As the pioneer of the PSA test, Roswell Park Cancer Institute (RPCI) has been in the frontlines of the recent national discussion on the challenges and value of prostate cancer screening using the PSA test. There is legitimate concern that widespread use of the PSA test may over-diagnose prostate cancer and put men at risk for complications from unnecessary treatments, such as surgery and radiation.
The decision to have a PSA test to detect prostate cancer early is one that is personal and should be made after careful consideration and consultation with an informed physician — and this point is consistent with all major recommendations regarding prostate cancer treatment and detection. RPCI has followed and continues to endorse the National Comprehensive Cancer Network (NCCN) guidelines for both early detection and treatment of prostate cancer. These are sound, evidence-based recommendations, supported by reliable, population-based research.
Here are some other considerations that should factor into the national discussion:
- Prostate cancer mortality in America has fallen by 40% since the introduction of the PSA test. The only comparable reduction in mortality is that achieved in lung cancer as a result of smoking cessation.
- Seventy to 90% of all men treated for prostate cancer have no evident disease and undetectable PSA 10 years later — a man whose prostate cancer is detected by PSA testing will usually have a normal digital rectal examination and those who receive radiation therapy or an operation in this setting are unlikely to die from prostate cancer.
- Prostate cancer is often over-treated: In up to 40% of men in whom prostate cancer is detected by an elevated PSA, the cancer probably does not require treatment. The NCCN guidelines note that observing men with low-risk prostate cancer without immediate treatment and rigorously monitoring those tumors for evidence of growth is an acceptable course. The reason that “active surveillance” is often the right choice is that many men harbor incidental prostate cancers that may be detected by PSA testing and biopsy, but would never have caused any health problems.
- The urologic community has been criticized for overuse of PSA in men over 80. At RPCI, we recommend that screening in men over 75 should be considered individually.
- There are certain groups of men who are at significantly higher risk for developing prostate cancer. African Americans are approximately 1.5 times as likely to be diagnosed with prostate cancer and, if they get prostate cancer, 2.3 times as likely to die from it compared to Caucasian Americans. The reasons for the racial disparity in prostate cancer incidence and mortality remain unclear. Another high-risk group is men who have a father — or, even more problematic, a brother — diagnosed with prostate cancer. Either circumstance increases the risk of getting prostate cancer more than twofold, and men in these groups should be proactive in seeking out information about prostate cancer testing and discuss detection with their physicians.
- If PSA is used intelligently for early detection of prostate cancer and intelligent decisions are made regarding treatment of prostate cancer, deaths from prostate cancer in America should continue to decrease. Population-based studies performed in Goteborg, Sweden and Tyrol, Austria demonstrated declines in prostate cancer mortality of 40% and 54%, respectively.
- Several highly reputable news sources, including The New York Times, continue to report that Arizona researcher Dr. Richard Ablin discovered PSA and developed the PSA test. While Dr. Ablin did discover a “prostate-specific antigen” that is confined to the normal prostate, he neither developed the PSA test nor discovered the PSA on which the current test is based. That credit goes to RPCI researcher T. Ming Chu, PhD, DSc, and his colleagues, who identified and purified PSA and later developed the simple PSA blood test that is used today for the early detection and management of prostate cancer. The team published its first major paper in 1979 in Investigative Urology, and in 1984, a patent was issued to New York and RPCI and the technology was transferred to the biomedical industry for preparing test kits. The PSA test received FDA approval in 1986 as a monitor for treatment response and disease recurrence, and in 1994, as a screening tool for diagnosis. Dr. Chu received the Presidential Award from the American Urological Association in 1993 and was featured in the April 1998 issue of Cancer Research for his seminal research on the use of tumor cell products in the diagnosis and treatment of cancer and for his leadership role in the discovery of PSA and the development of the PSA test.
A HemOnc Today article (posted 10/7/2011) includes comments from Dr. Trump and other national experts. Read more at http://www.hemonctoday.com/article.aspx?rid=88321
Dr. Mohler also shared his input as part of the expert panel for this Oct. 2011 Prostate Health Education Network webcast, "PSA Screening Debate & Black Men"