PSA TEST INADEQUACY
It’s the best screening test we have for prostate cancer, but the latest research shows it falls far short in acceptability. The PSA test has been used for over two decades now to guide treatment for prostate cancer, but how to use it remains blurry at best.
Doctors are not putting the PSA test out to pasture yet, but the latest data reaffirms what we’ve been seeing lately, that it’s not clear what an abnormal PSA value might be and it’s even fuzzier concerning how to address it.
Donald Westwood was following his PSA or prostate specific antigen test which tracks the possibility of prostate cancer. His PSA level was within the so called normal range back in 2003- below 4.0. A year later, it shot up above 6. “At that point I went back to the urologist had a biopsy done and of course got news that everyone dreads-I had prostate cancer,” says Donald.
It used to be that doctors performed a prostate biopsy looking for cancer only if the PSA reading was higher than 4.0, the so called normal cutoff.
But a new study, in the Journal of the American Medical Association finds there is no good cutoff of PSA level that catches most cancers and will also not result in many workups when there’s no cancer there, so-called false positive tests. The normal cutoff is far from adequate. Biopsies done for a PSA reading of 4.1, the traditional value for doing a biopsy, detected only one out of every five cancers.
Dr. Michael Palese, Director of Minimally Invasive Urology at Mt. Sinai Medical Center, says, “We really need to find something else that’s going to help us in addition to the PSA that is going to clearly define which cancers we need to treat and which ones we don’t need to treat.”
No studies yet show that doing PSAs lower death rates due to prostate cancer. So if you lower that threshold value of doing a biopsy, say from four to two, yes, you’ll do more biopsies and you’ll detect more cancers. But many of those cancers won’t be killers.
It was recently recommended to lower the cutoff to 2.6, but that would only detect 40% of cancers, and around one in five would get biopsied when there is no cancer there.
“Each patient needs to be individualized. You need to get a family history a and find out what their race is, what age they are and what other medical disease may or may not need to be treated,” says Dr. Palese.
So, the PSA test still has a place.
Donald is thankful he got his PSA tested and acted on it with surgery. “I’m the poster child for this because I followed my PSA when it was dangerous I did something about it.”
But the fact is, there is no dangerous, or normal PSA for that matter. It all depends on each individual person.
Another study on prostate cancer, this one done by the American Cancer Society, and published in The Journal of the National Cancer Institute, has found that long-term, regular use of aspirin or other non-steroidal anti-inflammatory drugs such as ibuprofen are associated with a reduced incidence of prostate cancer.
Men who took 30 or more pills of those medications per month for five years or more were 18% less likely to develop it.
However, more research is needed before aspirin and NSAIDS should be prescribed as a possible treatment for preventing prostate cancer, the researchers said.
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