Detecting prostate cancer

Two studies have ignited media scrutiny regarding testing to detect prostate cancer. . .

The recent publication of two medical studies in the New England Journal of Medicine has ignited media scrutiny regarding the necessity of PSA testing to detect prostate cancer. Prostate-specific antigen (PSA) testing is a blood test to screen for prostate cancer. The studies concluded that although screening may save a few lives, for many patients, a positive PSA test leads to treatments that can be aggressive, unnecessary and may cause side effects which include impotence and incontinence.

Dr. David Agus

Prostate cancer tends to be slow growing. So given PSA testing’s potential for significant side effects, Healthnetwork Foundation’s medical director, Susan Locke, M.D., spoke to David Agus, M.D., a Healthnetwork Service Excellence Award recipient and prostate cancer specialist.

When should a PSA be used as a screening tool?

Agus recommends a baseline PSA at age 40 for any man with one or more first-degree relatives with a history of prostate cancer — and for African American men who are at higher risk. A baseline level should be drawn for other men at age 50. After the baseline level, a PSA level should be checked annually.

What level of PSA is considered normal?

A normal PSA is less than 4 ng/ml. However, Agus says a PSAs rate of change may be a more important indicator than the absolute value. If PSA levels are rising quickly, further testing may be necessary.

Many factors — including age and recent sexual activity — can elevate a PSA level. Other factors that can cause PSA levels to rise include: benign prostatic hypertrophy (BPH), inflammation or infection of the prostate, a digital rectal exam, and a prostate biopsy.

Conversely, certain medications can cause a lower PSA level up to 50% including finasteride and dutasteride (used for urinary symptoms of BPH or prostatitis) as well as the herbal remedy saw palmetto.

If my doctor suspects I have prostate cancer, what should be done?

Further testing, which could include a digital rectal exam, a “free PSA” level (which provides more specific information), an ultrasound (to assess the size of the prostate), or a prostate biopsy.

Are new screening tests on the horizon?

Genetic markers for prostate cancer have been developed. Researchers are now actively developing more specific screening tools or “biomarkers” for prostate cancer. These biomarkers may help gauge clinical response to a treatment plan.

Kate Hannibal is Healthnetwork Foundation’s marketing manager.

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