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Dr Russ Blog - PSA, the Prostate, and a Word of Caution
PSA, the Prostate, and a Word of Caution
Created on 9/4/2009
Out of the prestigious Journal of the National Cancer Institute comes a disturbing study - results of the prostate-specific antigen test (PSA for short), long-relied upon for screening for the presence of prostate cancer, may be less useful than previously thought, and in some instances might even lead to potential harm.
How so?
When the results of a PSA test return higher than a certain level, or increase significantly over time, there is appropriate concern over the presence of prostate cancer. Many procedures can follow, including ultrasound evaluation of the prostate and prostate biopsy, to ensure the presence or absence of cancer. If cancer is indeed present, treatment can include surgery, radiation, and hormone therapy.
The problem is that the PSA test does not distinguish between forms of prostate cancer that are aggressive, can spread and ultimately prove fatal, and those types of prostate cancer that are slow-growing and may never cause identifiable health issues.
When a man is diagnosed with prostate cancer he often undergoes the invasive treatments noted above. These treatments can be helpful, but some men also develop difficult side effects such as impotence and incontinence. Some men have slow-growing tumors in their prostates, and thus may live a long time without the cancer causing any problems. But for doctors there has been no way to know that, and so what was deemed the safest course was usually taken - treat the illness.
Again, remember that some forms of prostate cancer are very aggressive, can spread throughout the body, and cause pain, suffering and death unless treatment is instituted in a timely and rapid fashion. These types of prostate cancer, unfortunately, are often recognized once they have already spread. The idea behind PSA testing, in part, has been to identify early stage prostate cancer before it spreads and to institute appropriate therapy to contain the disease.
But the question now becomes, what if the disease process wasn't going to spread? At present, doctors can't accurately predict which forms of early prostate cancer are more likely to spread.
So what is a man to do when his doctor brings up the PSA test? Right now the experts say it is a very personal choice - if a man is most concerned about cancer and its potential effects he may choose to have the test performed. If a man is most concerned with present-day quality of life he may choose not have the test. Clear as mud...
Men, speak to your doctor to get a sense of your unique risk profile for prostate cancer, and how the PSA test may be of benefit to you or not. You might even want to take a day or two to make your decision about having the test performed. Hopefully, we'll have more data with which to make a good decision on PSA testing soon.
Be well.
Dr. Russ
** Information on this web site is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information on this web site for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. **
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