The PSA Test: A Helpful Screening ToolBy: Gary Kirsh
Despite considerable evidence supporting the use of Prostate-Specific Antigen (PSA) testing as a screening tool, conflicting statements regarding the appropriateness of PSA screening have been reported recently. This has resulted in confusion among our patients and fellow physicians.
The Urology Group monitors and interprets PSA guidelines that have been developed by a host of national and international expert bodies, including the American Urological Association, the Large Urology Group Practice Association and the European Association of Urology.
We endorse the following guidelines and concepts regarding PSA testing:
1. Prostate cancer screening must be uncoupled from risks of prostate cancer detection and treatment. Various entities mistakenly assume that a patient with an elevated PSA will undergo an indiscriminate prostate biopsy, and a patient with prostate cancer will inevitably undergo treatment. This is not our policy at The Urology Group.
2. PSA screening facilitates the early detection of prostate cancer, which results in:
· reduced risk of being diagnosed with or developing locally advanced an/or metastatic prostate cancer;
· reduction in prostate cancer-specific mortality; prostate cancer-specific mortality has declined by more than 40% in the U.S. since the inception of PSA screening.
3. A baseline serum PSA level should be obtained from men in their 40s who have made an informed decision to pursue early detection of prostate cancer.
4. Intervals for an individual’s prostate cancer screening should be adapted to:
· the baseline PSA;
· prostate cancer risk factors (including African-American heritage and a family history of prostate cancer);
· the potentially short preclinical timeline of aggressive cancers.
5. PSA screening should be offered to men with a life expectancy of >10 years, regardless of age.
We will continue to monitor the discussion on this important topic and keep you posted on any significant developments. In the meantime, if you have specific questions, feel free to contact your physician at The Urology Group.