Prostate cancer is the most common cancer and the second leading cause of cancer death among men, with approximately 200,000 new cases detected and 30,000 deaths per year in the United States alone. These are staggering numbers, particularly given the advances in prostate cancer diagnosis and treatment in recent years. However, in 2012 the United States Preventive Task Force published a strong recommendation against the routine use of PSA (prostate specific antigen- a blood test used to determine men that are “at risk” for prostate cancer) for prostate cancer screening. I’ll explain and discuss why this blanket recommendation is a disservice to many men who could benefit significantly from prostate screening and subsequent treatment.
Prostate Cancer Testing
Historically, the PSA test was seen in “black and white” terms with an abnormal value being over 4 and triggering a downstream chain of events that lead to over detection and overtreatment of prostate cancer in many cases. However, we advocate for more intelligent and responsible interpretations of the test, applying the knowledge that the PSA will vary according to age, prostate size, and ethnicity. With appropriate screening, we know that we can decrease prostate cancer mortality by up to 20 percent.
One reason for the condemnation of PSA screening is the aggressive treatment of virtually all patients with prostate cancer. However, decades of research and observation have shown us that not all prostate cancers are created equally. Some prostate cancers are insignificant and with proper surveillance may never have any untoward effect on a patient’s health, while other prostate cancers are more aggressive and are indisputably better off being treated. The difficulty in the past has been determining which prostate cancers are the “bad” ones and warrant more aggressive treatment measures.
In general, low-risk prostate cancers are more aggressively being “watched” by what is called active surveillance, which primarily means the cancer is not treated but rather monitored to ensure it doesn’t progress. If low risk prostate cancers progress, or if a patient has a more aggressive form of the disease at the time of diagnosis, we can still achieve great outcomes with minimally invasive treatments.