PSA Confusion: Tips for the Right
Diagnosis and Treatment
Lewis Levy, MD
Medical Director, Best Doctors, Inc.
It’s no surprise that there’s confusion surrounding the
prostate-specific antigen (PSA) blood test. Doctors’
recommendations for when men should have it vary, and often results
are unclear. Some doctors encourage yearly screening for men over
age 50. Some advise men who are at a higher risk for prostate
cancer to begin screening at age 40 or 45. Still others caution
against routine screening altogether.
There is, however, general agreement that men should be informed
about the potential risks and benefits of PSA screening before
being tested. PSA tests are sometimes unreliable and potentially
misleading. They can cause both false reassurances and false
alarms:
- When the PSA is normal, 15 percent of men still have
cancer
- When the PSA is abnormal, only 12 percent of men have prostate
cancer
In 2009, The American Cancer Society estimates 192,280 men in
the U.S. will be diagnosed with prostate cancer and 27,360 men will
die from it. Adding to the confusion surrounding prostate cancer is
that while one man out of every six will be diagnosed in their
lifetime, most have slow-growing tumors that likely will not lead
to death.
The most common approaches to early stage prostate cancer include
surgery, radiation therapy, and “watchful waiting”. The decisions
surrounding these various strategies can be quite complex. Within
each of these treatments, there are further decisions to be made.
For example, if a 50 year old man chooses surgery, should it be
done conventionally or with robotic assistance? Or if radiation
therapy is the recommended treatment, should that involve a
conventional multi-visit regime of external beam treatments or is a
better approach to place radioactive seeds within the prostate
gland? Before choosing a watchful waiting approach, there are
important questions that a patient will want to know—What are the
chances that I am making a mistake by avoiding all treatments
now? Am I going to die from this disease as a result of my
“watchful waiting” approach?
Often the “right” decision can only be made after a thorough
understanding of all of the medical details of the prostate cancer
along with an understanding of the patient’s preferences and
values. The best approach to take is to ask questions of your
treating physician and get the right answers from the right medical
experts, so you can play an active informed role in the direction
of your care.
St. John's University is committed to helping members and their
families with access to cutting-edge medical advances and to
improving healthcare certainty with an important health benefit
that helps answer these tough questions. Best Doctors is ready to
help you with up-to-date analysis and opinions regarding prostate
cancer and many other diseases. St. John's University employees can
get the answers they need from Best Doctors to make informed
decisions about their care. To learn more about Best Doctors, call
1-866-904-0910.