New guidelines released by the Canadian Task Force on Preventive Health Care (CTFPHC) say the prostate-specific antigen (PSA) test is no longer effective as a prostate cancer-screening tool.

Posted on: January 11th, 2015
by: Jennifer


These guidelines say numerous cases of false positives and over-diagnosis could lead to potential harm.

“While it might seem logical to diagnose cancers early and to provide treatment as quickly as possible, this might not be the case for prostate cancer detected through the PSA test, where possible benefits do not outweigh the potential harms of unnecessary biopsies and treatments,” says Simon Fraser University health sciences professor Michel Joffres, who was part of the task force’s guideline working group.

The CTFPHC found that almost 20 per cent of men, ages 55 to 69, who had a PSA test received at least one false-positive, leading to about 18 per cent of the men undergoing unnecessary biopsies.

A PSA test measures the blood level of prostate-specific antigens or PSAs, with the theory being the higher the levels of PSAs in a man’s blood, the more likely it is that he has prostate cancer.

“In the best case scenario, the PSA test might save one death from prostate cancer for every thousand people screened,” says Joffres in a release. “But it is crucial to note that other lives might be lost due to complications from biopsies and overtreatment as a result of screening. The PSA test therefore does not have an effect on overall mortality.”

The updated guidelines now recommend against using the PSA test to screen for prostate cancer in men younger than 55 years old and older than 70 years old. They also recommend not using the PSA test for men ages 55 to 69, but say “men who place a high value on a small potential reduction mortality and are less concerned with undesirable consequences may choose to be screened.”

Response:

This article is similar to the one put out by the US preventative task force. The overall theme  is “ that it does not have an effect on overall mortality”.  This may be true but there are many many patients with metastatic prostate cancer who will attest that they wish it could have been caught at an early stage and cured rather than living with advanced stage disease requiring hormone therapy, and eventually chemotherapy.  Currently there is not a way to identify those cancers that will stay dormant and those cancers that are aggressive.

Just reported is an article summarizing the top-ranked consumer health websites that states two-thirds of the online community disagree with the US preventative task force (USPSTF) and Canadian preventative task force(CTFPHC). http://www.sciencecodex.com/most_internet_sources_on_prostate_cancer_disagree_with_expert_panels_recommendation-144354

The article also points out that “Both the American Urological Association (AUA) and the American Cancer Society state that men at average risk over age 55 (AUA) or age 50 (American Cancer Society) who expect to live at least 10 more years should decide, in partnership with their physician, whether to be screened for prostate cancer.4, 5”

Chicago Prostate Center ( www.prostateimplant.com) specializes in Brachytherapy, a treatment that can cure these cancers in a minimally invasive manner in one day.  It is an outpatient procedure that allows patients to go back to work or normal activity the next day with minimal side effects.   Cure rates are equal or superior to surgery and in fact, complications from surgery are much higher risk including bleeding, infection and even death.

PSA also lets us utilize active surveillance to monitor the cancer without treatment until the time comes when the physician feels treatment is warranted.

Furthermore, at Chicago Prostate Center there is an advanced biopsy technique, Stereotactic Transperineal Prostate Biopsy (STPB) that has little to no infection rate reported when compared to an in-office rectal prostate biopsy.   This biopsy of the prostate has a better chance of finding prostate cancer since many more samples of the prostate are taken including the apex of the prostate that typically cannot be reached in a standard rectal prostate biopsy.

 

PSA may not be perfect but it’s the only screening tool we have at this time and under the observation of an experienced oncologist it is a very useful tool in the diagnosis and treatment of prostate cancer.

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