A federal task force gave a final recommendation that healthy men should not longer get a PSA test because a resulting diagnosis may do more harm than good. Prostate cancer is still a top cancer killer, so many doctors are wondering if there is a better way to eliminate unnecessary treatment.
The most frequently used front-end screener for prostate cancer, the PSA test, is facing fire.
“There’s controversy about whether or not we should start everyone, no matter what, every man at the age of 40 with just a baseline,” says Jasper Rizzo, a urologist on Lee Memorial Health System's medical staff.
Organizations that do recommend a PSA screening generally encourage the test in men between the ages of 40 and 75, earlier in men with increased risk. The test measures a protein, which has no direct relation to cancer.
“It’s a protein that’s part of normal seminal fluid and helps the seminal fluid break down once it’s at the cervix and in the vagina. However, men that have prostate cancer may have up to ten times more of this protein or antigen than the normal man,” says Dr. Rizzo.
A government panel found the test is doing more harm than good. For every thousand men who get PSA, 30 to 40 will have a serious side effect, some of those coming from unnecessary biopsies.
“We do a lot of prostate ultrasound biopsy because the PSA’s elevated. And only three out of ten patients that have prostate ultrasound biopsy have prostate cancer,” says Meir Daller, a urologist on the medical staff of Lee Memorial Health System.
Doctors are encouraged by another screener, the PCA3 test, which uses a genetic marker to find cancer.
“The PCA3 is a urine test. We take the urine specimen from a patient after prostate examination and we extract some genetic material from it. Certain genes are associated with prostate cancer,” says Dr. Daller.
The test is proving more reliable than the PSA
“I see in the next few years more and more genetic testing done for prostate cancer,” says Dr. Daller.If cancer is detected, it still falls to the doctor and patient to determine the next course of action.