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Know More about the Prostate Cancer Test

Screen tests have always been controversial and the latest draft recommendation from the U.S. Preventive Services Task Force that men with no symptoms of prostate cancer no longer get screened through the prostate specific antigen (PSA) test has started the debate all over again.

The U.S. Preventive Services Task Force is an “independent panel of non-federal experts in prevention and evidence-based medicine and is composed of primary care providers that conducts reviews of scientific evidence on preventive health care services.” The panel is composed of primary care providers such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists.

The USPSTF or simply known as task force is the same group that recommended in 2009 that women in the 40s need not get regular mammograms which also became controversial. And the latest draft report from the Task Force gave the PSA-based screening a grade D which means that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits” and would suggest that doctors should “discourage the use of this service.”

The PSA test is actually a blood test that measures the levels of prostate-specific antigen which is a protein produced by cells of the prostate gland. Higher levels of the antigen could be signs of tumors since this protein tends to show up on cancer cells. Unfortunately the level of PSA may rise due to conditions other than prostate cancer such as benign growth of the prostate, infection or inflammation of the prostate, ejaculation, and even riding a bicycle can push PSA levels higher.

Doctors, urologists and prostate cancer patients who believe the test saved their lives and their families were disappointed with the task force recommendation. Opponents of the healthcare reform also see this report as another effort to ration medical services. Pro-screening argues that early detection still saves lives since it doesn’t reach metastasis or metastatic disease at the time of diagnosis which is rarely cured.

The recommendation of the task force is yet to be final and could still change after the medical community and the public has submitted their comments. But the task force has shown in their report that the PSA-screening can do more harm than net benefits since too many patients are encouraged to seek radical prostatectomy or radiation. According to the task force, while it is true that the PSA screening detects more prostrate cancers but no trial has shown a decrease in the overall mortality rate from the disease. The test itself does not pose any danger because it is simply a blood test.

The danger of PSA-based screening for prostate cancer is the risk of overdiagnosis together with overtreatment. The decisions made by doctors and patients based on the results is what the task force is getting at because many of these procedures have been unnecessary according to the task force. The draft report notes that between 1986 and 2005 the “PSA-based screening likely resulted in approximately 1 million additional U.S. men being treated with surgery, radiation therapy, or both compared with before the test was introduced.”  Depending on the modality used, other related effects include the risk of death, cardiovascular events impotence, urinary incontinence, and increased risk of bowel dysfunction.

PSA screening leads to unnecessary surgeries (Photo by Justin Sullivan/Getty Images)

If that is the case, then let us take the recommendation of the USPSTF as simply that – a recommendation. It should be a case to case basis, say the patient is adamant then so be it but he should be informed about the limitations of the test.  And if possible limit this test to men who may be at a higher risk of cancer because of their age, family and medical history, or presenting symptoms. Or use it in conjunction with other tests performed by those in nurse uniforms that can assess a man’s risk of prostate cancer such as digital rectal exam and a transrectal ultrasound test which can be of better help when predicting whether a biopsy is necessary.  And be informed about the different options, aside from the aggressive treatments, including another option called watchful waiting where in the patient and doctor use PSA tests at regular intervals, frequent physical exams, and biopsies to track a tumor’s growth and decide when, if ever, to pursue aggressive treatment.

Source of info: USPSTF – Some parts or whole parts of paragraphs are lifted from the source.

Prostate Cancer Screening Recommendations

Image Source: Mark Boster, Los Angeles Times / October 7, 2011

About Mecheil Lewis