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September 2012: Understanding Prostate Cancer Screening and the PSA “Controversy”

30 Aug 2012

Dr. Vishal Bhalani is a urologist at Vanguard Weiss Memorial Hospital. He completed his residency training at Northwestern University. His areas of expertise include robotics and minimally invasive urologic surgery. Additional areas of interest include erectile dysfunction, urethral reconstruction and laser prostate treatments.

Vishal Bhalani, M.D.
Urologist
Vanguard Medical Group
Weiss Memorial Hospital
Phone: (773) 564-5355

Each year, over 30,000 men will die from prostate cancer in the United States. Prostate cancer is the most common non-skin cancer in men in the United States, and it is the second leading cause of cancer death in men. It is estimated that one in six men will be diagnosed with prostate cancer during his lifetime, with African-American men facing a one in three chance of being diagnosed.

In May 2012, the United States Preventative Services Task Force (USPSTF) issued final recommendations discouraging the use of the PSA (prostate-specific antigen) test for all men. This announcement caused quite a stir in the media, as well as the medical community. The USPSTF discourages the use of the PSA test because of the risk of anxiety over "false-positives" that may lead to unnecessary follow up tests and procedures, as well as harmful side-effects caused by over treatment.

Currently, however, the PSA test is the most widely available means by which physicians can test for prostate cancer. Prior to PSA, prostate cancer was detected either by a nodule felt on digital rectal exam or because a patient developed symptoms of advanced cancer. These palpable or symptomatic tumors were usually high grade, and often lethal. The PSA test gives the medical community the ability to diagnose prostate cancer at its earliest stages – while it is still confined to the prostate (localized) and has not spread (metastatic). 

Why is early detection important?
Data from the Surveillance, Epidemiology and End Results (SEER) Registry shows that since PSA was introduced, there has been a 75 percent reduction in the number of men with metastatic prostate cancer and a 42 percent reduction in death from prostate cancer. This early detection is important because the relative survival at 10 years for a patient with localized prostate cancer is 72 percent compared to 3 percent for a patient with metastatic disease.

What about over-diagnosis and overtreatment?
In order to be effective and to minimize the risks of over-diagnosis and overtreatment, prostate cancer testing must be individualized based on a man’s risk factors. Not all men who meet the criteria for prostate biopsy following PSA testing actually undergo the procedure. The decision to biopsy is based on a number of factors including:

  • Age
  • Family history
  • Ethnicity
  • Prior biopsy history
  • Co-morbidities (other disease/disorder/complication present)

Furthermore, not all men who undergo biopsy and are diagnosed with prostate cancer actually receive treatment. It is true that most prostate cancers are low-grade and slow-growing; however, the problem is that the level of the PSA does not always reflect the cancer’s aggressiveness. A prostate biopsy which will assess the Gleason grade, an evaluation tool used to determine the grade of the cancer based on its microscopic appearance, is the only way to know how advanced the tumors  have become.

The bottom line is that, in order to achieve the best possible outcome, prostate cancer needs to be found while it is still at a treatable stage. We cannot treat that which we do not know exists; the only way to know if the cancer does indeed exist is through the use of the PSA test.

For more information
To learn more about prostate cancer screening, diagnosis or treatment, please contact Dr. Bhalani at (773) 564-5355 to schedule an appointment. 

In honor of Prostate Awareness Month, Dr. Bhalani will also be giving two lectures at Vanguard Weiss Memorial Hospital:

• Learning Café, Tuesday, September 18, 11:30 a.m. (lunch provided)
• Learning Café, Thursday, September 20, 6 p.m. (dinner provided)

Please call (800) 503-1234 or Contact Us if you would like more information or to reserve a seat at either presentation.