The PSA Test: What you need to know

If you have been under my care, then you know how important a healthy lifestyle is in reducing disease-risks. Chiropractic manipulation, a clean and balanced diet, aerobic exercise, nutritional supplementation, stress management and routine detoxification are essential to maintain optimal health and vitality. We can also monitor your health status through numerous lab tests, which allow us to screen for certain markers associated with increased risks of disease. This routine screening helps identify any problems early on so we can address them before becoming severe. For men, one such marker is Prostate Specific Antigen (PSA), which is a protein made by the prostate gland that, when elevated, may suggest prostate cancer or other prostate problems.

It is estimated that 15% of men will be diagnosed with prostate cancer at some point during their lifetime. The risk increases with age, with an estimated 66% of cases occurring after age 65. Men with a father or brother who had prostate cancer are more likely to get prostate cancer too. If you begin to experience any signs or symptoms of a prostate problem, please check with me so we can decide if the PSA test is for you. These signs include painful or difficult urination, or the presence of blood in the urine.

While the PSA test is not diagnostic for prostate cancer, the higher the levels the greater your chances are of developing the disease. Infections of the prostate and BPH can also increase your PSA levels. Additionally, it is possible to have prostate cancer while the labs measures low PSA. Needless to say, the test is not perfect and only offers a general risk-assessment. If your PSA levels are a cause for concern, a biopsy can be ordered to determine if cancerous cells are present.

Another important factor to consider is that there are different types of prostate cancer. The majority (81%) of those detected are localized and grow slowly. These do not cause harm and rarely result in prostate-related symptoms. Prostate cancer that has spread to the lymph nodes is called regional, and comprises 12% of those detected. Regional prostate cancer also has a 100% 5-year survival rate with treatment. The fast growing type quickly spreads to other parts of the body as is major cause for concern. This distant type comprises 4% of prostate cancer diagnoses and only has a 28% 5-year survival rate with treatment.

The tests we have today often cannot tell us which prostate cancers will cause harm and which ones will not. Therefore, men with slow-growing cancers often get treatment that they do not need. The side effects of these treatments include urinary dysfunction, bowel dysfunction, infertility, erectile dysfunction and numerous others associated with chemotherapy. As you can see, treating a potentially harmless tumor could drastically decrease your quality of life. This course of action should only be taken if the tumor is found to be aggressive.

If your labs come back with a high PSA and positive localized biopsy, the best approach is to monitor the tumor growth. In addition to measuring PSA, your primary care provider may utilize the Gleason score (a numerical representation of how a the tumor looks microscopically) and other factors (tumor size, how much of the prostate gland is involved, etc.) to assess tumor progression. This approach to monitoring has been called “active surveillance” by the NIH.

Last month (1/2012) the National Institutes of Health (NIH) brought together experts from around the world for a summit to examine the state of our scientific knowledge on “active surveillance” as a management strategy for prostate cancer. For those of you who are unfamiliar with the term, active surveillance essentially means monitoring the cancer closely and delaying active treatment (surgery or radiation, for instance) until there are signs it is needed; the delay may be months, years, or forever. This summit pointed out that while there is still much we need to learn about this once-controversial approach, there is a wealth of data supporting the potential value of active surveillance for a large number of the 240,000 men in the United States who are diagnosed with prostate cancer each year.

While active surveillance is becoming a more commonly used approach to prostate cancer, the question still remains; who should be getting the PSA test? For a number of reasons, The American Cancer Society does not believe that all men should have their PSA tested. Because of the high number of false positives, the test may create more stress and worry for the patient than is necessary. Additionally, the research is unclear whether or not PSA screens have a positive effect on outcomes.

One study published in the New England Journal of Medicine determined that “PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis.” Conversely, a more recent publication in the Journal of the National Cancer Institute found that “after 13 years of follow-up, there was no evidence of a mortality benefit for organized annual screening in the PLCO trial compared with opportunistic screening, which forms part of usual care, and there was no apparent interaction with age, baseline comorbidity, or pretrial PSA testing.”

When making the decision whether or not to check your PSA, it’s important you know that the research and literature is often contradictory as to the proposed benefits, effectiveness and validity of the test. Understanding this first allows you to see any results as just a small piece to your health puzzle. Finding a good oncologist who uses the active surveillance approach is currently the best treatment option for the majority of cases. If you would rather “just get the cancer out” and proceed with a potentially unnecessary treatment, please research the possible side effects mentioned above. They are severe enough for me to urge patients to delay treatment until it is absolutely necessary, which may not be ever. Remember, the vast majority of men with localized prostate cancer will end up dying of something other than prostate cancer, and few of these men would ever experience any harm from their cancer if it went untreated (or if it was never found in the first place).

Yours in health,

Dr. Hall

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