No one likes going for that annual physical exam. For many, the anxiety
increases when it includes a cancer screening.
For men, that fear can go up a notch when their exam includes a PSA -- the
screening for prostate cancer. While once believed to revolutionize the
diagnosis of this disease, today the PSA is at the center of debate, frequently
charged with leading to unnecessary treatment as well as causing unnecessary
Four years ago, Santa gave me the worst Christmas present I'd ever received.
The day after the most joyous holiday of the year, my doctor called and
delivered the news that I had prostate cancer.
Because my dad had prostate cancer decades before, I had been going to a
urologist since I turned 40 to have a PSA [prostate-specific antigen test].
Recently, my PSA had shot up very high, to 29, and the following biopsy
confirmed that I had a highly aggressive tumor. At 50 years old, I faced the
"It's a controversial arena -- the PSA is a marker of prostate bulk and
size, but it's highly expressed in benign prostate disease as well as cancer --
so in that context it's not a specific marker," says prostate cancer
researcher Arul Chinnaiyan, MD, PhD, the S.P. Hicks Collegiate Professor of
Pathology at the at the University of Michigan Medical School.
As a result, he says, a PSA score can not only frighten a man unnecessarily,
but also lead to overtreatment -- including unnecessary biopsy and even
"[The PSA] is responsible for hundreds if not thousands of unwarranted
biopsies a year, and ultimately overtreatment of incidental [cancers],"
Moreover, a recent study from the Yale School of Medicine and the VA
Connecticut Healthcare System found no evidence that a PSA screening could
improve the survival rates of men diagnosed with prostate cancer -- leading
many to wonder if the test is even necessary at all.
At the same time, however, prostate specialists like NYU's Herbert Lepor,
MD, remind us that not having this test can mean missing an early prostate
cancer, and ultimately losing your life.
"People forget that you can die from this disease. Prostate cancer can
kill you and right now the PSA is an important way to determine what your risk
of dying of prostate cancer is, and hopefully allow you to take steps to reduce
that risk," says Lepor, chairman of urology and professor at the NYU School
of Medicine in New York.
Indeed, new statistics released by the American Cancer Society (ACS) show
that the rate of death from all cancers has declined, suggesting that better
screening tools is one reason, particularly in the case of prostate cancer.
And while Lepor acknowledges that sometimes the PSA does lead to an
unnecessary biopsy -- and even unnecessary surgery -- still, he says, it's not
a screening a man should routinely ignore.
"What you ultimately end up with here is the risk of overtreatment
versus the risks of dying from prostate cancer," says Lepor, "and I
think most men would rather not die."
Understanding Prostate Cancer and the PSA Exam
The prostate gland is a small walnut-sized organ that sits in a man's
pelvis, right behind the pubic bone. The bladder lies just on top; the rectum,
just below. The urethra, the tube that carries urine out of the body, runs
through the prostate gland, and on either side is a network of nerves that help
control sexual function.