In the News – Controversy in PSA Testing for Prostate Cancer in Men of All Ages

Snippet from the non-hair-loss-related-but-still-impotant article:

Prostate cancer screening has become increasingly polarized, with experts weighing in on both sides of the equation. The draft recommendation issued by the US Preventive Services Task Force (USPSTF) in October 2011 ignited the controversy — like pouring gasoline into the fire.

Now 2 experts with opposing views on the USPTF recommendation offer evidence for and against routine screening with the prostate-specific antigen (PSA) test. The point–counterpoint appears in the March issue of Cancer Epidemiology, Biomarkers and Prevention.

The USPTF draft recommendation advised against routine screening with the PSA test, as reported at the time by Medscape Medical News. The USPTF had previously recommended against routine PSA screening in men older than 75 years, but the draft extends that to all men. It gives routine screening in men younger than 75 years a “D” rating, which means “there is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits.”

Read the rest — PSA Testing Continues to Polarize Medical Community

I know this isn’t a hair loss related entry, but it is an important issue I wanted to discuss. So what is this all about? In patients with prostate cancer, a protein (PSA – prostate specific antigen) is found in the blood. It is a cancer marker and like many cancer markers that are detected early (like in a pap test for cervical cancer) their presence means that the person who has tested positive, has cancer of that particular organ.

It has always been a goal to try to detect cancer early enough to produce a cure; however, it is thought that some breast cancers and now even the prostate cancers may never grow enough to be life threatening. If a woman has an in-situ breast cancer that will never grow (can be detected in about 10% of women who were autopsied) or potentially threaten her life, should the breast come off if it is present? That is the question.

For the prostate, even if the cancer grows as the PSA blood test indicates that it does (and biopsies often confirm its presence), is the treatment worse than the disease? Few patients with known prostate cancer ever die from the disease, as they usually die from other diseases like stroke and heart disease. If a man undergoes a prostate surgery, or radiation therapy, or other radical treatments to treat the prostate, their quality of life is often impacted by urinary and fecal incontinence (having to wear diapers for the rest of their lives), have chronic pain from surgery, lose their sexual capability, have their testicles taken off, etc.

The men who have extensively researched treatments for their prostate cancer easily get confused by the various doctors and their prejudices for treating the disease. The surgeons wanted to take out the prostate, the radiation therapist wanted to radiate the prostate, and so on. The medical community is “up in the air” on what to do to manage the wide differences between opinions of experts worldwide.

Now to add more confusion to the discussion, some small percentage of patients do die from prostate cancer, and when the disease spreads to the bones, there could be severe pain associated with the metastasis; but the problem is that today’s doctors do not know which patients with known elevated PSA tests will develop the virulent metastatic “killer” prostate disease. The decisions for the patient are like playing Russian roulette with the quality of what remains of their life.