Prostate cancer is the most common non-skin malignancy in men, and the second most common cause of cancer death after lung cancer. Approximately 220,000 new cases were diagnosed in the U.S. in 2007, with over 29,000 deaths reported. More aggressive screenings, along with more effective, better tolerated treatments, has resulted in improved survival world-wide. 

 

Early detection of the disease, achieved by using PSA blood tests and digital prostate exams, allows doctors to identify the disease while still localized to the prostate, making it more likely to be curable with either surgery or radiation. 

 

Prostate Specific Antigen (PSA), is a protein, found in the blood, which is produced by the prostate gland. PSA elevations are commonly caused by prostate cancer, but may also result from benign prostatic enlargement, or prostate infections. An elevated PSA, with or without an abnormal prostate gland, is often grounds for a prostate biopsy, which is how the disease is diagnosed or ruled out.

 

For twenty years, urologists have been using PSA for screening purposes, and have found it to be an effective, yet imperfect tool. Using appropriate PSA thresholds, along with other indications such as the prostate exam, age, race, and family history, we have made major inroads in the fight against prostate cancer. Prior to the PSA era, two-thirds of all newly diagnosed cases were metastatic, and therefore incurable and only one-third localized. Now, as a recent result of PSA screenings, the opposite is true, with more than two-thirds curable at the time of diagnosis. 

 

Recently, two studies, one from Europe, and one from the U.S., have evaluated the effectiveness of PSA as a screening tool. The European study demonstrated that PSA screenings resulted in 27% fewer deaths from prostate cancer, but the U.S. study failed to identify a significant decrease in death rates resulting from PSA screenings. Unfortunately, the media chose to emphasize the U.S. study in their reporting, which led to more confusion on this issue rather than clarifying it. 

 

As a result, the American Urological Association Best Practice Committee released a policy statement based on a review of all the available literature. The single most important message is that prostate cancer testing is an individual decision that patients of any age should discuss with their primary care physician and urologist. Healthy men, starting at age 40, with at least a 10 year expected survival rate, should be offered a PSA screening on a yearly basis. Although studies have shown that same cancer identified by screenings may be non-life threatening, most men fitting the above criteria will benefit from aggressive treatment of their disease. 

 

At this point in time, urologists strongly believe in PSA screenings, and remain convinced that it saves lives. Hopefully, in the near future, ongoing studies will help determine which cancers will be life threatening, and require aggressive treatments, and which ones can be observed. This will clearly help determine further recommendations for prostate cancer screenings.  

 

 

 

Stephen F. Dobkin, M.D.

East Orlando Urology is located in the Medical Plaza on the campus of Florida Hospital East Orlando.

407.303.1700