Recently, the United States Preventative Services Task Force (USPSTF) recommended that prostate-specific antigen (PSA) screening should not be offered to any man, regardless of risk factors, health status, or age. The USPSTF has come under fire from some urologists who claim that this recommendation could result in a “public health tragedy within 5-10 years” by ignoring the value of the PSA in identifying asymptomatic prostate cancer.
Challenging PSA Testing Guidelines
Leading urologists in Hampton Roads claim PSA-based prostate cancer screening can be as effective as screening for breast of colorectal cancer. They cite a European study that demonstrated a 21% survival advantage overall for prostate cancer screening with a 38.2% advantage for patients with more than 10 years follow-up.
The urology experts at Urology of Virginia have raised several objections to this finding claiming in a letter to physicians: “It is our view that PSA-based prostate cancer screening offers a substantial survival benefit to our male patients, for whom prostate cancer is the second leading cause of cancer death (behind lung cancer)… The risks of harm from PSA testing and prostate biopsy are negligible. On the other hand, available treatments for prostate cancer may lead to significant problems with urinary control and erectile function. Our objective in the care of patients at risk for prostate cancer is to provide evidence-based counseling, thoughtful and rational screening, and individualized management of prostate cancer when it is detected. There is no “one-size fits all” treatment for prostate cancer.”
Who Is a Candidate for PSA Testing?
All healthy men over age 40 should be offered the option of PSA testing for prostate cancer screening, but high-risk groups of men should be especially encouraged to undergo PSA-based screening. High-risk patients include African-American men, men with a strong family history of prostate cancer, and men who were exposed to Agent Orange in Vietnam. We believe that men with less than a 10 year life expectancy are unlikely to realize any benefits from prostate cancer screening, and should therefore not undergo routine PSA testing.
Early detection and intervention in high-risk candidates greatly reduces patient suffering and, in many cases, extends life expectancy beyond 10 years.
About Urology of Virginia
Urology of Virginia is a group of experienced, fellowship-trained urologists who practice throughout Hampton Roads – from Virginia Beach and Norfolk to the Eastern Shore. Partnering with cancer experts at local hospitals, they are Virginia leaders in the diagnosis and treatment of urological conditions, including prostate cancer. Learn more at the Urology of Virginia website.