Prostate Cancer is the most common cancer in men. It can occur at almost any stage in the adult and is most common in elderly men. Most PCa are indolent, not resulting in death. Yet some are highly aggressive and result in death in a horrific manner. Unfortunately one does not have means to differentiate well.
The PSA test is one simple test that can help. Yet a single PSA sample may be useless. In addition free PSA is also required. Then using time gathered PSA and free PSA can be dispositive in many cases.
Yet many want to eliminate PSA altogether. We have seen since the USPSTF suggested this a decade ago PCa deaths skyrocketed. Perhaps it tells something. Now we have another group:
A new strategy proposed by an international team of experts would limit the use of the prostate-specific antigen (PSA) test for screening tor prostate cancer to men who are younger than 70 years and who are at high risk or symptomatic. This would reduce potential harms from overdiagnosis and overtreatment, the risk for which is high with the on-demand screening that is the current standard of care in most wealthy nations. In a paper published online on May 17 in the BMJ, the panel recommends instead a comprehensive nationwide program that would base PSA testing on individual patient risk and direct those with abnormal results to a managed system of imaging, targeted biopsy only if indicated, and subsequent active monitoring or treatment for those with more aggressive disease features. Alternatively, government health programs could actively discourage widespread PSA testing and implement policies that would effectively limit PSA-based screening only to men with urologic symptoms warranting further exploration, say the authors, led by Andrew Vickers, PhD, a research epidemiologist at Memorial Sloan Kettering Cancer Center in New York, New York.
In my opinion and in my experience, this is grossly wrong. Gathering and comparing temporal data on PSA and free PSA is a highly useful tool. If necessary follow this up with MRI before invasive. Yet even MRI has problems if there were previous biopsies since scar tissue from the previuos tests may appear as lesions with diffusion analysis.
Ultimately a biopsy is needed. Yet even then we know that the Gleason biopsy is almost lower than the biopsy after prostatecomy. That is always the challenge. Namely an one get better results from tests looking for markers?
PCa treatment is about thirty years behind that of breast cancer. Men just die off I guess.
Posts
