There is no good time to discover you have prostate cancer. But, as with most cancers, earlier is much better — ideally even before symptoms appear.
That’s why we search for prostate cancer in people who are healthy, before they develop the problems with urination or pain that may only show up after the disease has spread.
For more than 20 years, there has been a blood test to monitor men for high levels of a protein called a prostate-specific antigen, or PSA, that is often associated with prostate cancer. Unfortunately, this test is not perfect; many harmless conditions can cause heightened levels of this protein, leading to unnecessary tests and procedures that carry their own risk.
The uncertainty over the value of the PSA test led the U.S. Preventive Services Task Force in 2012 to recommend it only be given to people at high risk of prostate cancer. Other groups, including the American Urological Association, opposed this decision at the time.
Recently, though, that recommendation has been softened. Instead of advising against this test for most men, the task force now suggests that men aged 55 to 69 should talk to their doctor about its risks and potential benefits.
Dr. Vipul Patel, a urologist and robotic surgeon at Florida Hospital Global Robotics Institute, calls that “a step in the positive direction.”
“Prostate cancer still kills approximately 30,000 men each year in the U.S. and it remains the second-leading cause of cancer death in men after lung cancer,” he says. “Chances of surviving prostate cancer are high if it’s caught early, and the PSA test is a valuable tool in that kit.”
Dr. Patel says a high PSA score, by itself, is no longer a reason for an invasive test to remove tissue from a prostate. Instead, this test is repeated and supplemented by other non-invasive tests, including an MRI scan.
“If you’re over 50 years old, get PSA screening and get a rectal prostate exam,” he says.
A useful but controversial test
At first glance, it’s tough to see the downside of a simple blood test to detect prostate cancer. But it’s not the test itself that has generated so much controversy; it’s what can come after the test. If it finds high levels of PSA, this test can lead to further testing, including the use of a needle to remove suspicious tissue, called a biopsy.
Furthermore, even when cancer is found, removing a small tumor does not necessarily reduce a man’s chance of dying. That’s because prostate cancer is often slow growing, and many tumors found after PSA testing would never have been life-threatening. Surgery and radiation to remove these tumors can cause serious side effects like the inability to control urination, erectile dysfunction and infection.
The central question for medical experts, then, is to weigh the risks of testing and the number of people harmed from unnecessary treatment against the lives saved through the early detection of cancer.
Dr. Patel says the task force’s 2012 recommendation, which limited the use of PSA tests to certain at-risk groups of people, may have slowed our progress in treating prostate cancer.
“A recent study showed that prostate cancer rates have leveled off, instead of continuing their steady decline in the past three decades,” he says. “I expect that now that the rates have stopped falling, they’re going to start increasing. We’re now going to start seeing the negative effects of recommendations from six years ago.”
PSA is just one tool
Though the PSA is at the center of the testing controversy, it is not our only tool to detect prostate cancer, Dr. Patel says.
At Florida Hospital, a patient with a high PSA score is first re-tested to ensure the protein wasn’t elevated due to other temporary causes. We also use a 4Kscore test, a newer version of the PSA, to look for evidence of high-risk prostate cancer.
Finally, a painless MRI scan is also often used to help figure out who needs a biopsy.
“High PSA levels are no longer the only indication for biopsy,” Dr. Patel says.
Even when cancer is found, surgery and radiation are not your only choices. Many men have slow-growing cancers that will never affect their lives. In these cases, we can actively monitor their prostate, so if the cancer grows we can step in quickly and catch it early.
Indeed, it was partly the use of this monitoring technique, called “active surveillance,” that convinced the task force that the risks of using the PSA test are lower than previously thought.
We do everything we can to minimize unnecessary biopsies and treatments while using the PSA test as one in a series of options. When surgery is necessary, many patients qualify for highly advanced robotic technology that consistently controls cancer while sparing nerves to avoid incontinence and impotence.
When to get tested
Given the controversy around the test, it’s easy to end up confused about whether you should take it. But Dr. Patel’s advice is clear: “For the average male out there, the message is, if you’re over 50 years old, get PSA screening and get a rectal prostate exam,” he says. “If you are an African American male and have a family history of prostate cancer then consider earlier screening.”
At Florida Hospital, we know the potential harms to men who receive unnecessary biopsies and treatments. So, we’re focused on employing a range of non-invasive tests and only using aggressive therapy when necessary.
If you’re looking for doctors who can give you the information you need to take charge of your health, call 407-303-3627 or visit our website to request an appointment.