A new approach to prostate cancer screening has been proposed by a group of investigators who claim the idea of informed decision-making by primary care physicians is not working when it comes to PSA testing.
In their paper, which was published in Urology (2016; 96:116-20), the authors suggest that men 73 years of age and younger who have a PSA below 1.5 ng/mL should have a follow-up test in 5 years, but those above that number should be referred to a urologist for further screening.
“We need a simple message to primary care doctors—who do 90% of PSA testing in the U.S.—about what is abnormal and what is normal,” first author E. David Crawford, MD, of the University of Colorado, Denver, told Urology Times. “When it comes in below 1.5, it gives them that simple message. The second message is that we can identify a danger zone and when you’re in that danger zone, you go to the next level of testing to try and rule in or rule out prostate cancer.”
The reasoning is that screening with PSA has limitations. A large percentage of men who do not have prostate cancer will screen positive and require a biopsy to rule out cancer, whereas a few with aggressive disease have low PSA. Since many prostate cancers grow so slowly that they never threaten a patient’s life, there is a danger of overtreatment if these cancers are detected. This is an especially important issue because treatment for prostate cancer is often associated with significant side effects.
Dr. Crawford noted that in 1989, when prostate cancer became the most common cancer diagnosed in men and the second leading cause of death for men, most of the patients with prostate cancer were cases that were advanced and incurable.
He helped start Prostate Cancer Awareness Week, and it became what he called “almost too successful” in that screening occurred so much that advanced disease was just about eliminated from the equation and it created an issue where doctors were sticking needles in prostates because men had an elevated PSA most likely due to an enlarged prostate from BPH.