At the end of the American Urological Association conference in Chicago on April 28, its conveners announced that the AUA's year 2000 standard of practice for all men 50 and over to get the PSA test should now be lowered to age 40 and up. This is an overt endorsement of the PSA test, despite its deficiencies, providing patients are likely to live at least another ten years.
It seems to me this reflects the reality that biomarker research advances are still experimental and inconclusive. As such the urologists at the AUA’s spring 2009 meeting in effect concluded that the PSA is still the most reliable test we have. Once the patient’s PSA level is tested, it’s to be determined if a biopsy is warranted, and in turn if some treatment option(s) are called for.
When urging PSA testing at age 40 for all men, and not just those at high risk (such as African Americans or men whose fathers or brothers had prostate cancer), the AUA was careful to point out that men, in conjunction with their urologists, should consider active surveillance as one of several treatment options they might choose.
This new AUA position is a clear endorsement of the PSA test despite the medical dispute that has raged this past month over its value. To me it confirms that not knowing your PSA level is worse than knowing what it is, to be followed by a biopsy (if indicated) and by determining what treatment, if any, is best. In short, if we want to determine that a man might have prostate cancer, we should not contend that “Ignorance is bliss.”
Sure, many men will continue to rush into surgery despite a slow-growing prostate cancer, rather than take a wait and see approach. On the other hand many others will continue to decry PSA, biopsies and surgery or radiation as blatant, costly overtreatment. Such disagreements are inevitable and will continue as long as scientists don’t come up with better alternatives.
Current studies of mice and a few men are insufficient to set aside the PSA test and the digital rectal exam (DRE). What's called for are large-scale, randomized studies of new, proposed biomarkers that are evidence-based and apply to men wherever they live.
It's so confusing for the patient on what to do.
I can see how some men would just throw up their arms and claim ignorance is bliss.
Since many men hate going to the doctor to begin with this is a likely occurrence.
It's too bad... When better diagnostic tools and treatments are available many men may still take this stance.
----Brian
I too will more actively promote active surveillance (aka, watchful waiting or expectant management) once scientists develop the means for determining how quickly a tumor contained within a man's prostate might metastasize to his other organs or bones. Where the likelihood of metastasis is scientifically determined to remain low for a given individual, more invasive approaches including surgery ought to be delayed or permanently avoided. Of course once our medical technology catches up with us, only a doctor can determine that with his or her patient.
----Rabbi Ed
----Rabbi Ed
Posted by: Brian | July 30, 2009 at 04:51 PM