BEFORE MAKING A DECISION to have a PSA test it is important to first and foremost understand what is the PSA test, why it is done and the advantages and disadvantages of doing such.
PSA (prostate specific antigen) is a protein secreted by prostate cells whether benign or malignant and is present in the urine or the semen, and spills over into the bloodstream.
PSA levels can be measured via a simple blood test. The presence of an elevated or high PSA suggests that either the prostate gland is enlarged or there is some abnormal condition affecting the prostate (inflammation, infection trauma or cancer).
Screening is the use of a test in a population at risk to detect a disease while it is asymptomatic and in its early stages. The purpose of screening is to allow for the early treatment of such disease to prevent complications or death (mortality).
In the case of prostate cancer, screening involves two things: 1) A PSA test and 2) A rectal examination by the doctor to detect any abnormalities in the prostate. If any of these returns abnormal they can be followed by confirmatory test such as a prostate biopsy.
Prostate cancer is the most common male cancer and the most common cause of male cancer death in Barbados. Approximately 100 men die per year from this disease and it poses a significant health problem to the nation. Having said that, there are advantages and disadvantages to screening for prostate cancer. Prostate cancer is more common disease as males advance in age.
All prostate cancers do not behave the same, and not all prostate cancers need be treated aggressively. So the main disadvantage of screening is overdiagnosis, in that a cancer is identified that may not have caused a patient a problem in their lifetime. Overdiagnosis may result in overtreatment and the possible side effects of such treatment (erectile dysfunction and incontinence).
Advantages of screening for prostate cancer include treatment and cure, and thus freedom from complications and mortality from prostate cancer. Having said this, the main controversy regarding prostate cancer screening is the overtreatment of some cancers that may be slow growing and the resultant long-term effects of such treatments.
This controversy has come about in recent times as the result of two large scientific studies (United States and Europe), one of which showed some benefit of screening which the other didn’t.
This data led to some authorities recommending against prostate cancer screening. Now the results of these scientific studies must be taken with a grain of salt – that is, the studies have some flaws in them and also they were not carried out in a representative population as Barbados (a high-risk population).
This further adds to the dilemma of whether to get a PSA test or not. What is very important to consider is the reason for screening is to go on to detect a cancer that would be life-threatening and treat and cure. So it is very important to risk stratify each patient.
What I and most urological associations recommend is that the informed patient who is at a higher risk (age between 40-69, race, family history) based on the individual patient’s risk factors consider having a PSA test and a rectal examination.
For example, a middle aged male whose father died of prostate cancer in his sixties is at obvious increased risk and may very well benefit from early diagnosis and treatment. This is a discussion one should have on a one to one basis with one’s doctor and decide if a PSA test is right for you.
Dr Jeetu Nebhnani, MBBS, DM (Urology), is a consultant urologist and uro-oncology, Queen Elizabeth Hospital, Cariburol Inc.
