Bisher AKIL, MD

PSA, should we check it?

In Cancer on April 28, 2009 at 4:37 pm

Prostate cancer is the most common noncutaneous cancer in men in the United States. Despite its prevalence, the natural history of this disease is remarkably heterogeneous. In many patients, the cancer progresses slowly, resulting in tumors that remain localized to the prostate gland. Although potentially life-threatening, such cancers are most often curable.  Many patients with low grade and volume cancers may be candidates for active surveillance. In other patients, however, tumor growth may be more rapid, resulting in cancer spreading beyond the confines of the prostate. In such cases, long-term survival may be considerably diminished compared to survival associated with organ-confined cancers. Strategies for managing prostate cancer have therefore been aimed at early detection, with selective, tailored treatment.  Prostate-specific antigen (PSA) is a tumor marker currently used for early detection of prostate cancer. The American Urological Association has recommended that baseline prostate-specific antigen testing (and digital rectal exam) be offered to men as young as age 40 — with life expectancies of 10 years or more — after a discussion of testing’s benefits and risks. The recommendation appears in the group’s updated “Best Practice Statement” on PSA testing and contrasts with guidelines issued by other groups, including the U.S. Preventive Services Task Force. In August 2008, the USPSTF concluded that “the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75”; the group also recommended against screening those aged 75 or older. Ref: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf. Comments: Two reports came out recently against routine testing for PSA. The reports created a lot of stir and made front page for may newspapers. The definitive study is yet to be done; in the meantime, testing for younger men, along with proper counseling, digital exam and common medical sense is the way to go for now_BA

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