on statistics, it might be easy to dismiss routine PSA testing. However, thousands of cancer survivors passionately defend routine use of the PSA, purporting it saved them from the ravages of prostate cancer. This battle over the PSA test will likely continue until scientists develop a more accurate way to screen for prostate cancer.[/box]