Written by Yvette M. Manard, MPH
Six years ago, the United States Preventive Services Task Force (USPSTF) ignited controversy in the medical community when they advised against most routine screening for prostate cancer with a PSA blood test.
Specifically, the recommendation set off a firestorm of debate in the urological community because most urologists are strong advocates of annual prostate testing with a PSA and a rectal examination.
Are you confused? Should men continue to have their annual prostate exam? I asked Dr. Robert Pugach, Medical Director of Pacific Coast Urology Medical Center, his opinion of the USPSTF’s finding and what he advises men to do.
Q: How did the USPSTF come to their conclusion that routine screening for most men for prostate cancer wasn’t necessary?
A: The rationale used by the USPSTF was that PSA testing leads to many prostate biopsies that do not show cancer and that many men are treated for prostate cancer with small, incon-
sequential cancers. They are correct! However, the problem is that we don’t have a better screening blood test than the PSA blood test. PSA, or Prostate Specific Antigen, rises not only in men with prostate cancer; it also increases with benign prostate growth and with prostate inflammation. So, a blood test doesn’t say if you have prostate cancer; it only says that you may have it. Only a biopsy can give a definitive answer.
Q: Given the fact that a PSA is still the best screening test for prostate cancer, do you recommend that men have an annual PSA blood test?
A: ABSOLUTELY! Prostate cancer is still CANCER! When the era of PSA blood tests started, 50,000 men died of prostate cancer every year. In 2011, when the USPSTF recommenda-
tions were released, that number had declined to 25,000. Cases of advanced (metastatic) prostate cancer had plummeted. Now that less men are being screened, that is no longer the case. Report after report now shows that the incidence of advanced, incurable prostate cancer is increasing. This year, the prostate cancer death rate is projected to increase to 29,000. We advised against most routine screening for prostate cancer with a PSA blood test. are literally throwing the advantages of early diagnosis away because of a misguided belief that we can afford to delay diagnosis and treatment of this deadly cancer.
It’s not just Dr. Pugach who is taking a stand. The American Urological Association has now spoken out against the USPSTF’s recommendations. Urologists across the country are encouraging patients, and their primary care physicians, to resume annual prostate cancer screening with a PSA and prostate exam.
About Dr. Robert Pugach
The Prostate Center of Excellence at Pacific Coast Urology Medical Center is the leading private practice in Southern California for diagnosis and treatment of prostate cancer. It is also the most experienced practice in the Western United States providing the non-invasive HIFU procedure for prostate cancer. If you would like to learn more, call (844) 443-8362.
This post was written by Western States HIFU