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Prostate Specific Antigen

Unites States Preventive Services Task Force Recommendations

Prostate Specific Antigen is a glyco-protein that is produced by normal prostate cells. It is produced in higher amounts by prostate cancer cells. Beginning in the early 1980’s, PSA was recognized as a useful tool for detecting prostate cancer. Since then, PSA has been the main mechanism we have used to identify prostate cancer at an early stage. Prior to that, the only way of identifying prostate cancer was through the use of abnormalities detected in the prostate via the digital rectal exam. Because of PSA, the number of prostate cancers detected increased dramatically. Along with that, our technologies to treat prostate cancer have also made incredible advances. These have been surgical advances, as well as radiation therapy improvements.

Current recommendations from the American Urological Association and the American Cancer Society have been that all men age 50 to 75 years of age should have annual PSA screening, along with digital rectal exams. In addition, men who have a family history of prostate cancer should begin screening at age 40. There has been some controversy regarding this, and other organizations, such as the American Academy for Family Practice, have simply recommended that patients be offered the opportunity to have PSA screening, but only after a discussion of the potential benefits and risks.

On October 7, 2011, the United States Preventive Services Task Force on Prostate Cancer recommended the elimination of the recommendation for PSA screening. This recommendation was not based on any new research, and the Task Force Committee itself did not include any urologists or oncologists.They essentially determined that there were not enough lives saved from PSA-determined detection of prostate cancer to outweigh the potential side effects of the diagnostic tests and treatments for prostate cancer. This is a prime example of a government panel determining for individual citizens that it simply would be better for them not to know whether or not they have prostate cancer.

There still are at least 27,000 deaths per year from prostate cancer. As urologists, we are committed to reducing this number even further. Even though PSA screening has many pitfalls, it still is the only test we currently have that allows early detection and treatment for what is the second leading cause of cancer death in men, after lung cancer.

Approximately two years ago the Breast Cancer Task Force made a similar recommendation regarding mammograms for breast cancer screening. The answer was the same – it would be better for women not to know if they had breast cancer or not. There was a huge public outcry after this recommendation, and the Task Force’s recommendations were rejected. Unfortunately for men, we tend to show greater concern for our mothers, wives, sisters and daughters than we do for our fathers, brothers and sons, and the outcry against this recommendation has been somewhat muted in comparison.

While acknowledging the deficiencies in the PSA screening test, we still believe strongly that as the only means of early detection of prostate cancer, we should continue to recommend routine screening for men in their 50’s and 60’s and early 70’s, and for men in their 40’s with a family history of prostate cancer.

We will continue to improve our treatments for prostate cancer, and hopefully will be able to expand our knowledge of this disease so that even more patients who are determined to have low-grade or insignificant prostate cancers may simply be followed, and avoid any specific treatment if not necessary. However, to simply turn a blind eye to this significant disease process would be an inexcusable retreat from care of our male family members.