Perspective
Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out
N Engl J Med 2011; 365:1949-1951November 24, 2011
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Forty years after prostate-specific antigen (PSA) was identified and nearly 20 years after it became available for prostate-cancer screening, the U.S. Preventive Services Task Force (USPSTF) recently recommended against PSA-based screening.1 In the interim, untold millions of men have been tested. Because PSA is not cancer-specific and because prostate cancer's aggressiveness varies widely, controversy and debate about PSA screening were predictable from the outset.
Although we agree fully with the task force's analysis, there are three issues that the panel did not address but that are relevant to primary care clinicians, who initiate most PSA screening. (One of us is a general internist who has discussed the pros and cons of PSA screening with hundreds of patients over two decades; the other discovered PSA in 1970.)
The first issue pertains to office-based decisions about whether to initiate PSA screening. Virtually all guidelines call on clinicians to discuss the benefits and harms of screening and to individualize screening decisions according to patients' values and preferences. For example, the American Urological Association states that decisions “should be individualized, and benefits and consequences should be discussed . . . before PSA testing occurs.”2 The American Cancer Society advises clinicians to provide “information about the uncertainties, risks, and potential benefits” to help men “reach a screening decision based on their personal values.”3
At first glance, these guidelines appear exemplary, because they embrace the idea of patient-centered informed decision making. However, before 2009 — when results from two large screening trials were finally published — an evidence-based discussion of benefits was impossible because no convincing data existed to support screening. To be sure, clinicians could speculate loosely about potential benefit (“We might catch prostate cancer early enough to save your life”) and potential harm (“Screening might result in burdensome interventions with serious complications”). But the idea that physicians could initiate truly informed discussion was wishful thinking, because clinicians and patients had to consider an enormous list of probability estimates and uncertainties: What PSA cutoff is best? What level should trigger repeat PSA testing or biopsy? How often should we repeat either one? What is the patient's pretest probability of cancer? What is the chance that a PSA test plus a biopsy will find cancer, if it's present? If cancer is found, will it be clinically important? Will this patient prefer surgery, radiation therapy, or watchful waiting? What are the probabilities of serious side effects from each treatment, and how will this patient weigh them? Most important, will screening reduce this patient's risk of death from prostate cancer?
All these factors are relevant to discussions of benefits and harms, harmonized with patients' values or preferences. But it was impossible to address so many probabilities and uncertainties coherently during routine office visits. Thus, patients were not really making informed decisions, and office-based discussion of the pros and cons of PSA testing was essentially a charade. Instead, most patients' decisions reflected their general concerns about cancer or their general inclination to accept (or resist) medical interventions.
In March 2009, initial results of the two major screening trials were finally available. Unfortunately, they created more confusion than clarity. A U.S. trial showed no mortality benefit from screening; a European trial showed a small reduction in prostate-cancer–related mortality, but large numbers of men received aggressive treatment to benefit few. Both trials had important methodologic limitations (which are addressed by the USPSTF). Discussions with patients about the benefits and harms of screening have therefore become even more difficult since 2009, since clinicians must now add another layer of uncertainty: explaining why two huge randomized trials were less than definitive and why experts disagree about their interpretation.
The second issue is the variable and often idiosyncratic management of PSA levels in primary care and urology practices. Many PSA levels fall near the commonly used action thresholds in the range of 2.5 to 4.0 ng per milliliter. Men are tested and retested — sometimes several times per year — hoping to hear that their PSA levels “went down” or at least “didn't go up.” Patients undergo repeated biopsies, often at arbitrary intervals, after small spikes in PSA levels. PSA screening has even contributed to overuse of quinolone antibiotics, which many clinicians prescribe for lowering mildly elevated PSA levels in asymptomatic men with presumed prostatitis, even though a recent trial showed no difference between the PSA response to antibiotics and placebo.
These approaches to managing serial PSA levels reflect either a fundamental misunderstanding of — or an unwillingness to acknowledge — PSA's limitations as a marker for early prostate cancer. Observational studies show clearly that PSA levels fluctuate spontaneously, moving above or below whatever threshold clinicians deem worrisome. In addition, random biopsies can detect prostate cancer in 12% of men with PSA levels below 2 ng per milliliter and in 25% of men with levels between 2.1 and 4.0 ng per milliliter4; the latter figure approximates the prevalence often reported for men with levels between 4.0 and 10.0 ng per milliliter. When the PSA goes up — for example, from 3.0 to 4.0 ng per milliliter — and triggers a biopsy that reveals cancer, clinicians refer to “PSA-detected cancer.” But many of these cancers are not really detected by PSA screening; they are incidental findings against a background of randomly fluctuating PSA levels and an age-related increase in prostate-cancer incidence.
The substantial variability in how clinicians manage serial PSA levels is understandable, since published guidelines are vague and offer little guidance. But the guidelines are vague precisely because the limitations of PSA screening preclude the kind of rational, standardized, evidence-based algorithm that should inform any routine preventive intervention.
The third issue lies at the interface of clinical practice, public health, and responsible stewardship of health care resources. Although the USPSTF explicitly does not consider costs, policymakers cannot ignore economic aspects of screening. Using data from the European screening trial, researchers have estimated that $5.2 million would have to be spent on screening (and the interventions that follow it) to prevent one death from prostate cancer. That estimate does not appear to include the costs of excessive serial PSA testing and repeated office-based encounters devoted to discussions about screening or interpretation of fluctuating PSA results. The extraordinary time, effort, and costs associated with the PSA-screening enterprise must be evaluated against other claims on health care spending and physicians' time and energy. We believe that the current PSA-based screening paradigm does not compare favorably with competing health care priorities.
Some people have argued that PSA screening should at least be available for black men, because the incidence and aggressiveness of prostate cancer are greater in black than in white Americans. This proposal, however well intentioned, is misguided. In 2007, the proportion of deaths among U.S. men that were attributed to prostate cancer was 3.3% among blacks and 2.3% among whites; these rates are close enough that race-specific distinctions for screening are unwarranted. Furthermore, there is no evidence that the balance of benefits and harms from PSA screening differs for blacks and whites. If PSA screening is worthwhile, it should be applied universally; if it is not, selective screening would be a disservice to black men. Eliminating the unconscionable racial gap in overall access to essential health care services would be a far better way to address disparities than promoting a questionably effective cancer-screening program: the percentage of blacks without medical insurance is nearly twice that of whites.5
For two decades, primary care physicians have been expected to present a flawed screening test to patients, cloaking the flaws in an elaborate ritual of informed decision making. In turn, men have been expected to make sense of a confusing mix of hypothetical outcomes. Although the USPSTF recommendation is unlikely to end the PSA controversy, a document finally exists that should provide guidance to clinicians and policymakers.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article (10.1056/NEJMp1112191) was published on October 26, 2011, at NEJM.org.
Source Information
From the Department of Medicine, University of South Carolina School of Medicine, Columbia (A.S.B.); and the Department of Pathology, University of Arizona College of Medicine, Arizona Cancer Center, Tucson (R.J.A.).
- References
References
1
Screening for prostate cancer: draft recommendation statement. Rockville, MD: U.S. Preventive Services Task Force, October 7, 2011 (http://www.uspreventiveservicestaskforce.org/draftrec3.htm).
2
Prostate-specific antigen best practice statement: 2009 update. Linthicum, MD: American Urological Association, 2009 (http://www.auanet.org/content/media/psa09.pdf).
3
Wolf AMD ,Wender RC ,Etzioni RB , et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin 2010;60:70-98
CrossRef | Web of Science | Medline4
Thompson IM ,Pauler DK ,Goodman PJ , et al. Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4.0 ng per milliliter. N Engl J Med 2004;350:2239-2246[Erratum, N Engl J Med 2004;351:1470.]
Full Text | Web of Science | Medline5
Department of Health and Human Services. ASPE issue brief — overview of the uninsured in the United States: a summary of the 2011 current population survey. September 13, 2011 (http://aspe.hhs.gov/health/reports/2011/CPSHealthIns2011/ib.pdf).
- Citing Articles (2)
Citing Articles
1
Alain Braillon, Catherine Hill, Gérard Dubois. (2012) Prostate Specific Antigen (PSA), encore combien de dégâts ?. La Presse Médicale 41:5, 482-485
CrossRef2
Schröder, Fritz H., Hugosson, Jonas, Roobol, Monique J., Tammela, Teuvo L.J., Ciatto, Stefano, Nelen, Vera, Kwiatkowski, Maciej, Lujan, Marcos, Lilja, Hans, Zappa, Marco, Denis, Louis J., Recker, Franz, Páez, Alvaro, Määttänen, Liisa, Bangma, Chris H., Aus, Gunnar, Carlsson, Sigrid, Villers, Arnauld, Rebillard, Xavier, van der Kwast, Theodorus, Kujala, Paula M., Blijenberg, Bert G., Stenman, Ulf-Hakan, Huber, Andreas, Taari, Kimmo, Hakama, Matti, Moss, Sue M., de Koning, Harry J., Auvinen, Anssi, . (2012) Prostate-Cancer Mortality at 11 Years of Follow-up. New England Journal of Medicine 366:11, 981-990
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- Comments (48)
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48 Reader's Comments
JEANNE LENZER | Other | Disclosure: NoneKINGSTON NYNovember 27, 2011Poll query linked to article improperly framed
As a journalist, I've found that many providers who believe the USPSTF Grade D recommendation, also believe in initiating a discussion with the patient by explaining the controversy, the reasons for the Grade D recommendation, and letting them decide based on that information. By shoehorning every provider who agrees with the Grade D recommendation into an option that states they would not initiate a conversation with the patient (according to the 3 poll options), NEJM introduces an element of bias, potentially forcing some providers to check off option B (support Grade C recommendation and initiate a conversation).
Ferdinand Frauscher | Physician | Disclosure: NoneAustriaNovember 27, 2011Do we need imaging for successful prostate cancer screening?
One of the major problems I see in the discussion to screen or not for prostate cancer, is the lack of an imaging method, which allows for detection, localisation and size and number of prostate cancer lesions. In Innsbruck we have already introduced PSA screening in 1988. The acceptance of PSA testing was good, however the approach when PSA is elevated, the next step is systematic biopsy has shown to be not effective. Systematic biopsy is an old technique with a lot of disadvantages including inaccuracy, invasiveness and no detailed information about the cancer size. Furthermore systematic biopsy has shown often to result in undergrading of prostate cancer, which may result in inadequate therapy. New imaging techniques - including contrast-enhanced US and sono-elastography - have shown the potential to detect cancer. Furthermore multiparametric MRI is also useful. In addition the combined use of US and MRI with new imaging fusion techniques is promising. Therefore I believe that imaging will play a major role in prostate cancer screening, since the current data show that imaging may allow for diagnosis of "relevant cancers", where therapy will improve patient survival.
WILLIAM FULLER | Student | Disclosure: NoneBROOKLYN NYNovember 27, 2011Missing the Point
I am disheartened by several of the comments on this page that seem to miss a main point of the discussion. Even if we grant that there is some small absolute prostate cancer-specific mortality reduction associated with PSA screening, what is the cost, both financial and in terms of personal harm, associated with one death prevented by PSA screening? Those on this forum having undergone prostate biopsy will agree that it was a painful procedure, and the costs associated with it and its complications are high. How many patients will undergo this hardship and possibly suffer lasting harm in the hopes of preventing a disease that their PSA, due to its lack of specificity, does not reliably indicate that they have?
The question is not whether PSA might find cancer, but whether ordering it will be in the interests of an individual patient. If we refuse to believe the results of two controlled trials indicating that it truly isn't, we have given up any pretense of practicing evidence-based medicine. In short, just because it is the best test we have does not mean it's a good test, or that it should be used in a screening capacity for patients without a history of prostate cancer.IAN HOLLIDAY | Other | Disclosure: NoneGRAVESEND United KingdomNovember 24, 2011A question of values?
Although a professional, I have read these comments as a patient looking for some facts before opting for biopsy following a superb PSA velocity which should be studied. Interesting as it is that the "ding dongs" a someone calls us, are arguing about research limitations and findings but there are several anecdotes of patients who are now alive because of screening, whether via DRE, PSA or biopsy. In the face of those anecdotes, I find myself saying "Regardless of the statistics, here are people - able to speak because of life saving intervention. OK, only a few but, I am minded to say I'd like to be one of those whose life is extended and who can continue to read this web site for a few more years." Maybe I am wrong but, then again, those of you who advocate patient discussion might glean something from my, maybe twisted, mind set. Alternatively, maybe someone should do some decent research on why patients have trouble deciding, rather than, again, anecdotal stuff.? Dr Siguel above seems to be the only one making sense to me, as a patient, when he says that patients need more data and more depth.
Timothy Dayton | Other | Disclosure: NoneNovember 24, 2011PSA Testing
The PSA testing I had done over a number years showed a gradual rise in the last 3 years until it reached > 4.0. At that point I did not have any symptom detectable by DRE. I decided to have a biopsy and was presented with cancer in several pin samples with a Gleason of 6 or 7. I decided to have surgery, I was 55. I had successful surgery and post operative testing showed a Gleason 7 and a relatively aggressive sort of cancer. I am very glad I did what I did and I am satisfied with the results so far. Had I not had the testing I am not sure how long it would have been to have a DRE indicate a problem and then what would be my choices several years further into cancer growth. Until there is a better test the PSA is the best we have even if it isn't perfect. Early detection permitted prostate removal with wide margins and with the use of nerve sparing surgery. I have had excellent results and am not worried about this problem anymore. I do get a PSA test every 6 months just to make sure it hasn't spread.
HENRY FOURCADE, MD | Physician | Disclosure: NoneBlaine WANovember 23, 2011Retired Anesthesiologist
My father had annual H&P's and was in good health until his first PSA test result returned at 79. He had external beam radiation for invasive prostate cancer followed by a complicated medical course. I would like to continue my annual PSAs & DRE, and know when my PSA is rising before it hits 79. Is someone in this free country going to tell me that is unethical?
MR ERNEST KRAUS, RPH | Other | Disclosure: NoneWOODBURY NJNovember 23, 2011My PSA <4.0
I too had increasing PSA's but never hit that magic .4.0. Digital exam found no enlargement, firmness and a small nodule. My urologist scheduled me for a biopsy with the comment " I'm sure it will be negative, but let's be sure." An evening phone call from him said that 12 of 16 biopsies were positive with Gleasons og 6/7. I opted for surgery with continuing PSA follow up. Some years later, the PSA went from <0.01 to detectable levels. Consultation with both my surgeon and the radiation oncologist came up with a diagnosis of recurence. I also found out that I'm part of the 35% that do reoccur. I opted for XRT and continue to monitor PSA. I can only speculate what would have happened had I not had the surgery; would I still be alive? Would I have mets? No one knows. I don't care about the studies, the statistics, the cost. To me, it was worth it.
JAI JOSHI, MD | Physician | Disclosure: NoneLAREDO TXNovember 23, 2011Answer to Poll Question
The four articles in this issue illustrate, there is no right answer to the poll question. The seemingly easy answer is that you initiate a discussion, but that’s the wrong choice.
john williams | Other | Disclosure: NoneNovember 23, 2011PSA alternatives
I keep waiting for the medical "experts"to tell me what alternative tests are available for determining the presense of prostate cancer?????
GIOVANNI SALAMANO, MD | Physician - Endocrinology | Disclosure: NoneVERCELLI ItalyNovember 06, 2011Prostatic cancer screening: what is the most useful screening procedure?
The hypothesis that the pathogenesis of prostatic cancer is linked to an inflammatory process seems sufficiently demonstrated by both hystological and clinical evidences supporting the presence of a precancerous lesion called "Proliferative inflammatory atrophy."
Molecular genetic supports this idea demonstrating that hypermethylation of CpG island of Gluthatione Methyl Transferase (GTP1) gene, on chromosome 11q13, is the cause of reduced transcriptional and antioxidant activity of this enzyme, causing an increased genomic instability at prostatic epithelial basal cells.
The "gatekeeper" gene for "prostatic intraepithelial neoplasia" development is NKX3.1, located on chromosome 8p21, encoding a prostatic specific homeobox gene, essential for normal prostate development, inactive in cancer, and able to repress the expression of Prostatic Specific Antigen (PSA).
PSA, also called Kallicrein 3, is itself a protein involved into inflammatory processes, present at increasing concentrations during prostatitis.
Bearing these pathogenetic considerations in mind, the measurement of PSA total, free, velocity and density for screening pourpose is unjustified in otherwise healthy patients.john williams | Other | Disclosure: NoneNovember 05, 2011PSA tests
My prostate cancer was diagnosed indirectlly through a PSA test >4 followed by a free PSA and a biopsy. It was very localized but a gleeson 9. What alternative do you ding dongs have to offer in lieu af a PSA test( the DRE was clear so you can't use that answer!!!)?
SERGIO STAGNARO, MD | Physician | Disclosure: NoneRIVA TRIGOSO ItalyNovember 05, 2011PSA Evaluation only in presence of Protate Oncological Inherited Real Risk.
To ascertain PSA in all men, without knowing prostate cancer Inherited Real Risk, is neither scientific nor useful.
MR EDWARD JAGO | Other | Disclosure: NoneDUBLIN OHNovember 04, 2011Just a survivor's comment
It was suggested that I have a PSA test by my physician some years ago. The test showed a very small level. The test was repeated first at two year intervals and than at one year intevals over a period of about 10 years. My physician plotted the data each year on a time line and we watched first a steady very low increase then an accelerating rate until the last increase showed about a thirty % increase. At that point a biopsy indicated a cancer. I elected surgery and the prostate was removed and the margin cleared. I elected no further treatment be performed. Continued PSA monitoring for the last 12 years has shown no significant PSA so I consider my self prostate cancer free. So I say montitor and watch the trend liine.
MR MARIO GUARNIERI | Other | Disclosure: NonePRATO ItalyNovember 04, 2011PSA Screening does help ....
Understand that more prostate volume and more inflammation gets more PSA . However PSA high value does not mean a prostate cancer. There is a helpful new blood test being done in Milan and Firenze, Italy and named P.H.I. (Prostate Health Index) which in my case and others did indicate high-risk of cancer, proven by biopsy. I had surgery on August 31 and am feeling good. PSA will help again this month for deciding whether radiotherapy applications may be advisable or not.
NORMAN SOLOMON, MD | Physician | Disclosure: NoneLOS ANGELES CANovember 04, 2011Advice On Counseling
The dilemma is clear and has been for years. All the anxious waiting for these studies to help clarify what to do have not really changed much. You can explain this to patients till you're blue in face or give them handouts, and they still ask you the same questions. The bottom line is what psychological burdens an individual patient can handle. If learning that ten years from now, they have prostate cancer and if they had only had a psa, maybe things would have been better is something they couldn't handle, then PSA screening is right for them. If they have a poor tolerance for making difficult decisions and would have difficulty knowing that they have a "cancer," but that they are just watching it, then PSA testing would probably be the wrong choice for them. The decision has more to do with what they can handle than it has to do all the facts we bombard them with. I've yet to have a patient NOT ask me at the end of my discussion, what would you do, which shows you their inability in many cases to process the information in a manner that is best suited for themselves.
Jim Thayer | Other | Disclosure: NoneNovember 03, 2011Missing a most relevant issue
As a researcher supporting the medical and pharmaceutical industry, and a prostate cancer (PC) survivor, I am appalled that so much effort is applied to this issue without considering the most obvious benefit of REPEATED PSA testing. While I did not know that my grandfather had died from metastasized PC until after I had been diagnosed, I had my PSA tested periodically (2-3 year intervals). It was fairly consistent until last year when it increased by several fold (over a 3-year period). I had the biopsy and discovered the PC in time to take action.
While a single PSA test may not be very instructive for all the reasons listed by others, periodic PSA tests are very helpful as they establish a baseline for subsequent comparisons. Because of the current controversy, my physician did not intend to perform the PSA test during my last physical, but I insisted. In my case, it probably saved my life. To me, all this controversy over the value of the PSA test seems ridiculous without consideration of repeated tests to establish a baseline, perhaps best initiated during the age of 45-50.HANS-HERMANN DUBBEN | Other | Disclosure: NoneHamburg GermanyNovember 03, 2011Prostate cancer screening: A controversy about random numbers
Studies on prostate cancer screening are principally not qualified to provide scientifically valid information about a benefit in terms of (cancer specific) mortality. Such trials have too low statistical power because of low cancer-specific mortality combined with long history of disease, lack of compliance, contamination, and unclear causes of death. Trials with sufficient power require millions of participants and tolerate no loss from follow up. Their results become available only decades after trial initiation. Then they are necessarily antiquated due to changes of the population, treatment options and diagnostics. Indispensible prerequisites of science are testable hypotheses and replicability. Neither is a given for early detection of (prostate) cancer. Underpowered studies simply generate random numbers. Thus it is not surprising that the results of the ERSPC and PLCO study are contradictory. Alone the disadvantages are evident because the number of overtreatments are much higher than the number of allegedly prevented PCa-deaths.
Cancer screening studies appear unethical and contradict §17 of the Declaration of Helsinki.John Costello | Physician | Disclosure: NoneNovember 02, 2011Internist
The US Task Force stance is correct, but - it changes nothing . The trial in the US may be too compromised to prove the value , and the European trial suggest- with varying criteria for entry, and followup- that screening helps about 1 in 1, 000 or so /year- about the same as mammography, for those likely to live 10 years , between 50 and 65 -70. It's still up to the individual to decide, with the help of a physician/family / friend what is best for them, based on imperfect data. The larger ? is -should a health system pay for such screening?
CHUAN PHING TANG, MD | Physician - Dermatology | Disclosure: NoneSITIAWAN MalaysiaNovember 02, 2011Find a better treatment
It is agreeable that DRE with PSA screening if done properly will help to pick up early prostate cancer with better accuracy coupled with TRUS biopsy. It is the treatment options to the patient and its complications that put off the patients. PSA screening itself is not a big issue. It is time for the urologist to find a better and less invasive way of diagnosing and treating the Ca prostate. Man is worried of ED,incontinence,retrograde ejaculation... Man wants better quality of life.
JEFFREY HOROWITZ, MD | Physician | Disclosure: NoneFALL RIVER MAOctober 30, 2011What is the code for "PSA discussion with patient"?
I can't help thinking about where are we going to find the extra 10-15 minutes to properly discuss the option of PSA screening with our patients. It seems impossible to tack that on to a routine office visit, do a good job and not feel rushed and fall behind schedule all day. Realistically, forget it unless there is a code for it!
GEORGE ADAMS, MD | Physician | Disclosure: NoneOctober 29, 2011Whenever You Like
It's not yet illegal to check your PSA. I check mine q6 months as that's what Im confortable with. So do what you're comfortable with. Check it whenever you like. You will be as right as anyone else as the final answers are not in and may never be. When it becomes illegal to check it frequently in the US go to Costa Rica on vacation and check it there.
EDUARDO SIGUEL, MD | Physician | Disclosure: NoneGAITHERSBURG MDOctober 29, 2011Need Better data, not longer philosophical decisions
Change research and data to offer better data on choices. Build mathematical models probability distributions of types of cancer and treatment outcomes given values of variables such as age, weight, race, nutrient status (such as Vit D and essential fats), family history, prostate size, rate of increase of PSA, treatment type, etc. And chart probability distributions and changes in PSA as a function of biological variability, exercise, lab variability, diet, weight, etc. Develop accurate models of the causes of prostate cancer, the factors that increase or decrease cancer rates. This is feasible today. Instead, we spend millions on useless clinical trials. Current financial incentives discourage better mathematical/biophysical/biological models.
When the data become available, the optimal decisions will usually be obvious. Now, with ignorance, with poorly designed clinical trials, with focus on profits, we don't have data to make optimal decisions and we must obfuscate recommendations.CLYDE SCHECHTER, MD | Physician | Disclosure: NoneCYPRESS CAOctober 28, 2011The PSA Dilemma -- A Result of Entrepreneurial Medicine
So the major trials were seriously flawed. Those in the US suffered from severe contamination in the control group, and screening prior to randomization. Why is that? Because PSA screening was so deeply entrenched in medical practice before it was ever subjected to serious testing. This is typical of entrepreneurial systems: products and services are launched, marketed, and hyped before anyone has time to figure out if they are any good. When it's ordinary consumer goods, probably that doesn't matter much. But here we see that the US undertook a mass campaign of genital mutilation for decades, and the practice became so widespread that it was impossible to mount a valid study of whether we had anything good to show for it. We still don't know if even a single life was saved, and we never will.
The late Thomas Chalmers used to say "Randomize the first patient." His dictum, still ignored, is the wisest advice I have ever heard from any health professional.James Mohler | Physician | Disclosure: NoneOctober 28, 2011Clarification on development of the PSA test
While Dr. Ablin did discover a "prostate-specific antigen" that is confined to the normal prostate, he neither developed the PSA test nor discovered the PSA on which the current test is based. That credit goes to Roswell Park Cancer Institute researcher T. Ming Chu, PhD, DSc, and his colleagues, who identified and purified PSA and later developed the simple PSA blood test that is used today for the early detection and management of prostate cancer. The team published its first major paper in 1979 in Investigative Urology, and in 1984, a patent was issued to New York and RPCI and the technology was transferred to the biomedical industry for preparing test kits. The PSA test received FDA approval in 1986 as a monitor for treatment response and disease recurrence and in 1994 as a screening tool for diagnosis. Dr. Chu received the Presidential Award from the AUA in 1993 and was featured in the April 1998 issue of Cancer Research for his research on the use of tumor cell products in the diagnosis and treatment of cancer and for his leadership role in the discovery of PSA and development of the PSA test.
Missing the point
Just getting your prostate cancer diagnosed does not mean a doctor has saved your life, or even given you longer to live. The science in the studies simply has not shown that to be true. I am pleased that those who have had a diagnosis are glad they went through the ordeal and feel it has made a difference for them, but I worry when they go around preaching that their life has been saved by having a PSA and getting their colleagues to get one too.
So what are the alternatives to PSA you all ask?
Get on with life, spend less time in a doctor's room and more time walking and enjoying life, and if you get symptoms, go and see a doctor. You will live just as long and perhaps with all that extra exercise a little bit more.