Even with the U.S. Preventive Services Task Force (USPSTF) and other experts recommending against routine PSA blood test screening for prostate cancer, physicians continue to order, and patients continue to request, the PSA test. The primary reason is that even with the availability of advanced tests that can predict how aggressive a form of prostate cancer might be, the PSA test remains the starting point for testing – it’s non-invasive (simple blood test), relatively inexpensive, and remains one of the few ways of detecting the early signs of prostate cancer.
In 2012 the USPSTF took the controversial position that the PSA test saves few lives and that “overtreatment” (through biopsies and surgery) can lead to health complications in the diagnostic and treatment phases that they deem unnecessary for a disease with a 98%-99% cure rate.
New York University urologist Stacy Loeb takes issue with the mandate to refrain from testing, instead putting the onus on how the results are read and addressed. “The PSA test doesn’t cause harm. It’s what you do with the results,” she says.
Earlier this month researchers from New York-Presbyterian and Weill Cornell Medical Center analyzed the large-scale study by the USPSTF that concluded that PSA tests do not save lives and found that 90% of the participants in the control group had at least one PSA test in their lifetimes, making comparisons problematic. The USPSTF is scheduled to review the 2012 recommendations later this year, and the reality they will be forced to address is that with their recommendations came less frequent PSA testing and with it, a decrease in the number of prostate cancer diagnoses…but a higher percentage of more serious, later-stage diagnoses of the disease.
Statistics suggest that it is not less across-the-board testing that is called for but testing that is more selective based on baseline and follow-up PSA screenings and other factors. As a result, healthcare experts in all categories –researchers, oncologists, urologists, primary care doctors –agree that the routine annual PSA test could well become a thing of the past. A 2013 study by Memorial Sloan Kettering Cancer Center found nearly half of all prostate cancer deaths by age 75 occur in a small group of men who have high PSA levels at age 45. It also concluded that many men whose test scores and race/family factors do not fall into at-risk categories might need as few as three PSA tests in their lifetimes. The 2013 MSKCC study recommends that men from the ages of 45 to 49 have one baseline PSA test. If their PSA level is less than 1 ng/mL, they should have another test in five years. If it is between 1 and 3 ng/ml, they should repeat the PSA every two to four years. If it is 3 ng/mL or higher, they should consider more advanced testing and should be discussing all possible diagnostic options with their doctors. Similar recommendations apply for men between the ages 50 and 70. If a man’s PSA is below 1 ng/ml after age 60, the MSKCC study indicates that no further PSA screening would be needed. Ever.
As with African-American men and men with a family history of prostate cancer, men who have the BRCA2 gene mutation linked to breast cancer in women are at a higher risk for prostate cancer and may want to start PSA screening earlier.
We at Fans for the Cure urge men in their 40’s to KNOW YOUR STATS and get the baseline PSA test advocated by Sloan-Kettering. With advances in science now yielding more efficient testing schedules and a much-improved set of best practices around diagnosis and treatment, it is now easier than ever to stay current with one’s prostate health. As we have been recommending since our first days as a charity, give yourself the best shot at early detection, less invasive treatments, and the most successful long-term outcomes by making sure you get that first PSA