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Prostate Specific Antigen (PSA) Test Still the Best

Posted May 12 2009 6:15pm

The other day I read about a 60 year old man's triumphant statement that he's glad he skipped his PSA test this year. He was glad he didn't get screened to determine if his PSA reading went up. He stated this in view of new European and American studies that concluded that PSA tested men didn't have a significantly greater mortality rate due to prostate cancer when compared to non-tested men.

I'm here to tell you that this is bad advice, at least for now. With all its false positives and false negatives, the PSA test (which is at most 60% accurate) is the first line of defense in the battle against prostate cancer. Advising folks to do nothing because they are more likely to die with prostate cancer than from it is ill-advised. A PSA test coupled with a biopsy where warranted and vigilant surveillance or a treatment like surgery or radiotherapy if your prostate cancer is localized and at an early stage, is the least you can do to safeguard yourself.

One of the reasons you should not  take the two major studies seriously is that you are an indvidual who can determine what's best for you only after discussing this matter with your doctor. Second, these studies are not complete or conclusive.

There are other reasons expressed in the release yesterday of the European Association of Urology's statement of these matters. I've appended it below, so you can read it for yourself.

Good health always! And as always I welcome your comments.

Rabbi Ed

  EAU Position Statement on screening for prostate cancer

16 April 2009 European Association of Urology

    The European Association of Urology (EAU) has taken into consideration the recent scientific information on randomised screening studies on prostate cancer (Schröder et al, NEJM 2009). Based on the results of the European Randomised Study for Screening of Prostate Cancer (ERSPC), the EAU has formulated a position statement regarding prostate cancer screening in Europe, and the subsequent actions to be taken by health professionals and health authorities.

    In summary, the ERSPC reports on a relative prostate cancer mortality reduction of at least 20% by PSA-based population screening in 162,000 asymptomatic men aged 55-69 years. For every prostate cancer death prevented, 1,410 men have to undergo screening, while 48 are needed to be treated in excess of the control group population to save one prostate cancer death. Results of the PLCO (Prostate, Lung, Colon and Ovary) US randomisedstudy of screening were also published in the same issue of the New England Journal of Medcine - NEJM (Andriole et al, NEJM 2009) and to date show no significant effect of screening on mortality from the disease, but suffered from a significant level of contamination in the control arm. The study continues.

    The EAU adopts the conclusions of the ERSPC study and recognizes the benefit of screening in terms of mortality reduction, as well as the adverse effects of overdiagnosis and overtreatment of prostate cancers which could be quantified for the first time in the setting of a randomized screening study. Further publication of relevant data is awaited from the ERSPC group in due course to inform the debate.

    In the interest of men’s health in Europe and elsewhere, the EAU formulates the following statements:

    • Prostate cancer is a major health problem, and one of the main causes of male cancer deaths. However, current published data are insufficient to recommend the adoption of population screening for prostate cancer as a public health policy due to the large overtreatment effect. Before screening is considered by national health authorities, the level of current opportunistic screening, overdiagnosis, overtreatment, quality of life, costs, and cost-effectiveness should be taken into account. 
    • Overdiagnosis of prostate cancer leads potentially to significant overtreatment. Health professionals, especially urologists, should avoid overtreatment by developing safe methods of cancer surveillance/monitoring without invasive therapy. Invasive therapies should be tailored to patients’ needs and the prognosis of cancers diagnosed.
    • Current screening algorithms are insufficient due to a lack of specificity and lack of selectivity for aggressive cancers which require treatment. The development of novel diagnostic and prognostic markers and imaging modalities is needed urgently to enhance the predictive value of screening tools.
    • In the absence of population screening, the EAU advises men who consider screening by PSA testing and prostate biopsy to obtain information on the risks and benefits of screening and individual risk assessment.
    • The EAU and the ERSPC study group represent essential European stakeholders to further develop health strategies for prostate cancer screening.
    • The EAU promotes the quality of care for prostate cancer patients in Europe in collaboration with the patient support organization Europa Uomo (www.europa-uomo.org) through the development of information support and guidelines.
    • The EAU wishes to support and foster research needed to develop reliable active surveillance protocols for low-risk prostate cancers, prognostic markers, and targeted therapies in order to deliver optimal patient care. 
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