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To Screen or Not to Screen for Prostate Cancer
By Phranq Tamburri, NMD
that regular PSA (prostate specific antigen) testing does not save lives and
can lead to aggressive treatments that leave men impotent, incontinent,
or both. Although this statement made the recent medical news cycle,
their conclusion is anything but new. This conclusion has been debated
for over 10 years but it has only been since the last 4 years that the
studies backing this originally contrarian view began to be reported in the
mainstream.
However, after each new declaration of the PSA inaccuracy, pro-screening
groups counter the recommendations not to screen with their view that
PSA testing saves lives. Thus the confusion for patients is
understandable. The honest truth from the data does show that since
PSA screening for prostate cancer began that the overall mortality from
the disease has modestly decreased. However the rate of diagnosis of
the disease greatly increased. This was due to the great number of
slightly elevated PSA patients that were biopsied when they otherwise
would not have been. These positive PSA screens are automatically
translated into a biopsy that then, if positive, lead to surgery, whether the
cancer would have been fatal or not. The overall problem then has
become that for each life saved from an eventual metastasis of the cancer
due to PSA screening, there are on average 4-5 men (depending on
study) that had surgery who would never have died from the disease at
all. Since prostate cancer surgery typically leads to severe side effects
as erectile dysfunction and incontinence, a 1 to 4 risk ratio make many
men feel after surgery that they now suffer from unnecessary life
changing side effects. However, as stated, the screening does save lives.
The problem for the proponents of these two opposing views is
determining what the 'proper ratio' should be of risk. Many in the proscreen
camp believe that "if PSA testing can save only one life then it is
worth the side effects for everyone else". The anti-screen camp says
that 'only' 1 in 4 is not good enough when quality of life issues can
routinely be so severe, especially when these odds risks are not typically
explained to them before the procedure. When you further add in the
exploding increase in medical costs for surgeries and their original PSA
screens that are all thought to be unwarranted, the need to reanalyze
reflex PSA screening is necessary.
Overall it seems that both sides, especially in the quick manner the media
explains it, are missing the underlying point of the recommendations.
The PSA is not being advised to stop in its use as a screen but only when
used as a sole screening measure. What is being advised is an advanced
aggregate approach of screening that employs numerous PSA values to
see trends and patterns, a detailed patient history, new DNA molecular
lab studies, urinalysis, urinary history, and new imaging like color
Doppler. Used in this constellation of data, the PSA is a good marker but
when put into context rather than using it to rush into the preordained
reflex medical system that would immediately order a biopsy and then
surgery. Essentially, if the physician, hospital, cancer prevention
association, or especially one's health insurance can not provide multiple
data to serve in an aggregate assessment approach, then the PSA by itself
is too unreliable to stake the patient's future on it, ergo, to omit the PSA
screen entirely.
The PSA will no doubt be superseded by a more reliable test eventually.
However until then the PSA will continue to bring debate and will
challenge a broken medical system to find a more ethical and pragmatic
way to incorporate this outdated lab test.
For information on how the new advanced aggregate screen and
assessment for prostate cancer is utilized, feel free to contact me at this
office at 480-767-7119.
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