Local Urologist Weighs-in on Controversial Prostate Screening

By Rachel Martin

May 24, 2012 Updated May 24, 2012 at 10:46 PM EDT

FORT WAYNE, Ind. (Indiana’s NewsCenter) – Controversy surrounds a blood test that some doctors say is the best way to detect prostate cancer. The U.S. Preventive Services Task Force says the test does more harm than good.

According to Dr. Donald Urban, 20-30 thousand men die of prostate cancer each year and it is the number one caner-related cause of death for men ages 65-75. Despite the statistics, the task force advises against routine PSA cancer screenings, and urologists across the country strongly disagree.

“With PSA, there’s been a shift towards lower grades, lower stages [of cancer] and we’ve actually seen a decline in mortality in the last decade,” said Dr. Urban. “There’s that indirect evidence that PSA may have had a beneficial impact. Without the PSA, most men were present with a more advanced stage cancer at an older age. At that time it gets managed as a disease that can’t be cured.”

PSA stands for prostate-specific-antigen. It’s a protein produced by the prostate gland. The test measures the level of PSA in the blood. Men with higher PSA levels are more likely to have a form of prostate cancer.

Indiana’s NewsCenter spoke with Dr. Urban, Urologist at Parkview Regional Medical Center. He says even though the PSA screening is more accurate in tracing early signs of cancer, it also traces the forms of prostate cancer that aren’t deadly.

“It’s a test where we can’t say someone automatically has cancer and automatically react to an abnormal blood test. We have to put it in perspective and correlate it to the patient’s circumstances,” he said. “Those circumstances that might give an abnormal blood test could include an enlarged prostate, or a prostate that has an infection or inflammation, or one that’s been traumatized by bike riding.”

As a result, many patients receive treatment that can include needle biopsies. The task force says the problem is those treatments can cause impotence or incontinence.

“If the cancer needs to be treated for a cure, then sometimes that’s an acceptable trade-off,” he said. But Dr. Urban says there are many forms of prostate cancer, some of which are not deadly and men can live with. He says the main issue is over-diagnosis and over-treatment.

“Subjecting men to treatment that has quality of life effects that are permanent or, for sure, life changing--life changing quality effects that men have to live with for the rest of their life, perhaps not having needed the surgery if it was not a cancer that impacted them.”

Dr. Urban says other ways of testing are by a rectal exam or ultra sound, but those screenings are about 3 percent accurate, compared to 33 percent accuracy from the PSA.

U.S. task force members claim they’re not against PSA testing, they just don't recommend it become routine. The task force advises doctors to explain the pros and cons to patients before administering the test, and suggest only African-American men and those with a history of the disease in their family undergo PSA regularly.

Dr. Urban says he supports the blood test because of its accuracy, but would like to see a new test that is able to distinguish between deadly forms of prostate cancer, and other forms.

“The ideal screening test would be a test that’s abnormal only when there’s cancer and would detect, 100 percent of the time, clinically significant cancers that have treated would be cured,” he said. “Unfortunately there are very few ideal screening tests for any cancer.”




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