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PSA Screening

What is PSA?

  • Prostate-specific antigen (PSA) is a substance produced by the prostate gland and is an important marker of many prostate diseases, including prostate cancer.
  • Change in PSA levels over time, known as PSA velocity, is used to assess both cancer risk and aggressiveness.

Why Screen?

  • Screening results that show higher PSA levels are the number one reason why prostate cancer is detected in the United States.
  • Combining both PSA and DRE tests improves the rate of detection, diagnosis and recovery.
  • Consistent screening practices help doctors find and treat many instances that otherwise might not have been detected.

When to Start Screening

  • Age 40 For those at highest risk - genetic predispositions or strong family histories of prostate cancer at a young age
  • Age 40-45 For otherwise healthy men at high risk - positive family history or African American men

Understanding the Controversy

U.S. Preventive Services Task Force recommends against PSA screening for prostate cancer in men - WE DISAGREE!

An important decision has just been made by the U.S. Preventative Services Task Force: to eliminate PSA screening in men. This is a major injustice to all American men and their families. We encourage you to show your indignation by visiting the link below and signing our petition to ask the Task Force to reconsider their stance on the life-saving PSA test: http://www.change.org/fightprostatecancer

We at the International Prostate Cancer Foundation object to this on behalf of all families globally as it deprives men of their right to know that they have prostate cancer and of the right to make decisions about their own health.

Current American Urological Association (AUA) response to the USPSTF Recommendations

  • The AUA has responded to the USPSTF Recommendations quite clearly. CLICK To read this response.
  • Additionally, in the above link are responses from LUGPA, American Association of Clinical Urologists, Prostate Cancer Roundtable, Veteran’s Health Council, and ZERO speaking against the flawed recommendations.

Why the new Task Force guidelines could negatively affect prostate cancer mortality

Reference Material :

 

  • The importance of PSA screening has been shown to reduce the mortality of prostate cancer. In a 2010 Swedish study,Mortality results from the Göteborg randomized population-based prostate-cancer screening trial, published in the Lancet Oncology, showed that prostate cancer screening reduced deaths by nearly a half over 14 years.
  • PSA testing has been shown to lower the chance of prostate cancer mortality. The 2012 European Randomized Study of Screening for Prostate Cancer (ERSPC) study showed that men randomized to an invitation to screening showed a 21% reduction in prostate-cancer specific mortality versus patients who had not undergone the testing. When adjusted for potential impurity, (i.e. failure to screen in the screening arm of the randomized trial) the benefit of screening increased to 29% reduction in mortality.
  • According to the U.S. SEER* Database (1992-2007), there has been a 75% decrease in metastatic disease at time of diagnosis and at least a 40% decrease in age-adjusted prostate cancer mortality rate.
  • Although prostate cancer is the second leading cause of death in men, the mortality rates of prostate cancer have declined considerably since screening became commonplace in the early 90’s. The decline in mortality to rates below those that were prevalent prior to screening are consistent with the benefits of PSA screening.
  • The USPSTF recommendation is a universal dismissal of prostate cancer screening, even in high-risk males, such as African Americans and those with a familial history of the disease.

The Facts Around PSA Testing

  • PSA testing is an early detection test which requires only a simple blood test. PSA testing is not a definitive diagnosis, which requires a biopsy.
  • PSA tests are also used to: follow the status of cancer in men who are treated for prostate cancer; predict the outlook for prognosis/outlook for survival; determine if additional tests are needed for evaluation (in conjunction with a DRE); and to decide which is the best option for treatment.
  • Complications associated with continence and potency are not a direct result of PSA testing.
  • Prostate cancers can vary from very slow to very fast growing. Improved tests to differentiate slow and fast growing cancers are needed; however PSA velocity and doubling time are common indicators of both active and aggressive cancer.

Deciding to Screen

Each man should talk with his doctor and partner on an individual and specific basis.

Ask your Doctor…

  • What are the pros and cons of PSA testing?
  • Do I have an increased risk of developing prostate cancer?
  • How long before I results are obtained?
  • If PSA results are normal, will I need to have regular tests in the future?
  • What is my PSA level?
  • Do I need a DRE?

Ask Yourself…

  • Are you more at risk for prostate cancer?
  • If the result of your PSA test was normal, would this reassure you?
  • If your PSA was high, what would you do?
  • If you went on to be diagnosed, would you consider treatment?

Should I Be Screened?.

  • Decisions should be based on
  • Level of risk
  • Overall health
  • Life expectancy
  • Desire for needed treatment