Are 400,000 Men Enough to Prove a PSA Point?


For every 199 men screened for prostate cancer, another life will be saved.

I BELIEVE that men between the age of 55 and 80 benefit from an annual blood test for Prostate Specific Antigen (PSA) to evaluate for the possibility that they have prostate cancer.

I BELIEVE that the mixed messages for and against PSA screening from various panels, experts, and government agencies have resulted in confusion, lower rates of PSA testing, and an increasing number of aggressive prostate cancer cases being diagnosed. It is certainly what I see in our lab.

I HAVE BELIEVED  research studies will confirm my views. Now I think one has.

The medical journal Urology has published a study by Dr. Paul Alpert of the University of California San Francisco School of Medicine. Dr. Alpert dug deep into the electronic medical records of Kaiser Permanente Northern California, a massive healthcare organization to determine whether PSA screening was beneficial.

The records of over 400,000 men seen at Kaiser from 1998 to 2002 were examined. First Dr. Alpert reviewed the records to determine if, and how often, the patients had PSA testing. He then analyzed whether those men were ever diagnosed with prostate cancer, whether they died from their cancer, whether they died from another cause or whether they were still living in 2014.

The study is difficult to read and digest. When I tried to read it on-line the embedded charts were swimming and diving before my eyes. To really dig in I needed to download and print a copy.

Dr. Alpert has given very precise definitions to terms like “Marker PSA,” “Prior PSA” and “PSA Interval.” He has divided the 400,000+ subjects into 42 distinct categories, based on age and time between PSA determinations. Alpert has then applied statistical evaluations to determine how the various categories compared. Still following me?

The results, as encapsulated by Dr. Alpert, show “that yearly PSA screening is beneficial, reducing prostate cancer death by 64% for men aged 55-75,” and that “yearly screening is the interval of choice.” Other calculations in the study demonstrated that for every 199 men screened by a simple PSA blood test another life will be saved. Death from all causes was also reduced in men having yearly PSA screening.

I know not everyone will be convinced. I know that some will claim too many non-aggressive prostate cancers are diagnosed by PSA screening and that some men will be treated by surgery or radiation therapy who would do just fine without it. But urologists are getting better at determining which men really need therapy and which men don’t, and concentrating their treatment efforts on the men who will benefit from it.

So I BELIEVE EVEN MORE STRONGLY. I support annual PSA testing. I support organizations like SEA Blue. I tell my friends and family. And now I am telling YOU. Get screened. Or have your husband, brother, boyfriend or father get screened. 400,000 men can’t be wrong!

The above is the opinion of the author and not necessarily UroPartners LLC.
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Filed under: Health, Prostate Cancer

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