Gerald Andriole, MD, chief of urology at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, says PSA (prostate-specific antigen) testing should be tailored to individual risk.
In a recent editorial in the September 14 online edition of the British Medical Journal (BMJ), Dr. Andriole writes that young men at high risk of prostate cancer, such as those with a strong family history and higher baseline PSA concentrations, should be followed closely and could also be considered for “risk reduction” approaches while elderly men and those with a low risk of disease could be tested less often, if at all.
For example in a recent study published in the same online edition of BMJ, men at age 60 who had PSA levels below two were extremely unlikely to die of cancer; hence, they could potentially not undergo further testing, while men with higher PSA levels at that age had rising chances of dying of prostate cancer; hence, they could be screened more intensely or possibly attempt to modify their risk of cancer by life style modifications and/or medications.
Tailoring the intensity of screening in this way can reduce over diagnosis and over treatment of small, non-life-threatening cancers.
“If a man has PSA testing done on an annual basis, his chance of being diagnosed with prostate cancer is six to seven times greater than his chance of dying from it,” says Dr. Andriole. “And, because PSA can be elevated with any inflammatory process and even with a benign enlarged prostate, known as BPH, many men without cancer undergo unnecessary biopsies of the prostate.”
Dr. Andriole says with mass screening for prostate cancer there are “winners and losers.” “Some men clearly benefit from early detection and early treatment, but other men are losers,” he says. “They are diagnosed with a cancer, undergo unnecessary treatment and have side effects, and they go through all pain and anxiety associated with having cancer.”
For example, if a man finds he has an elevated PSA, gets a biopsy and finds out nothing is wrong, the patient has suffered unnecessary anxiety, unnecessary procedure, unnecessary pain and unnecessary cost.
That’s why the American Cancer Society recently changed their screening recommendations, encouraging men to talk with their doctor before getting screened with PSA saying, “men should discuss the uncertainties, risks and potential benefits of screening for prostate cancer before deciding whether to be tested..”
“Approaches such as these will hopefully make the next 20 years of PSA based screening better than the first 20,” says Dr. Andriole.
For more information about prostate cancer risk, visit www.yourdiseaserisk.wustl.edu.