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PSA Or Not-to-PSA, That Is The Question!

Updated: Jan 3, 2020



On October 7, 2011, the United States Preventive Service Task Force (USPSTF) released their guidelines recommending against prostate specific antigen (PSA) screening for the 2nd most common cancer in men in the United States. This recommendation was formulated based on poorly interpreted data with no oncologist or urologist on the USPSTF panel that made the recommendation. Since then, numerous studies have identified a negative upward trend towards more aggressive prostate cancer in the US. A study by researchers at Pennsylvania State University that was published in 2018 found that in the post-USPSTF guideline era, "...patients presented with higher PSA with prostate cancer dectected more frequently." Furthermore, they discovered "more adverse, pathologic prostate cancer features were found on biopsy with the extent of disease implicating locally advanced/metastatic disease."


This is especially concerning due to the fact that prostate cancer, if discovered early, is very much treatable and often even curable. Some primary care physicians, who astutely followed the USPSTF guidelines ended up discovering prostate cancer in the metastatic stage and have faced legal backlash because of it. Since then the USPSTF has modified their guidelines and says that PSA testing is an "Individual Decision".


However, we need to also be aware of over-diagnosis and over-treatment of this complex disease. Prostate cancer is generally considered a slow growing cancer and if in early stages, can be watched through an active surveillance protocol. The decision for treatment should be made on an individual basis. Patients should discuss the risks and benefits of prostate cancer screening with a urologist who is well versed in the diagnosis and treatment of prostate cancer.


 

As always, the information above is meant to be informative and does not replace your physician's recommendations or judgement. Each individual case has to be evaluated carefully to determine the best course of action. Call or use our contact page to request an appointment to further discuss your unique case.

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