-- Second opinion: The PSA Test: Do You Need It? --

Lauren Langford, MD

Prostate cancer is the second-most-common cancer in men, after skin cancer. But the necessity of routine PSA screening has been questioned recently by the United States Preventive Services Task Force (USPSTF).

The USPSTF is an independent, federal advisory panel of private-sector experts that conduct impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Although the panel does not contain any urologists or oncologists, its recommendations are considered the "gold standard" for clinical preventive services and affect standard of care and insurance coverage.

The panel recently recommended against routine prostate-specific antigen (PSA) screening in healthy men of all ages, regardless of whether they have certain risk factors, such as having a family history of prostate cancer.

This decision could adversely impact the health of many men. Instead of throwing out the whole baby with the bathwater, they could have refined their recommendations and identified the subset of men who truly can benefit from PSA screening.

The PSA test is a simple procedure that measures blood levels of prostate-specific antigen (PSA), which is a protein produced by the prostate gland. And as PSA levels rise, the theory goes, so do your odds of having prostate cancer. But PSA levels can also increase due to an enlarged or inflamed prostate - both benign conditions. Therefore, determining what a high PSA score means can be complicated, but the test is still the only means of early detection of prostate cancer. That it is not perfect makes little difference to the men whose lives it has saved or to their families.

Before the test was available, 80 percent of men diagnosed with prostate cancer were already in advanced stages. Today that number has dropped to 20 percent and the death rate has declined significantly. Not only has the PSA saved thousands of lives, early detection has saved countless men from the pain and discomfort of cancer treatment.

The American Cancer Society recommends that doctors with each individual patient discuss the pros and cons of the test. The PSA test can still be used to good advantage, especially in certain men, including:

• African-American males who have a higher risk of prostate cancer;

• Men whose father or brother has been treated for prostate cancer;

• Men who desire screening and are healthy enough to live well for at least another 10 years.

Many physicians will continue to recommend that their patients undergo a baseline PSA at age 50 (40 if high risk), keeping in mind that just because the first PSA test is elevated does not necessarily mean you have cancer.

Depending on your levels, your physician may repeat your PSA every six months to distinguish a false positive from an upward trend. If you skip the PSA test, you will never undergo an unnecessary biopsy or treatment. But you will have no way of knowing if there is an aggressive cancer in your prostate until it is too late.


For information on free screenings available in San Antonio, visit http://www.urologysanantonio.com/classesEvents_prostateScreenings.aspx.