Prostate Specific Antigen (PSA) Test Controversy Revisited And New Research On PSA Test

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To PSA or Not to PSA …

The PSA (prostate specific antigen) test controversy in the recent years has become a continuous process with researchers unearthing new data in support as well as against routine testing. However, in the wake of planning a prostate cancer panel on Cure Panel Talk Show, I think it is worth the while to revisit PSA testing and the surrounding controversy.

CureTalk followed the PSA test, prostate cancer, USPSTF recommendations in 2011 and 2012 and we were honored to have connected with Dr. Richard Ablin (discoverer of the prostate specific antigen). You can read many of the posts here for a complete background on the PSA controversy,

Is PSA Screening Controversy Done Post USPTF Recommendations

Prostate Cancer PSA Screening Giving Patients The Right Not To Know

No More Routine PSA Test For Prostate Cancer Screening

PSA Test Controversy : Richard Ablin and William Catalona Present Views

In brief, the main reason for the PSA test controversy is the uncertainty of whether the test can save lives, as well as the concern regarding it leading to unnecessary invasive procedures and treatments. In 2012, the US Preventive Services Task Forces (USPSTF) recommended against PSA tests for normal risk men based on lack of evidence that screening can save lives. However, choice of screening now lies with the patient. The patient can opt for screening once he is briefed about the pros and cons of being tested.

But, it seems that not all doctors are discussing the option with their patients prior to screening them. A new study published in the Annals of Family Medicine and conducted by Robert Volk and colleagues from The University of Texas MD Anderson Cancer Center in Houston, finds that over 24% of surveyed family doctors (total of 246 family doctors) order PSA tests without discussing screening with patients. while 48% discuss it with patients, the remaining doctors specifically recommend PSA test to their patients post discussion.

I should think it would be hard to resist if your doctor recommends the test!

Thus, it follows that in spite of all the hue and cry over USPSTF recommendations, many men get screened without fully understanding the implications.

According to the American Cancer Society, one in six men is diagnosed with prostate cancer during his lifetime; however, only one in 36 will die of the disease.

Here are some statistics given by Dr. Richard Ablin to CureTalk during an interview:

Some quick figures about prostate cancer:In 1985, before the widespread use of PSA screening

Chances of man having prostate cancer (incidence)– 8.5%
Chances of man dying from prostate cancer (mortality) – 2.5%

In 2005, after the widespread use of PSA screening

Incidence of prostate cancer – 18% (it has essentially doubled)
Mortality - 3%

Consider a man of 50 years, in the next 25 years,

Chances that he may have prostate cancer is 40%
Chances that he would have clinical symptoms are 10%
Chances that he may die from prostate cancer are 3%.
Chances that he might die from cardiovascular diseases is 50%
Chances that he might die from some other type of cancer is 20%

The mortality among 100 men,

With lung cancer would be 33%
Number of men with prostate cancer is only 3%.

Quoting Dr. Ablin,

What the foregoing means is that PSA screening in the manner currently used may very understandably do more harm than good. I know that prostate cancer can be a deadly disease, my father died from it. (Read more here).

In another study, published in the British Journal of Urology International, Lauren P.Wallner, PhD, MPH, lead author and team demonstrated that repeated measurements of PSA over a course of time provides a more accurate strategy for detecting aggressive forms of prostate cancer. The study team agrees that single elevated PSA levels may result in unnecessary prostate biopsies and treatments, however, annual percent changes in PSA predicted presence of aggressive prostate cancers more accurately. The study examined electronic health records of 220,000 men aged 45, who had at least one PSA test measurement and no previous diagnosis of prostate cancer, for over a period of 10 years.

The study results may be able to help clinicians predict aggressive forms or indolent forms of cancer. However, the bottom line remains that the patient has the right to know what the PSA test constitutes.

The problem with prostate cancer detection tests are that these tests cannot identify aggressive forms of the cancer which are usually fatal, from the harmless indolent ones. If only research throws up new detection strategies or tests it would let the men have a good night’s sleep, not to mention, their doctors too.