In most types of cancer, advanced cases or stages are more difficult to treat, and cure rates are lower. As of this date, the rate of prostate cancer diagnoses at an advanced stage has increased by 4-5% since 2011. If this continues, it is expected that death rates will increase as time passes. The cause and effect? Advanced prostate cancer diagnoses rising as PSA screening declines.
The First Problem—The PSA Blood Test
There are really no early signs of prostate cancer. That is why screenings have always been recommended at certain intervals during a man’s life. Men are screened via the PSA blood test and a DRE test.
Problems encountered with PSA tests are as follows:
- There are many false positives and false negatives.
- Prostate cancer is very slow growing.
- Tests can lead to overtreatment.
- Overtreatment leads to complications like ED and incontinence.
- Screening does not provide a diagnosis.
- It is a prostate specific blood test but not prostate cancer specific.
The PSA blood test only tells doctors if there is a non-cancerous protein in the blood which affects the prostate. The higher than normal number could mean anything affecting the prostate. This could easily be BPH or an enlarged prostate, which occurs as men age.
The other test to diagnose prostate cancer is a DRE, or a digital rectal exam, performed by Dr. Mercado in the office setting. This test looks for a lump or hard place on the prostate.
Second Problem—Pendulum Swings Too Far
For a little over a decade researchers have de-emphasized the PSA test in order to reduce overdiagnosis and overtreatment of men with low grade prostate cancer.
In 2012 there was a halt in recommending all men be screened with a PSA test. The US Preventive Services Task Force concluded the benefits of the test did not outweigh the risks.
Then in 2018, the USPSTF amended its decision in 2012 to include a shared decision between patients aged 59 to 66 and their physician. This was hailed by many urology groups and many practicing physicians who still feel this is the proper way to handle screenings.
Today we are reaping what studies and recommendations have sown. It’s not all good news.
Changing the protocol on PSA screenings has led to an increase in prostate cancers which have metastasized to other parts of the body. They weren’t diagnosed in their early stages, which impacts the possibility to cure.
The American Cancer Society now recommends that after a one-on-one discussion between a patient and urologist like Dr. Mercado, and weighing the merits of early screening, a baseline of PSA and DRE should be obtained by age 45. The exception can be for African Americans and those who have a family history and have a higher risk, as they are recommended for earlier screening.