There has been a lot of controversy about PSA testing lately: should it be done? Should we completely quit it? Should Doctors offer this?
To solve some of these problems, let me analyze the issue step by step.
PSA is a substance that is exclusively produced in the prostate. It is not an exclusive marker for cancer, it is more a marker of “insults” to the prostate: cancer, trauma, infection, sexual intercourse, etc.
This is the reason why an “elevated” PSA (or more than a value of 4 ng/dl) does not directly tell us that there is cancer. The approximate chances of cancer (at a PSA level of 4-10) are about 20%, but the aggressive cancer chances are about 3%. Such numbers make most urologists recommend a prostate biopsy.
We believe it is an important maker due to an interesting fact: In the pre-PSA era approximately two thirds of patients that presented with prostate cancer were metastatic and non-curable. Today, probably more than 80% of patient are curable upon presentation.
The problem comes when PSA can lead to diagnosis of prostate cancers that may not need treatment (clinically indolent cancers) right away. This, according to some groups, can lead to unnecessary anxiety in the patient population. I believe that no unnecessary anxiety is generated if the diagnosis and treatment plans are discussed and explained to patients and their families.
We do recommend Prostate cancer screening. The question is not whether to do it or not. The question is how often and when to start it.
The point becomes how often to screen for prostate cancer. There is data suggesting that (depending on PSA values) the screening should start at the age of 50 (in individuals with no family history of risk factors). If the initial value is very low, the repeat test could be done in another 2-3 years. We recommend to make that decision in a conversation with a urologist. The screening should include PSA and Digital rectal exam.
If a patient had ever a diagnosis of prostate cancer and received treatment, then the frequency of PSA testing has to be coordinated with the treating physician (urologist, radiation oncologist, oncologist, etc)
If you are in the adequate patient population, we believe you should be part of a screening protocol. We strongly recommend that patients take an active role in this and bring up the discussion with their primary care physicians and urologists.
This discussion must include the risks and benefits of obtaining a PSA and the risks and benefits of a potential biopsy. All of this should come together with an understanding about the biology of the Prostate Cancer.
Palm Beach Urology is a full service urologic practice established in Palm Beach County in 1986. We are proud to offer our patients world-class, state of the art urologic treatment in their own community. The hallmark of the practice is a devotion to patient care by specialists who are dedicated to providing the residents of this area with the very best in medical care and access to the latest in medical technology, including urologic robotic surgery. The physicians of Palm Beach Urology take pride in surrounding themselves with a caring and well-trained staff that treats each patient with compassion and the utmost care. We have offices in Wellington, Palm Springs, Boynton Beach, Jupiter and Belle Glade to conveniently provide services to our patients. For more information, please check our website at www.palmbeachurology .com or call 561-790-2111, to schedule an appointment.