MDNews - Central New York

+++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++ PROVIDER PERSPECTIVE +++ +++ PSA Testing Is Still Worthwhile By David M. Albala, M.D., Medical Director, Associated Medical Professionals of NY A PART FROM LUNG cancer, prostate cancer is the leading cause of cancer death in American males and remains a significant cause of mortality and illness throughout the world. By current statistics, it is estimated that one in six men will be diagnosed with the disease during their lifetime.1 At present, the most commonly used detection tools for prostate cancer are the serum prostate-specific antigen (PSA) test and a digital rectal examination (DRE). Together, these complementary tests provide physicians with an indication of whether or not to proceed with biopsy for a definitive pathological diagnosis of prostate cancer. Despite the common nature of this disease, the U.S. Preventative Services Task Force (USPSTF) recently published its recommendation that men should not seek PSA testing. Disputes regarding the effectiveness of PSA screening as an indicator for prostate cancer are ongoing. However, a superior alternative test has yet to become available for men at risk. Until such a time, forgoing prostate cancer screening 18 | Central New York MD NEWS s MDNEWS.COM by ways of the available methodologies — as suggested by the USPSTF — could prove extremely harmful to many men. While prostate cancer is commonly referred to as a slow- growing disease, this overgeneralization could be disastrous. Thanks to early detection from PSA tests, currently, 90% of all prostate cancers are discovered before they spread; yielding a 5-year survival rate of nearly 100% at this early stage.2 The USPSTF's primary criticism of this screening methodology is that it causes many "overdiagnosed" men to undergo treat- ments with considerable side effects of urinary incontinence and impotence for disease that, if otherwise ignored, would do them no clinical harm during their lifetimes. Arguably less severe complications, such as pain and infection associated with biopsy, and the psychological effects of false-positive test results have also been cited as reasons to avoid PSA screening.3 However, not all men who are screened need to pursue a biopsy, and not all men diagnosed with prostate cancer require aggressive treatment. The American Cancer Society (ACS) counters the

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