The PSA Prostate Cancer Test: Should You Get Tested?

PSA test
Science & Medicine

It was revealed earlier this month in a study published in the journal Prostate Cancer and Prostatic Diseases that cases of advanced prostate cancer in the United States have spiked 72% in the last decade. There are a few reasons why this might be happening.

The findings made researchers wonder whether the increase was attributable to a recent trend of fewer men getting screened for the disease.

Senior study author Dr. Edward Schaeffer, chair of urology at Northwestern University Feinberg School of Medicine and Northwestern Medicine, said:

“One hypothesis is the disease has become more aggressive, regardless of the change in screening.

The other idea is since screening guidelines have become more lax, when men do get diagnosed, it’s at a more advanced stage of disease. Probably both are true. We don’t know for sure but this is the focus of our current work.”

To find the answer, researchers culled data from the National Cancer Data Base. They looked at information regarding more than 767,000 men from 1,089 medical facilities nationwide who had been diagnosed with prostate cancer between 2004 and 2013.

The researchers focused on cases that had metastasized, or spread, from the prostate to other parts of the body by the time it was diagnosed.

The largest increase was observed among men 55 to 69 years old. That age group saw an astonishing 92% increase in cases in the past decade, from 702 new cases in 2004 to 1,345 in 2013. This is especially troubling because men in this age group are believed to benefit most from prostate cancer screening with the PSA blood test and early treatment.

Additionally, researchers discovered that the average PSA level of men diagnosed in 2013 with metastatic prostate cancer was 49, which is nearly double that of men diagnosed in 2004. That means these cancer cases were already quite advanced when they were diagnosed. [1]

“PSA-Based Screening Results in Considerable Overdiagnosis”

In 2012, the U.S. Preventative Services Task Force (USPSTF) recommended against routine PSA tests to detect prostate cancer, citing “convincing evidence” that “PSA-based screening results in considerable overdiagnosis.”

Read: PSA Creator: PSA Test for Prostate Cancer is Problematic

The recommendation was a controversial one, and it seems it may have done men more harm than good.

Schaeffer said:

“The fact that men in 2013 who presented with metastatic disease had much higher PSAs than similar men in 2004 hints that more aggressive disease is on the rise. If I were a patient, I would want to be vigilant. I firmly believe that PSA screening and rectal exams save lives.”

Others Say the Tests are Necessary

The American Cancer Society (ACS), however, has called into question the findings and the methods used to reach them. The organization also supports the USPSTF’s recommendation. Dr. Otis Brawley, the ACS’ chief medical officer, said:

“This study makes a dramatic claim about an issue all of us have been watching eagerly: namely, whether less PSA screening might lead to more advanced cancers. But the current analysis is far from adequate to answer that question sufficiently.”

He added:

“Epidemiologists learned long ago that you can’t simply look at raw numbers. A rising number of cases can be due simply to a growing and aging population among other factors.

In addition, in this study, the rise they detected began before USPSTF guidelines for screening changed. There may or may not be a rise in the rates of metastatic disease; but because of a flawed analysis, this study does not answer that important question.”

Approximately 240,000 men are diagnosed with prostate cancer each year in the United States. It kills about 30,000.

Dr. Jonathan Simons, president and CEO of the Prostate Cancer Foundation, said:

“Prostate cancer is 100 percent treatable if detected early, but some men are more likely to develop aggressive disease that will recur, progress and metastasize.”

Once cancer begins to metastasize, it can rarely be cured. Simons went on to say:

“Not all men with prostate cancer need immediate surgery or radiation. But every case needs precision prostate cancer care.

We urgently need smarter and more targeted cancer screening, so we don’t leave men at highest cancer risk unprotected from early, curable disease being missed and turning into incurable disease.” [2]

Symptoms of prostate cancer include:

  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Blood in the urine or semen
  • Frequent pain or stiffness in the lower back, hips, or upper thighs. [3]

Don’t hesitate to contact your health care provider if you experience any of these symptoms. When it comes to cancer treatment, time is of the essence.

Sources:

[1] CBS News

[2] NBC News

[3] Prostate Cancer Foundation