Doctors divided on necessity of PSA blood test

June 15, 2011 2:02:43 PM PDT
Other than skin cancer, prostate cancer is the most common cancer. To screen for it, doctors often recommend the PSA blood test. However, not everyone agrees that the test should be done.

The American Urological Association advices a screening PSA test for prostate cancer, they even lowered the age from 50 years of age to 40 for the first test. But other preventive health groups don't recommend it at all. Obviously, no agreement about when and if a man should do the PSA.

Thomas Gencarelli, a baker who works in Carney, New Jersey, got a shock 15 months ago when his doctor did a PSA cancer screening test.

"The red flag went up in my mind, it kinda scared me he said anything over 4 should be followed by a urologist doctor, mine was 16."

He had prostate cancer and had surgery to remove the prostate. He had another PSA test today. The PSA is useful in monitoring the return of cancer but its use as a screening test that Thomas had months ago is quite controversial.

"Absolutely I think that PSA testing is a controversial subject, but not every man who has an elevated PSA has prostate cancer, and a man can have a normal PSA and have cancer," said Dr. Ihor Sawczuk, of Hackensack University Medical Center.

The PSA can go up with a simple prostate infection or benign prostate enlargement. In some cases, doctors may repeat the test at a later time to see. If a cancer is found, it may never kill a patient, but can lead to unnecessary treatment with side effects such as impotence and incontinence of urine.

Fortunately, Thomas has no side effects from surgery. If only a screening PSA, such as his, worked to reduce deaths as doctors planned. It doesn't.

"The goal of baking bread is like the goal of the PSA. Start early to avoid problems. The doctors hoped the PSA will find cancer early when they're most treatable. But in study after study, whether men had PSA or not, death rates were the same," Thomas said.

So why do screening PSAs? Some doctors think it leads to over-diagnosis of non-aggressive cancers, overtreatment, and unnecessary side effects. Some say it lines the pockets of urologists.

"That may be true, you may be bringing patients in for excessive testing. On the other hand, I think most urologists are aware, but if there are no risk factors for prostate cancer, they may not do PSA every year, but every other year," said Dr. Sawczuk.

A prostate rectal exam may also find a cancer. Dr. Sawczuk recommends that the doctor and patient must have a frank discussion about where the PSA fits in with risk factors and the rectal exam, and what steps to take, if any. In Thomas's case, there was good news about his PSA.

"My PSA that I had a week ago didn't even read on the scale. Point one or something, which is nothing to worry about," said Thomas.

As with Thomas, following PSA after surgery to look for a cancer recurrence was why the PSA was developed in the first place, not to screen all middle-aged men for cancer. It's important to stress Dr. Sawczuk's advise to have a detailed, open discussion with your doctor about whether you need the PSA test or not.