No PSA test


Bottom Line


The United States Preventive Services Task Force (USPSTF) has prepared a draft recommendation against prostate-specific antigen (PSA)-based screening for prostate cancer. While not binding, primary care doctors usually follow USPTF guideline. Insurance companies have already begun discussions about ceasing psa test coverage.


The U.S. Preventive Services Task Force (USPSTF) is an panel of experts in primary care and prevention that  reviews the evidence of effectiveness and develops recommendations for clinical preventive services.


My take on this


PSA is an imperfect blood test that increases for a variety of non-malignant reasons: infection of the prostate, recent ejaculation, enlarged prostate and digital rectal prostate exam before blood test.


PSA is poorly sensitive and specific to prostate cancer and often leads to excess unnecessary worry for men before prostate cancer diagnosis and after prostate cancer treatment.


The problem is that this is all we have right now. PSA kinetics, that is, how fast PSA increase or decreases within time, is a major contributor in the total prostate cancer picture. In addition, a single PSA value may not linked to cancer. Another words, a 52-year-old man with a PSA of 7.2 ng/ml may have no cancer in their prostate.


However, if a single PSA score is above 10ng/ml that may be more indicative of malignant disease and further testing should proceed.


It is also disturbing that the USPSTF consist of primary care physician’s who rarely are confronted with having the challenge of diagnosing and saving the lives of men with prostate cancer.


As imperfect as this blood test is, it saves lives and it should be one of several factors used to determine if a man has prostate cancer and the proper steps that proceed.

Until a better, less invasive test comes about, PSA along with a properly done physical exam should be part of a responsible prostate health work-up.


Let me know what you think.



In Optimal Health,

Dr. Geo


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