PSA Screening

Prostate cancer and screening

PSA tests. The jury was out. Top specialists like Tony Costello at RMH actively push for early detection for early treatment. Other  groups like the USANZ preferred that screening not be done as the rewards of detection and the downside of the treatment outweigh, they felt,  any active management. How times change. Now the guidelines are to

  1. Offer evidence-based decisional support to men considering whether or not to have a PSA test, including the opportunity to discuss the benefits and harms of PSA testing before making the decision.
  2. For men at average risk of prostate cancer who have been informed of the benefits and harms of testing and who decide to undergo regular testing for prostate cancer, offer PSA testing every 2 years from age 50 to age 69, and offer further investigation if total PSA is greater than 3.0 ng/mL.

Compare and contrast the attitude here to that for women. Several factors weigh in the men are older, The cancer is internal rather than external so harder to get at. The operation has functional rather than cosmetic consequences..

I am an interventionist, I believe that the test itself is easy to do, compared to a mammogram and the results are easier to interpret. The follow up for a positive result is just as traumatic with the biopsy and examination being more difficult. I find it hard to square the idea of watching known cancer if presumed low risk and would prefer the idea of some treatment earlier rather than later.  Of great interest are 3 concepts. One that with a low PSA < 1.0 at 40 and at 60 YO ones risk of cancer is almost negligible [less tests one good outcome. Secondly that if the blood test is going up but there is no lump felt an MRI of the prostate can be done to give complete visualization of it and guide management better.

Choice of procedure Robotic surgery or radiation or both. With apologies to the surgeon who has done all the work Radiation would be a preferred option, just. The upside is that any local spread should get knocked off. secondly the side effects are broadly similar. Prostate cancer is particularly prevalent in the Shepparton area and perhaps a study should be done by our local hospital on the actual incidence.

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