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When Should PSA Testing be Done?
Prostate specific antigen (PSA) is a chemical produced in the prostate gland. It may increase as a result of inflammation, of enlargement of the gland, or because cancer is present. The most common recommendation regarding PSA screening tests is that they be done annually on men between the ages of 50 and 70.
PSA screening in older men is problematic. While the blood test costs $45 on average, a recent analysis found that the true average cost of prostate screening is closer to $1500 when extra office visits, imaging tests, and biopsy costs are considered. (Report presented at the American Urological Association Annual Scientific Assembly, May 2011.)
The question of whether or not to treat prostate cancer if it is found by a PSA test does not have a definitive answer. The overwhelming majority of men with prostate cancer will die of a different cause, and had they not been screened and found to have an elevated PSA they would never have known that the cancer was present. Some estimates have suggested that 50 men must be aggressively treated for asymptomatic prostate cancer (found by PSA screening) to save 1 from dying from the disease. Unfortunately, there is currently no good way to identify which men will benefit from the treatment.
For years I have argued that PSA testing should be done on younger men – those in their 30s and 40s, when it is still possible to intervene and reverse cancer development. The reason is that it has been demonstrated that a PSA test result of 1.0 or greater always represents inflammation in the gland. (Some studies have shown that levels above 0.7 are associated with inflammation.) Since inflammation is the first phase of cancer development, PSA tests in young men should be able to alert them of the need to make lifestyle changes that will reduce inflammation and stop it from progressing to prostate cancer.
This May, a study confirming my position was presented. (American Urological Association (AUA) 2011 Annual Scientific Meeting. Abstract986. Presented May 16, 2011.) Researchers analyzed blood samples drawn between 1974 and 1986 from over 20,000 Swedish men to determine their PSA level at the time the blood was drawn. They then cross-referenced the results to the Swedish Cancer Registry and found that 241 had developed metastatic prostate cancer and that 163 had died of the disease. While only 10 % of the blood samples tested showed PSA levels above 1.5, they account for 50 % of the prostate cancer deaths.
Unfortunately, the researchers are not thinking about prevention, but rather about how to determine which men should continue to be screened regularly for prostate cancer. This is tragic, for I am certain that preventive measures could be taken to reverse pre-cancerous changes in the prostate. These would include instituting an anti-inflammatory diet (1/3 of each meal made up of a protein food approximately the size of the palm of one’s hand with the other 2/3 consisting of fruits and vegetables with a dash of olive oil), supplementation of omega-3 fatty acids and resveratrol, and avoidance of activities that might inflame the gland (e.g. sitting on a hard bicycle seat). We possess the tools and knowledge to prevent prostate cancer. I hope that one day physicians, insurers, and politicians in the U.S. will adopt a preventive strategy rather than remaining locked into an early detection and treatment mode.
Dale Peterson, M.D.