To screen for prostate cancer, or not to screen, that is the question. Every now and then there will be an article in a newspaper or magazine-saying PSA testing (a blood test) for prostate cancer is not worthwhile for men. Shortly thereafter there may be an article stating PSA testing is great and should be done. What is a man to do?
PSA stands for prostatic specific antigen, a protein that is made only in the prostate, and is found in the semen to promote the function and viability of sperm. . PSA screening began in the middle 1980’s; prior to that there was no good way to screen a man for prostate cancer other than a digital exam of the prostate or a blood test that was only positive if prostate cancer had already spread to the bones. Most men at that time were not diagnosed of prostate cancer until it had spread outside the prostate and were therefore not curable.
Initially the guideline for a normal PSA was up to 4.0. However now the data shows a PSA of over 2.6 may be abnormal. Just as importantly, if a PSA is going up, how fast is it going up? This is known as PSA velocity. Studies now show if a PSA velocity is over 0.35 in per year, if the patient has prostate cancer, it is more likely to be an aggressive cancer.
Reasons for an elevated PSA or heightened PSA velocity are: enlargement of the prostate, infection of the prostate, and cancer of the prostate. Anytime a PSA is abnormal, or if the digital exam of the prostate is abnormal, prostate cancer must be ruled out. This is done by an ultrasound of the prostate with possible biopsies under local anesthesia in the office of a Urologist. At this time this is the only way to diagnose prostate cancer prior to it’s spreading.
Is PSA testing perfect? No. Many patients may be diagnosed with prostate cancer with a PSA under 1.0; and there are many men with PSA’s over 4 that do not have prostate cancer. PSA testing may not be perfect, but it is the most effective tool available for early diagnosis of prostate cancer.
The bottom line is since the advent of PSA testing and follow up with ultrasound of the prostate, the number of deaths from prostate cancer every year is going down.
Who should be screened for prostate cancer? According to the American Cancer Society, all men over the age of 50. Exceptions are African American men or men who have a close family relative with prostate cancer. These men should begin annual testing consisting of a PSA blood test and prostate exam at least once a year at age 40.
Prostate cancer screening may be done in the office of your primary care physician, and if the total PSA level, the PSA velocity, or the digital exam is abnormal then referral to a Urologist is necessary.
-Dr. James Young, M.D.