"An Urologist's View on PSA Testing" by Dr. Roger E. Schultz, MD, of Riverside Hampton Roads Urology. Schultz is the co-author with Alex Olive of "Humanizing Prostate Cancer," a manual for patients.
"The U.S. Preventive Services Task Force has decided that the PSA (prostate specific antigen) blood test is not a reliable screening tool. ... Their decision will, in the opinion of many, 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."
(Editor's note: The U.S. Preventive Services Task Force is an independent 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. Its recommendations are considered the "gold standard" for clinical preventive services and affect standard of care and insurance coverage.)
... "We can still use the PSA test to good advantage by limiting its application to selected men:
1. African-American males who have a higher risk of prostate cancer;
2. Men whose father or brother has been treated for prostate cancer;
3. Men who desire screening and are healthy enough to live well for at least another 10 years.
The argument against PSA testing stems from concern about overdetection and overtreatment. Current urologic practice does address these concerns. Instead of acting upon a single PSA value, we often choose to monitor the PSA values over time. We can decide NOT to do a prostate biopsy if the PSA is stable. Likewise, we can reduce overtreatment by recognizing that low grade/low volume cancers may be monitored by active surveillance and not necessarily treated. Often this entails another prostate biopsy at a later time, but there is hope that we may be able to rely on the less invasive MRI for information about cancer progression.
It is not the PSA blood test itself that is a problem, but rather what we choose to do with the information. If the test is properly applied to selected men and monitored serially, it will uncover early cases of potentially lethal prostate cancer.
Every urologist knows this, but they were not part of the U.S. Preventive Services Task Force panel of experts.
We are concerned that insurance carriers may stop paying for PSA testing in all men. Until we have a better test (and there will certainly be one), the PSA still performs well when applied sensibly and interpreted carefully."
By Roger E. Schultz, MD.
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