Since the advent of the prostate specific antigen (PSA) blood test, which came out in the 1980s, the prostate cancer death rate is down more 45 percent.
PSA is a normal protein that the prostate makes, so all men who have a prostate should have some PSA. However, prostate cancer makes extra PSA, so if a man’s PSA is too high it makes us wonder if he has prostate cancer. Other things such as infection, inflammation, obstruction to the flow of urine and prostate size can also raise the PSA levels in the blood. So a high PSA test doesn’t necessarily mean that a man has prostate cancer.
And, in general, prostate cancer is very common and slow-growing so there are many men who get diagnosed with prostate cancer and choose to just keep an eye on it instead of having it treated because there is a good chance they will die of something else before prostate cancer ever causes them a problem.
Since its advent, the PSA blood test check has been the best way we have of knowing whether we should suspect someone might have prostate cancer — the No. 3 leading cause of cancer death in American men after lung and colon cancer.
It’s been almost a decade since the United States Preventative Services Task Force (USPSTF) vilified prostate cancer screening by giving it a “D” grade in 2008. This means that the task force felt that screening someone for prostate cancer was not only not helpful but was, in fact, actually harmful due to overdiagnosis and overtreatment. That set the stage for Medicare and insurance companies to not pay for the test. Since this recommendation, prostate cancer screening declined quite a bit. Most of us who diagnose and treat prostate cancer feel that we are now seeing prostate cancer cases that are more advanced and therefore less curable.
The USPSTF made its recommendation based on two large studies, comparing groups of men that were screened for prostate cancer with PSA testing and groups of men that were not screened for prostate cancer. They compared the two groups and found relatively equal numbers of prostate cancer deaths in the two groups. That means that the men who had the PSA tested were just as likely to die of prostate cancer as the men who were in the control group that were not supposed to have the PSA tested.
Once the data from the studies were subjected to widespread scrutiny it was clear that more than 80 percent of the men in the control group actually had PSA testing done during the study period. That explains why many of the men in the control group were treated for prostate cancer when they weren’t actually supposed to even have been screened for prostate cancer. Instead of moving those men to the experimental group they were left in the control group and that made the two groups look equal.
The task force is now in the process of revising its recommendation. It proposes screening men between ages 55 to 69 (giving it a “C” grade, meaning there is a "moderate" certainty of a small benefit) and not screening anyone age 70 or older (that still gets a “D” grade). https://screeningforprostatecancer.org/
Most urologists who are on the front line of actually diagnosing and treating prostate cancer feel that the issue deserves involved discussion of the pros and cons of prostate cancer screening between a patient and his physician. I don’t think we can, in good conscience, unequivocally deny someone a cancer screening tests just because he is 70. We should especially not do that to someone who has never had their PSA checked because they could already have an advanced cancer. Most of us know people in their 70s who are healthier than people in their 50s and 60s.
Considering that PSA screening has lowered the prostate cancer death rate so much and actually saves people’s lives, I would expect the task force to at least give it an “A” or “B” grade; some people are helped substantially and have their lives spared from prostate cancer because of early detection and treatment.
It may take another decade for recommendations to evolve further but if we can use history as a guide, I will not be surprised to see the recommendation change again.
Dr. Jared G. Heiner is a board-certified urologist who has practiced adult urology in the Treasure Valley since 2006. He is now with Idaho Urologic Institute in Meridian. Heiner has a special interest in treating prostate disease and prostate cancer. He earned his bachelor's in music from BYU and attended medical school at the University of California, San Diego. Heiner completed his internship and urology residency training at the Medical College of Georgia in Augusta, Ga.
September is Prostate Cancer Awareness Month
The Idaho Urologic Institute encourages men to talk to their doctor about getting screened for prostate cancer.
Idaho Urologic Institute and The Iron Cross Warriors and Babes are sponsoring the Blue Ribbon Rally, a motorcycle, classic cars and Corvette fun run, on Saturday, Sept. 16. Registration for riders will start at 9 a.m. at Idaho Urologic Institute, 2855 E. Magic View Drive in Meridian. The cost is $15 for drivers and $5 per passenger.
Or, bring your friends and family to welcome the riders at High Desert Harley at 1 p.m. for music, food, auction and raffle. Each $10 raffle ticket gives you the chance to win a 2017 CFMOTO C-Force 400, courtesy of Birds of Prey Motorsports, or a 2007 Harley-Davidson 1200 Nightster Sportster, courtesy of Fairly Reliable Bobs.
If you can’t come out to the ride you can still help men battling prostate cancer by eating at any local Freddy’s Frozen Custard and Steakburgers, any time between 4-9 p.m. Thursday, Sept. 14, or Friday, Sept. 15. Tell them you’re there to support the Blue Ribbon Ride and Freddy’s will donate 15 percent of sales to the Blue Ribbon Ride beneficiaries.
Proceeds benefit Idaho2Fly and the Saint Alphonsus Foundation Prostate Cancer Fund.
For more information go to www/idurology.com/brr/ or go to Facebook.
About the prostate gland
The prostate is a small gland that is part of the male productive system. Generally about the size of a walnut, the prostate sits below the bladder and in front of the rectum, according to WebMD.com. The prostate helps make some of the fluid in semen, which carries sperm from the testicles during ejaculation.
About one in seven men will be diagnosed with prostate cancer during his lifetime. Ask your doctor for guidelines about testing.