Examining the Test
Guidelines for Prostate Screening Prompt Questions among Patients
After skin cancer, prostate is the second-most common cancer in men. Currently, the only test available to screen for the cancer is the prostate-specific antigen test that many men over the age of 50 simply know better as the PSA. However, in 2012, the U.S. Preventive Services Task Force, an independent group of national experts in prevention and evidence-based medicine, published a recommendation that the PSA no longer be used.
After a review of research studies on the test, the group “concluded that the expected harms of PSA screening are greater than the potential benefit.” The recommendation applies to men of all ages except those who have been diagnosed with, or are being treated for, prostate cancer.
That guideline might seem a bit extreme, but the Task Force shines light on some important points in its recommendation. If nothing else, it should serve as a conversation starter between patient and physician, with some gray area to be navigated in order to make a personal decision about the test.
Problems with the test
The current screening test measures the amount of PSAs in the blood. Men with cancer have high amounts of this substance. Sounds simple enough, right? However, the presence of cancer is not the only thing that can raise levels of PSA.
Reasons for an elevated PSA can also include non-cancerous problems with the prostate, having sex within two days prior to the test, and even a long bike ride or other activity that might apply strong pressure to the pelvic area.
Most men are unaware of these mitigating factors and therefore may not have prepped properly for the test, as it is usually part of bloodwork they receive from a general practitioner at a routine check-up.
If the PSA level is high, men are then sent to a specialist for an exam and further testing. Those followup tests are typically invasive and can cause problems such as infection, bleeding, urinary issues and pelvic pain. But even if the diagnosis is positive for cancer, it does very little to help define the ensuing decision tree.
That’s because most prostate cancers grow slowly and are not likely to cause symptoms in the patient until later stages of the disease. But in some cases the cancer can be more aggressive and can spread beyond the prostate.Currently, there is no test available that can differentiate between the two types of cancer.
Therefore, men who test positive for prostate cancer might receive treatment as if the cancer was aggressive, and that has led to some men being treated unnecessarily. At first, that may seem like a reasonable tradeoff, but the side effects of treatment are not inconsequential. They can have a great affect on a man’s lifestyle.Possible issues include erectile dysfunction, urinary incontinence, problems with bowel control and a small risk of death and complication from surgery.
Walking a fine line
Understandably, there has been a lot of confusion among doctors and patients since the Task Force recommendations were published. Most medical societies are not comfortable with the guidelines and have sought to keep the test, but use it in a more tailored way.
“In general, there is a greater benefit for men age 55 years to 70 years old,” says Dr. Jared Berkowitz, a urologist at Monocacy Health Partners in Frederick. “However, if there is a strong family history of prostate cancer, or if you are African American, you are at greater risk and may want to consider screening a little earlier.”
A responsible approach to PSA testing should involve a conversation with your doctor to discuss the risk versus benefits as they apply to your individual circumstances. To make the most of that conversation, a little research will go a long way. You may want to first visit the U.S. Preventive Services Task Force website at www.uspreventiveservicestaskforce.org.
It features the full recommendation statement, as well as links to research used to make the decision. Then, to get a more tailored view of those recommendations, visit the American Urological Association at www.auanet.org or the website of a major medical establishment.
Also, the Memorial Sloan-Kettering Cancer Center website at www.mskcc.org features a good explanation of their guidelines, as well as short, informative videos. “Even though the PSA test is flawed, there isn’t a better test at this time,” Berkowitz says. “It really is a conversation a patient needs to have with his doctor to assess risks and advantages.”
Whether to test—and when— is not an easy decision. Taking advantage of the research, expert opinion and thoughtful conversation with a physician will help a patient find an answer that is compatible with his risk level and lifestyle.
Prostate Surgery Improved With Robotic Technology
Surgery is one of the methods used to treat prostate cancer. With the new robotic surgery system now available at Frederick Memorial Hospital, that procedure has been improved. Prostate Surgery Improved With Robotic Technology The surgery is performed using very small incisions.
The miniaturized tools allow for careful dissection of tissues in an area where precision is very important. And lest you think the doctor has less control not being in touch directly with the body, think again.
“It offers greater magnification and the arm can move in many different directions and can make very fine movements that a hand cannot make,” says Dr. Jared Berkowitz, a urologist with Monocacy Health Partners in Frederick.
“It also results in less pain, less blood loss and quicker recovery times.” The nature of the robotic arm also makes it ideal for a variety of other surgeries such as gynecological and complex general surgeries.