Apr. 7--Prostate cancer screening in the La Crosse area hasn't changed much in the month since the American Cancer Society further discouraged routine screening.
Patients and physicians still are paying attention to the PSA blood test despite the fact that the cancer society warned of its limitations. Area doctors say they already knew the test's limitations.
The recommendations probably will lead to fewer annual routine prostate screenings but won't change physician practices.
"Screening probably won't need to be done every year, but it still should be done often after age 50," said Dr. Kiernan Minehan, a Franciscan Skemp radiology cancer specialist who treats patients for prostate cancer.
Dr. Chris Hofland, a Gundersen Lutheran urologist, said men with a low PSA probably won't need another test for two years. "But I wouldn't wait any longer than that," Hofland said.
Controversy has risen over screening for the prostate-specific antigen (PSA) because it is not cancer-specific. Further, once cancer is diagnosed, it is still very difficult in some patients to differentiate between the slow-growing and very aggressive, potentially lethal, varieties of prostate cancer.
American men have long been urged to have prostate cancer screenings, but over time studies have suggested that most cancers found are so slow-growing that most men could have avoided treatment.
The treatments can lead to incontinence or impotence.
Prostate cancer is the most common non-skin cancer in American men. An estimated 192,000 new cases and 27,000 deaths from it occurred last year in the United States. The American Cancer Society recently called for more reasoned discussion that empowers patients and their physicians and improves patients' understanding of PSA data, prostate cancer and treatment options.
"There is the danger of over-treating patients, but we don't want to miss a cancer that kills a young guy either," Minehan said.
Minehan and Gundersen Lutheran urologists still agree that all men should have a baseline PSA test at age 40.
"It's still important to find out what is normal, and a baseline will tell us more information down the road," Minehan said.
Gundersen Lutheran guidelines recommend that men older than 50 without symptoms who have a life expectancy of 10 years should be offered the PSA test and a digital rectal exam every year.
"The goal here is to detect prostate cancer early, and the PSA is pretty reliable," Hofland said. "The question is what do you do with the test results, carefully watch or treat."
Hofland said a digital rectal exam will be abnormal in 5 percent of patients who have normal PSA tests.
Minehan and Hofland said PSA velocity, or rate of change in PSA over time, increases more rapidly in men with prostate cancer. "We want to pay attention to the PSA levels that quickly go up," Hofland said.
Hofland said PSA screening has resulted in some over-detection and over-treatment of prostate cancer. Recent studies show men's lifetime risk of getting prostate cancer is 16 percent, but the lifetime risk of dying from it is less than 4 percent. Still, 90 percent of men choose some form of treatment, Hofland said.
"The problem is that at this time there is no accepted definition of clinically significant or insignificant prostate cancer," Hofland said. "The difficulty lies in trying to discern which prostate cancers are destined to cause significant illness and premature death from those that are not."
Hofland said future tests, which may include DNA testing, could provide more specific information that could make the distinction clearer.
The new cancer society guidelines say evidence indicates periodic screening can save lives but that there are significant uncertainties about the overall value of finding prostate cancer early.
Minehan said before PSA was regularly used in the late 1980s, one-third of patients had localized positive lymph nodes and and two-thirds had advanced prostate disease.
Since PSA testing was introduced, prostate cancer deaths have declined by 30 percent, and fewer patients have advanced disease, Minehan said.
"I think you could argue there is something to better screening, and it has been suggested that the PSA played a role," Minehan said. "I'd hate to throw the baby out with the bathwater. Perhaps we're over-treating but we're also catching cancer earlier."
Minehan said patients should thoroughly discuss screening and treatment options with their physicians.
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