PSA Screening of Informed Patients
Recently I blogged concern over population-wide research revealing how women, feeling current, economic constraints from their household's loss of income and insurance coverage, are increasingly foregoing screening for cancers and cardiovascular disease. The behavior of women is running counter to medical advice and opinion.
A very different situation looms for men. Controversy rages over who should have the prostate-specific antigen (PSA) blood screening test for detecting prostate cancer and how often it should be repeated. Doctors' recommendations for PSA screening vary, some widely. In 2008, the Preventive Services Task Force of the Agency for Healthcare Research and Quality issued a clear recommendation against PSA screening after age 75. Meanwhile, the National Cancer Institute estimates that in 2009, nearly 200,000 new cases of prostate cancer will surface, while 27,360 men die from the disease. That is three deaths every hour of the year in the U.S. alone. Prostate cancer is the most common form of cancer in men, aside from skin cancer.
There remains general agreement that men should be informed about the potential risks and benefits of PSA screening being performed. A "normal" level of the protein found in the blood has not been established. This is complicated by the fact PSA levels generally rise with age even without the presence of cancer. Men receiving a "false-positive" reading, with elevated PSA but no cancer, may undergo costly tests and a biopsy resulting in adverse side effects such as incontinence or infection. Others receiving a "false-negative" reading, or a "normal" PSA level in the presence of cancer, may die prematurely from undetected, untreated cancer. Currently, Medicare covers an annual PSA test for all men age 50 and older. The FDA has approved use of the test along with a digital rectal exam (DRE) to help detect prostate cancer in men 50 and older1.
Having now a dear friend in his mid-‘50's, whose doctor elected not to order a PSA reading from blood work during his last several annual physicals and who is today diagnosed as a result with prostate cancer too advanced for surgical treatment, I feel strongly about the need for safe screening to be continued on all at-risk men. Every man from age 50 onward should have an annual PSA check, alongside a digital rectal exam. What to then do with the information from results of the test is between the patient and his physician. Patient education and open dialogue are critical to avoid mental stress, confusion, outcomes for which a man is ill-prepared, and outright anger.
The entire burden for communication, however, cannot reside with the doctor. The patient has a responsibility to get informed. It's why there are patient education and advocacy organizations such as NAFC to supply information about risks of both diagnostic and treatment options and how to address negative side effects. For access to information on this subject, visit the NAFC website.
