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Khoddami: PSA test helps prostate cancer survival rates soar

With skin cancer ranking as the leading cause of cancer deaths among men in the United States, wearing sunscreen is wise medical advice.

For American men age 50 and older, getting a Prostate-Specific Antigen screening — commonly called a PSA test — is equally imperative because prostate cancer ranks second among cancers in male mortality. Indeed, according to the National Cancer Institute, in 2010 there were 217,730 new cases of prostate cancer with 32,050 deaths in the U.S.

The good news is that the mortality rate of prostate cancer has steadily declined almost 50 percent over the past 10 years — deaths in 2001 numbered approximately 45,000 — and one major factor is PSA testing and digital rectal examination.

Unfortunately, the benefits of PSA testing came under question in 2009 when the New England Journal of Medicine published results from a prostate, lung, colon, and ovarian study showing over a period of seven to 10 years that screening provided no difference in the prostate cancer death rate in men ages 55 and over. Further examination, however, revealed the trial to be flawed because some patients in the nonscreening group actually had PSA testing and were pulled out early to receive treatment.

Also in 2009, the New England Journal of Medicine published results from a second clinical trial by the European Randomized Study of Screening for Prostate Cancer that provided strong evidence that PSA testing can reduce deaths by 20 percent nine years out. This finding is especially important because 16.22 percent of men — roughly one in six men — will be diagnosed with cancer of the prostate during their lifetime.

In addition to increased diagnosis, PSA testing has the potential to lead to overtreatment. The truth is oftentimes prostate cancer does not need to be treated. Indeed, the likelihood of dying of prostate cancer is 3.4 percent with no treatment at all.

Because prostate cancer generally grows very slowly, the majority of men who are diagnosed with it will die of something else long before the symptoms of the cancer catch up with them. On the other hand, when the prostate cancer is an aggressive form, early detection — and, in turn, early treatment — saves lives.

And who should get a PSA screening, which is performed by a simple blood test? The American Cancer Society recommends that all men ages 50 and older get a PSA test annually. (High-risk groups, including African-American men and men with a family history of prostate cancer, may actually want to be tested at age 40.)

As a urologist who sees countless people's lives saved thanks to early detection of prostate cancer, I cannot overstate the importance of getting a PSA screening — and always in conjunction with a digital rectal examination.

The consequences of not detecting prostate cancer early can be horrific. Too often I have tragically witnessed a cancer that was potentially curable instead metastasize and spread through the body, leading to a miserable quality of life before finally taking the life.

Before the PSA test came onto the scene, organ-confined disease (that is, prostate cancer which has not spread) was 35 percent. With PSA screening that figure is now approaching 80 percent. The result is we are seeing fewer deaths from prostate cancer annually.

But statistics don't tell the human story. For instance, I currently am caring for a patient in his early 60s whose prostate cancer has spread. He thought he was in excellent health and never had a PSA test. Early detection could have possibly made all the difference in the world for this man.

Everyone should wear sunscreen and men over age 50 — or 40 if they are high risk — should get an annual PSA test and digital rectal exam.

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