PROSTATE CANCER STUDY
“The initial shock hit me like a ton of bricks.”
Joseph Califano was diagnosed with prostate cancer in spite of the fact his PSA was by current guideline standards, completely normal. PSA is the blood test that detects prostate cancer when elevated. “My PSA was still low, I think the highest it’s ever been was a 1.7,” recalls Joseph.
Now new research adds to the confusion and concern over the diagnosis and treatment of prostate cancer. The research finds that a full 15% of men who have a normal PSA, which is 4 and below, do indeed still have biopsy proven prostate cancer. In those who have a PSA of between 2 and 4, again considered in the normal range, a full one-fourth of men were found to have prostate cancer on biopsy. So the question now is, should we lower what is considered normal to perhaps a PSA of 2, and biopsy and treat men over that number?
Dr. Evan Berger is a medical oncologist who believes, “I don’t think that we ought to take men over 50 and change our normal level of 4 at this point in time. I’m afraid that if we start biopsying men whose PSAs are significantly lower than that, we’re going to come out with a lot of microscopic cancers that the patients are not going to die of.”
Here’s the rub. Sometimes cancer isn’t that bad. It lives in us, and never causes any real problems. Prostate cancer may in fact be one of those cancers. While 15% of men in this study with a normal PSA have prostate cancer, only 3% will die from it.
The study did show that as the PSA number went up from 0 to 4, again all in the normal range, there was in increasing risk that if a cancer was detected, that cancer was more likely to be one that would spread and could actually kill the patient. So this might fuel some argument that biopsies should be done at a lower PSA level, maybe 2 or 3. The researchers believe this is going to be a hot discussion issue.
Right now, the recommendation is for men with a family history of prostate cancer, to get PSA testing and rectal exams starting at an earlier age, 45 rather than 50. And this study shows that even in the normal ranges of PSA, those with a family history are more likely to have prostate cancer. So family history may change the perspective on whether doctors should biopsy men with a family history and a PSA of perhaps 2 to 4, in the high normal range.
So, are we overdiagnosing, and overtreating a disease that doesn’t cause any problems?
And is the treatment which can result in incontinence and impotence, worse than the prostate cancer itself? Dr. Berger says, “We don’t have any cut and dry tests that tell us whom to treat and whom not to treat.”