PSA is performing appropriately, allowing us to diagnose prostate cancers at an earlier stage and grade and allowing treatment while cure is still possible.
Dr. McGuire and colleagues performed a retrospective review of 651 men who underwent radical prostatectomy at a single tertiary center in Ireland between 2000 and 2010. Clinical and pathologic features were compared to a population of 1,302 men treated in the U.S. by an experienced surgeon (Dr. Catalona) over the same 10-year period. The authors attempted to match the patients based on age and year of diagnosis. A separate, equally important comparison was done between the study group and a group of 150 American men treated in the early PSA screening era of 1990-'92.
It should come as no surprise that compared to contemporary Americans, patients in Ireland had significantly higher PSA values, more Gleason 7-10 tumors, higher tumor volumes, and slightly higher stage disease. Conversely, American men in the early PSA era had almost equivalent results with the recent Irish experience.
In my opinion, PSA is performing appropriately, allowing us to diagnose prostate cancers at an earlier stage and grade and allowing treatment while cure is still possible. However, overtreatment then becomes a problem. Treatment complications are a separate problem, but we all know that not all prostate cancers require treatment. This is where we need significant research and new serum markers, changes in treatments to reduce morbidity, and a more focused screening effort. I would argue that discontinuing focused PSA screening will be throwing the baby out with the bath water and lead us to a 20-year step back in time in our fight against prostate cancer.
Dr. Thrasher, a Urology Times editorial consultant, is professor and chair of urology, University of Kansas Medical Center, Kansas City.