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To Screen or Not to Screen: Prostate Specific Antigen (PSA) and the United States Preventative Services Task Force (USPSTF) Recommendations
Prostate cancer remains the leading cancer diagnosis among men in the U.S. with approximately 192,000 cases diagnosed each year with greater than 90% having localized disease. The role of PSA in the early detection of prostate cancer has come into question and the United States Preventative Services Task Force (USPSTF) issued a preliminary statement recommending against the use of PSA screening.
Several important facts should be considered prior to abandoning PSA screening. PSA has had an overall decrease in prostate-cancer specific mortality in the U.S. Level one evidence from the ERSPC trial showed an overall reduction in prostate cancer specific mortality in the screened arm by 20%. The PLCO study showed no significant advantage in mortality, however, with contamination of the PLCO control group up to 52% makes any conclusions questionable.
The American Urological Association (AUA) has issued a preliminary statement suggesting that ‘disparaging the test before a suitable alternative is widely available does a great disservice to men worldwide who may benefit from early prostate cancer detection’.
Dr. Williams of AUOC has recently developed a nomogram to be published in Cancer, Official Journal of the American Cancer Society, utilizing PSA and other risk factors to discern patients at risk for clinically significant cancer ‘prior’ to prostate biopsy. While the performance of this nomogram is not 100%, it does offer patients reassurance that we are utilizing PSA and other factors to decide whether or not proceed with a biopsy to detect clinically significant disease. Until we have improved biomarkers to detect clinically significant prostate cancer we should not abandon one of our most useful weapons to combat this disease.
The doctors at AUOC are dedicated to providing our patients the most up to date information regarding this sensitive subject and there is no other urology practice in Orange County that can provide as recent peer-reviewed publication on the utility of PSA and prostate cancer as that found at AUOC. Please feel free to make an appointment with any of our doctors if you have further questions and/or concerns regarding this or any other urologic condition.
Doctors with expertise in incontinence, bladder suspension ("bladder lift") and sling procedures, kidney stones, no needle no scalpel vasectomy, vasectomy reversal, laparoscopy and laparoscopic kidney and prostate surgery, prostate diseases including cancer and enlarged prostate, cryoablation (or cryotherapy) of prostate and kidney, robotic (da Vinci) prostate surgery.
Adult and pediatric urology, urologic surgery, in Orange County, California
serving Anaheim, Garden Grove, Irvine, Orange, Santa Ana and Tustin.
Our office accepts most major insurance including Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net, Pacificare, United Health, Medicare.
The information on this site is solely for purposes of general patient education, and may not be relied upon as a substitute for professional medical care. Consult your own physician for evaluation and treatment of your specific condition.
1801 N Broadway, Santa Ana, California 92706
Associated Urologists of Orange County
State-of-the-Art
UROLOGY AND UROLOGIC SURGERY
In a Minimally Invasive Way
