As noted in last week’s post, prostate cancer has personally affected me and my dear friend due to the loss of our loved ones.   With that in mind, how can men take the necessary precautions to minimize the chance of death due to prostate cancer?  The PSA (prostate-specific antigen) screen requires a simple blood draw and results are available within just a day to two. However, there has been some conflicting information on the “value” of a PSA screen.

Last year Science Based Medicine posted a blog on PSA screening http://www.sciencebasedmedicine.org/?p=443, and they commented that doing PSA screens “boils down to a value judgment. Is it worth screening 1068 men and treating 48 to save one life from prostate cancer when you don’t save lives overall? How do you weigh the costs and the suffering against the value of a life saved? There is no easy answer. Future research will try to assess things like quality of life and cost effectiveness, and we may come up with better recommendations about when to test and what level of PSA to use as a cut-off.”

On the other hand, Patrick C. Walsh, M.D., University Distinguished Service Professor of Urology, provides his thoughts….on the results of two long awaited trials published in the New England Journal of Medicine.^{1, 2} One said that screening with PSA reduced deaths from prostate cancer by up to 27% and the other claimed it didn’t work. What are we to believe?  Like many things “the devil is in the details” and understanding these details could save your life!  

…. the positive trial was a landmark study carried out in seven European countries that studied 162,000 men who were randomized to PSA screening every four years versus no screening.¹ With long-term follow up out to fourteen years, there was a 20% decrease in deaths from prostate cancer in the group of men assigned to screening.  However, since only 85% of these patients actually underwent screening, if one includes only the men who were actually tested, the decrease in prostate cancer deaths is 27%. This reduction in death from prostate cancer is similar to the 30% reduction in mortality from breast cancer in women who undergo mammography and the 33% reduction in prostate cancer mortality that occurred in the United States between 1994 and 2003 following the introduction of PSA screening. Thus, the results from the European study support other findings and unequivocally demonstrate that PSA testing can save lives.” For more information, please see  http://urology.jhu.edu/prostate/PSA_controversy2.php.

With all of this conflicting information, how does a man determine if he should or should not do a PSA screen?  Although the statisticians can crunch numbers all day long, I think that it’s a matter of empowerment and taking control of your health with a good understanding of the pros and cons of the screen.   With that in mind, Roald started his annual PSA screens at age 46, so we have a good baseline and we’ll definitely watch for any changes.  

Isn’t it all about a man becoming educated and making the best decision for his situation?  The Mayo Clinic has a great tool to help men understand the pros and cons of PSA screening http://www.mayoclinic.com/health/prostate-cancer/HQ01273.  If you decide to do a PSA screen, you may want to consider visiting ANY LAB TEST NOW®.  At ANY LAB TEST NOW® the doctor’s order is included and folks are typically in and out within 15 minutes.  It’s fast and affordable with friendly service.   Please see http://www.anylabtestnow.com for a location near you. 

Take control of your health.

Clarissa Bradstock

1. European Randomized Study of Screening for Prostate Cancer (ERSPC):         Schroder FH, Hugosson J, Roobol MJ, et al.  Screening and prostate-cancer
mortality in a randomized European study. N Engl J Med 2009;360:1320-8.

2. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO): Andriole GL, Grubb, III RL, Buys SS, et al.  Mortality results from a randomized
prostate-cancer screening trial.  N Engl J Med 2009;360:1310-9.