The concept of screening tests is to detect disease in an asymptomatic healthy subject, at an early stage to maximize the chance of treatment, reduce the treatment cost and increase the quality of life of patients. Screening tests are not new to the medicine. By definition, screening tests are done in the healthy population in hope of detecting diseases at the earliest possible stage when interventions are most effective. Today, multiple screening programs are running and have benefited the society.
Successful programs include mammograms for breast cancer, colonoscopy for prostate cancer, blood glucose test for diabetes and other tests including the famous Pap smear for cervical cancer. As for the prostate cancer, which happens to be the most common cancer among American men, the story is different. “The screening for prostate cancer using prostate specific antigen (PSA) has been a hot topic among medical authorities in the past couple of years” stated Dr. David Samadi.
The PSA was introduced in the early 90s and gained huge popularity in prostate cancer detection. The use of PSA was accepted generally among primary physicians and was administered in general population of older men to detect prostate cancer. “It worked excellently. The rates of prostate cancer detection increased rapidly and men were diagnosed with prostate at earlier stages of the disease. Parallel to increase in detection of prostate cancer, the mortality rate was decreasing as well” explained Dr. Samadi.
However, with new studies and long-term follow-up data, the role of PSA test in decreasing the mortality was questioned. Dr. Samadi continued “the data showed that patients with very low-risk prostate cancer, even without treatment, would have similar mortality outcome compared to patients undergoing surgery or radiation. However, the early detection was the key point in that studies”. Following the review of these evidence in 2012, the US Preventative Services Task Force (USPSTF) commented against the regular use of PSA among men for screening purposes rating PSA test as grade D. A decision which was discussed by many medical societies.
After the USPSTF recommendation against PSA screening test, the data showed an increase in the stage of the detected prostate cancers in the US. However, whether this increase in the stage is due to decrease in use of PSA is not clear yet. “The main concern with PSA screening test was that PSA screening for prostate cancer leads to the detection of indolent, low-grade prostate cancer that is not life-threatening even in the absence of any treatment action” Dr. Samadi explained.
Recently, the USPSTF published a draft of suggested updates on the prostate cancer screening guideline. “In the new guideline, PSA screening is considered as grade C in men between 55 and 69. This change in grading from grade D to grade C means that men in this age group should be consulted about the PSA test, benefits and harms and decide if they like to perform the test” said urologic oncologist, Dr. Samadi.
Dr. Samadi continued that “Although the change from a D grade for all men to C grade for men between 55 and 69 is a huge move, the better part of releasing the draft is the transparency that it provides to the medical community. The USPSTF has provided the evidence and documents that it uses to make decisions and draw conclusions from. I believe it is a huge opportunity for the medical community to comment on the draft and to collaborate with USPSTF to make a more generally acceptable recommendation”. Since prostate cancer affects more than 180,000 annually in US, multiple medical communities address guidelines on the use of PSA and approach in the diagnosis of prostate cancer. Most guidelines have supported the use of PSA in the screening of prostate cancer.
One common chapter in all guidelines for prostate cancer detection is the shared decision-making model. It is evident that the decision to perform a screening test is the patients call. At the end, the whole process of discussing risk factors and making wise decisions about the best treatment for each individual patient is an individualized process requiring a trustful relationship between the physician and the doctor.
Patients newly diagnosed with prostate cancer can contact world-renowned prostate cancer surgeon and urologic oncologist, Dr. David Samadi. For a consultation and to learn more about prostate cancer risk, call 212-365-5000.
By: Ariella Haviv