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June 13, 2012 at 8:00 AMComments: 0 Faves: 0

New Prostate Check Guidelines: Should You Get Checked?

By Jeffrey VanWingen M.D. More Blogs by This Author

Have you ever had to go against an authority’s recommendations to do what you feel is right? 

As human beings we have a moral compass - logic, prior experiences and plain old gut feelings that guide us. In medicine, doctors look to various guidelines for advice on the practice of medicine. The most authoritative is perhaps the U.S. Preventative Task Force which recently  changed its recommendation for prostate cancer screening leaving many doctors puzzled and feeling disobedient.  

This blog will discuss these guidelines and the prevention of prostate cancer.

How Serious is Prostate Cancer?

It is commonly said that men die with prostate cancer and not of prostate cancer.  Conventional wisdom is that if a man lives long enough, he will get prostate cancer but will die of something else due to its indolent nature. However, in 2012 there will be an estimated 240,000+ new cases of prostate cancer and over 28,000 deaths from the disease. That’s a lot.

Established Prostate Check Guidelines

A standard regimen of prostate cancer screenings typically begin at the age of 50 with a digital (finger) rectal exam and the PSA (prostate specific antigen) blood test. While a careful exam of the prostate gland feels for cancerous nodules, the PSA detects abnormal immune mediating signals from the prostate.

With this standard in screening, as in life, nothing’s perfect. The finger exam is doctor-dependent and can only examine the outside portion of the gland. The PSA is complicated by both falsely positive and falsely negative results.

New Prostate Check Guidelines

The recent U.S. Preventative Task Force recommendations calls for an end to PSA testing.  In their decision statement, the Task force cites statistics showing potential complications from the procedures and the treatments for cancer actually outweigh the risk of the disease itself. The recommendations came from a large 11 year study that looked at 180,000 men. This study found that 1,000 men needed to be screened to prevent one prostate cancer death.

This Doctor's Opinion on the New Prostate Check Recommendations

I am sorry to disagree, but if you are that one life saved out of 1,000, or your husband or father is that one life saved, this is a worthy test! 

My father had prostate cancer only detected by a rising PSA. While it is difficult to say where he would be now had it not been caught, I can say that he is alive and well, free of the disease.  I have multiple stories among my patients just like this. While I do agree that biopsies and therapies for the cancer have some potential serious side effects, shouldn’t it be the patient’s decision? Shouldn't they be allowed to weigh out the risks and benefits with their doctor?

The American Urological Association's Opinion on the New Prostate Check Recommendations

The American Urologic Association (AUA) was outraged by the decision to nix the PSA.  They said in a statement,

"The AUA is outraged and believes that the Task Force is doing men a great disservice by disparaging what is now the only widely available test for prostate cancer, a potentially devastating disease." 

Their written position further stated that, "When interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer patients."

The US Government's Opinion on the New Prostate Check Recommendations

The government basically stepped aside from the controversy (as not to catch heat over the socialized healthcare debate). President Obama simply stated that Medicare would continue to pay for the PSA.

In Conclusion...

Nothing is perfect. Screening tests are not expected to be either. They are a low-cost tool to help set those who are at risk for a disease apart from those not at risk. Those at risk are then left to determine what steps, if any, need to be taken from there. 

I feel that digital rectal exam and the PSA test are the best way to accomplish this until something better comes along. Ultimately, both sides of the issue should be presented so the patient can make an informed decision on whether screening should be done.

If anything, this shake-up should prompt a discussion with men over 50 and their doctor regarding prostate cancer risk and appropriate testing.

Source:

http://onlinelibrary.wiley.com/doi/10.3322/caac.20138/full

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