Contradicting government recommendations four years ago that men should not get routine PSA testing, a new study says this simple blood test used to detect prostate cancer can reduce the number of deadly cases.
For Foothills Urology prostate surgeon Derek Zukosky, DO, the new findings reinforce his longtime position. “I strongly believe every man with a life expectancy greater than 10 years should be offered the option of prostate screening including a rectal exam and PSA test. The issue isn’t the screening—it’s what’s we do with the information that it produces and the interventions we do or do not employ,” Zukosky says.
Prostate specific antigen, or PSA, testing measures antigens in the blood that are linked to the presence of prostate cancer. Since PSA testing was introduced in the early 1990s, the United States has seen about a 50 percent reduction in the death rate from prostate cancer, but questions remain about the role testing played. Prostate cancer remains the second leading cause of cancer death among American men and the second most common cancer in men after skin cancer.
In 2012, the U.S. Preventive Services Task Force recommended against routine PSA testing, saying the benefit was offset by the risk of exposing men to potentially unnecessary treatment. The 2012 recommendation cited the possibility that PSA screenings could identify cancers that would never spread and never pose a risk. Detecting such non-threatening cancers would, overall, provide little benefit, but could needlessly expose men to treatment that carries potential side effects, including erectile dysfunction, urinary incontinence, and bowel dysfunction, according to the recommendation.
That recommendation also cited “the current inability to reliably distinguish tumors that will remain indolent from those destined to be lethal. . . “
But the advent of genomic biomarkers has provided patients and physicians with more reliable guideposts to help them together determine the best treatment path. “This new technology helps us to separate patients needing immediate treatment from those requiring only active surveillance,” Zukosky says. “When we get a new diagnosis, we can run these tests to determine how this cancer is likely to behave in the future.”
In the new study, published in the May 5, 2016, edition of the New England Journal of Medicine, researchers from NewYork-Presbyterian/Weill Cornell Medicine questioned the results of that earlier study, saying it had limitations that should prompt healthcare policy leaders to take another look at the possible benefits of PSA screening. That older study, the Prostate, Lung, Colorectal and Ovarian (PLCO) trial, sponsored by the National Cancer Institute, did not compare a group of men who had PSA screening to a group of men who were not screened.
"While there are risks of over-diagnosis and over-treatment associated with PSA testing, it can play an important role in preventing prostate cancer deaths as part of a personalized approach to cancer screening. We're going to have to reconsider this issue,” researchers said.
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A board-certified urologist, Derek K. Zukosky, DO, specializes in minimally invasive urological procedures. One of the most experienced and highly trained robotic surgeons in the Denver area, Dr. Zukosky specializes in robotic prostatectomies. He also has a special emphasis in prostate cancer, BPH, urinary stone disease, kidney cancer, urolithiasis, and men’s sexual health including erectile dysfunction.