The Importance of The PSA Test

On the heels of the cancer screening controversy by the American Cancer Society (ACS), Dr. X
continues to drive the point home on the importance of prostate-specific antigen (PSA)
screenings. The ACS suggested that detection of early stage disease nearly doubled for breast and
prostate cancers over the last 20 years, but this early detection did not result in more patients
being cured.

While the ACS indicated that the advantages of screening guidelines might have been
exaggerated due to the fact that current cancer screening methods are not perfect, subsequent
clarification stated that screening should continue to be done. Recently, the American Urological
Association lowered its recommended PSA screening age from 50 to 40.

This suggestion is a sound one and the importance of prostate cancer screening must continue to
be stressed, particularly in men who have known risk factors. The bottom line is men need to
work with their doctors to make an informed decision about prostate cancer screening and
treatment. PSA screening may not be the best tool but is still one of the most effective tools in
fighting prostate cancer.

Cancer grows at different rates, but a diagnosis of prostate cancer is not necessarily a death
sentence if caught early enough. Combined with early detection, patients can expect a cure rate of
over 95%. There have been definitive decreases in advanced-stage cancers and age-specific
prostate cancer mortality rate in the “PSA screening era.”

Studies have shown that the monitoring of PSA fluctuations is crucial for tracking the occurrence
and rate of prostate cancer. A rise in PSA level of 0.25 in one year is definitely something to
research further. Cancer cells tend to attach themselves to blood proteins while enlarged but
noncancerous prostates typically release "free" PSA throughout the body. Understanding the ratio
of the types of PSA can help doctors determine the next course of action.

High PSA levels in young men are a definitive cause of concern, which should prompt further
monitoring of PSA velocity. Treatment is most effective, with fewer side effects, when the cancer
is detected early because the disease is organ-confined and has not spread outside of the gland.
Post-surgical tests are equally as important because any change in levels can indicate a cancer
recurrence. Understandably, this is precisely the reason why many urologists advocate prostate
surgery because it is only by removing the prostate that the cancer range, stage and rate can be
fully ascertained.

Many doctors do not rely on the prostate-specific antigen (PSA) test alone in making a diagnosis
of cancer and prescribing treatment. They use a combination of markers, including digital rectal
exams (DRE) and Gleason scores. Until science comes up with a superior "biomarker" than the
PSA, the combination of testing is the most ideal way to detect prostate cancer. The PSA as a
standalone test, however, remains as the best diagnostic tool for the disease.