One of the most important decisions a man can make is whether or not to have the PSA test as a screening tool for prostate cancer. Across the U.S., physician groups recommend that doctors talk to their male patients, especially those between ages 55 and 69, about the advantages and disadvantages of this test, but data for 2014 show that about 30% of men do not have this discussion with their doctors.1
One might wonder why the hype about having this “talk.” Isn’t the PSA test a potential lifesaver for men? Isn’t it a simple blood test? Is there any reason men should not have this test? The answer to all of these questions is a qualified “yes,” but let’s delve deeper.
Introduced in the late 1980s, the PSA test has been proclaimed as the best way to detect prostate cancer at an early stage when the rate of cure is relatively high. But most prostate cancers grow slowly, so while an elevated PSA level may indicate the presence of cancer, it does not tell us if the man will ever have symptoms of cancer or actual cancer. The PSA may overdiagnose nonaggressive prostate cancers and lead to unnecessary biopsies and treatments, or it may underdetect aggressive cancers that need treatment. And the PSA may produce a false positive due to temporary or non-cancerous conditions.
The value of the PSA test has become a controversial topic, and research continues on this important topic, often with contradictory conclusions. Overdiagnosis generally results in the man opting to go into high gear for the diagnosis and treatment of cancer, which may include an invasive transrectal ultrasound-guided (TRUS) biopsy, possibly followed by more surgery, radiation therapy, and/or chemotherapy. The consequences of such treatments may be significant and may include impotence, incontinence, and emotional upheaval.
For the man who opts for the PSA test and gets an elevated reading, technology now offers means other than the TRUS to determine if cancer is actually present. The newest technology for diagnosis is the multi-parametric MRI (mpMRI), a pain-free procedure that takes detailed images of the prostate to determine if a tumor is actually present. The mpMRI is highly regarded for diagnosing prostate cancer and predicting aggressive prostate cancers while eliminating the need for the uncomfortable TRUS. If any suspected lesion or lesions are confirmed, a targeted MR/US fusion biopsy can be performed to pinpoint actual lesions for biopsy. It is important that men discuss these options with their physicians before proceeding with the TRUS.
Sarasota Interventional Radiology, headed by Gerald E. Grubbs, MD, works closely with area urologists to coordinate and perform mpMRI and MR/US fusion biopsy. For more information, click here to go to our main website.
1 Harrison, Pam. (2017 April 25). Many Men Have No Discussion of Pros and Cons Before PSA Test. Retrieved from http://www.medscape.com/viewarticle/879065?nlid=114397_4503&src=wnl_dne_170426_mscpedit&uac=153271MX&impID=1335901&faf=1#vp_1