PROSTATE CANCER

 Each year, millions of American men are confronted with a decision about early testing for prostate cancer.  The American Cancer Society predicts that there will be more than 218,890 new cases of prostate cancer in the United States in 2007.  

Controversy Over Early Screening

Over the past few years, there has been significant controversy surrounding recommendations for early detection.  This issue is now less controversial because of evidence from recent clinical trials.  

Prostate cancer is often diagnosed in elderly men who may have other significant illnesses effecting their health. In addition, most prostate cancers are slow growing and some argue that treating these cancers is costly and offers no benefit. However, screening does detect small, curable cancers, and often catches them before they have spread and become more difficult to treat. 

PSA Testing

In 1986, the Food and Drug Administration (FDA) approved the Prostate Specific Antigen (PSA) test as a method to monitor prostate cancer progression.  The significance of the PSA test was recognized almost immediately and PSA testing became widespread in early detection programs.

According to National Cancer Institute (NCI) data, the diagnosed incidence of prostate cancer among Caucasian men increased 108% from 1986-1992 and 102% among African American men from 1987-1993.  This increase has been attributed to the growing use of PSA testing resulting in easier detection.

Many experts agree that the use of early detection methods - digital rectal exam (DRE)  [image]  and PSA testing - has had a significant impact on diagnosing cancers earlier and reducing death rates.  Recent studies have shown that prostate cancers detected by PSA screening are more often confined to the prostate than cancers detected by DRE alone. Currently, 70-80% of cancers are confined to the prostate at diagnosis, which was not the case before the widespread use of PSA screening tests. 

Recommendations for Early Screening

The American Cancer Society (ACS) and the American Urological Association (AUA) were the first groups to offer recommendations for early detection of prostate cancer.  They recommend annual screening tests begin at age 50 including a digital rectal examination (DRE) and serum prostate specific antigen (PSA) test. Both the ACS and AUA recommend that men who fall into high risk categories (i.e. strong family history, African American males) should begin screening before age 50, with the AUA recommending initiation of an early detection program at age 40 and ACS suggesting initiation of testing at age 45.

What’s Normal for a PSA Reading?

In general, the normal PSA level is defined as less than 4ng/ml. Patients with PSA levels over 10ng/ml, regardless of DRE results, are usually recommended for biopsy of the prostate.  It should remembered, however, that an elevated PSA reading does not necessarily mean cancer is present.  Research has suggested that the rate of increase in PSA  level may be more important for predicting cancer than the actual PSA number.

Other Factors To Consider

There are several things to consider beyond family history and race when deciding when to begin an early detection program, including general health and life expectancy. This decision should be made in collaboration with your physician.

Since it was introduced, many new derivatives of the PSA test have been developed in an effort to improve patient outcomes.  In addition, there are many research initiatives related to prostate cancer currently underway to determine how often screening tests should be conducted to achieve the best patient outcomes at the lowest cost.