Why Should Men Discuss a PSA Test With Their Doctors?

Why should men discuss a PSA test with their doctors? Recommendations have recently changed and could play a key role in preventing and treating prostate and other cancers, Dr. Owens shares in a editorial.

The U.S. Preventive Services Task Force took a second look at the PSA (Prostate Specific Antigen) blood test for prostate cancer screening and updated their recommendation.

In 2012, the task force made a blanket statement that PSA screening “did more harm than good” and applied a “D” rating.

This essentially advised against the use of the test for all men, was a disservice to those men in high risk groups, and created a state of confusion in the diagnosis and management of prostate cancer.

The new recommendation advocates that men between the ages of 55-70 should be considered for PSA screening, especially those with a family history or African-American descent, after a thorough discussion and shared decision making with their clinician.

The change in recommendation is a result of updated data from a European study that demonstrated a 30 percent reduction in the development of advanced prostate cancer and 20 percent decrease in the risk of dying from the disease with the use of PSA testing.

As clinicians who treat prostate cancer, we have been advocating for a more comprehensive look at the data and are pleased at the new recommendation since it now opens the door for communication between patient and physician.

A door many of our patients couldn’t walk through because the test was ill advised. It also further empowers the patient to be a strong advocate for his health and be actively involved in the shared decision making process.

Prostate cancer remains the second leading cause of male cancer deaths and claims the lives of more than 26,000 men nationwide, 1,200 of whom are from Pennsylvania.

African-American men are more aggressively affected by the cancer. They have a 60 percent higher risk of developing prostate cancer and a 140 percent higher mortality rate.

The common misconception about prostate cancer that gets lost in the message is that it is a “slow growing”, “old man’s” disease that won’t kill you. This is far from the truth and not the prostate cancer we see in central Pennsylvania.

We compiled our patient data at my practice, Urology of Central Pa., over the past 5 years since the initial USPSTF recommendation looking for trends and risk stratification.

Our physicians diagnosed 1400 patients with prostate cancer over this 5-year period (2012-2016).

In this population of men, ages 40-80, we discovered a disturbing trend and migration to higher risk cancers.

The majority of the cancers diagnosed (approximately 70 percent) in the last 5 years represent intermediate to high risk disease, indicating a potential to spread within a 10 year time frame.

This is a significant shift compared to what we as urologists were seeing 10 to 15 years ago in which approximately half were low-grade or low-risk disease.

These same trends are being seen nationally as well, but have a greater significance when we realize the impact on the men of our central Pennsylvania community.

Another alarming finding in our data is that nearly half the men (46.4 percent) who presented to us in 2016 with an elevated PSA were found to have prostate cancer (compared to a 30 percent positive biopsy rate in 2009).

The reason for the trend is not clearly understood and difficult to extrapolate but certainly the decline and reluctance in PSA testing plays a significant role.

The men in our data set, who presented with an elevated PSA, were minimally symptomatic and 20 percent were under the age of 55.

Of those aged 70 and older, the diagnosed cancers were more aggressive. This begs the question: “Should the USPSTF’s recommendations be broadened?”

As physicians who recognize the controversy surrounding prostate cancer, recognize the risk associated with the treatment of prostate cancer, and who recognize the anxiety associated with a cancer diagnosis, we also witness the devastating impact it has made on the patients and their families in our community.

Having conversations with your clinicians, family members and fellow men who have overcome this disease can provide clarity and direction along with understanding the unpredictable nature of this disease.

Data can be a valuable tool that allows us, as physicians, to clearly communicate to our patients both risks and benefits.

Data can also be a dangerous tool that can be used to manipulate the message. Unfortunately, many patients become overwhelmed in the data “pool” and struggle to find clarity.

Prostate cancer, and more specifically the PSA test has been the poster child for this data confusion and we as urologists are pleased with the recent USPSTF recommendation.

All clinicians, including primary care providers, now have clarity and guidance on PSA screening and diagnostic testing.

Plus, the emergence of the updated data and studies reinforce the clinical utility and value of the PSA blood test in its ability to diagnose potentially life threatening prostate cancer in its early stage, before it becomes clinically symptomatic or spreads.

At Urology of Central Pennsylvania, we are witnesses to the clinical value of this test every day in the lives of our survivors.

It is our hope that all men in the central Pennsylvania community embrace this new (upgraded) recommendation and actively participate in their health by having an informed discussion with their primary care provider or urologist.

Shared decision-making plays a critical role in the physician-patient relationship and it is essential for patients to properly equip themselves with all the facts and be an active participant in their health.

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