New guidelines individualize prostate test results
About 75 percent of men who undergo prostate-specific antigen testing end up with a false positive result, according to the National Cancer Institute.
To address this, the U.S. Preventive Services Task Force made a change to screening guidelines, said Dr. Glenn T. Bloiso, a urologist with UPMC Susquehanna.
“False positive tests, because of these efforts, are going to drop in the U.S., and less men are going to undergo treatment they don’t need,” Bloiso said.
Prostate cancer is one of the most common cancers in men, second only to skin cancer, according to the American Cancer Society. The prostate is a gland found only in men that develops a fluid found in semen.
Prostate-specific antigens are proteins made by the prostate that can tip doctors off to that gland’s health. Tests using this “powerful tool” for detecting early prostate cancer became popular in 1985, Bloiso said, and the cancer’s mortality rate in the United States has dropped by about 40 percent since then.
“More men are going to live with prostate cancer than die with it,” Bloiso said.
While the tests have been crucial in lowering mortality rates, he said, the problem lies in how sensitive they are — something as simple as a urinary tract infection could cause an elevated protein count, leading to a false positive result.
Also, some of the cancers it may detect don’t need to be treated, Bloiso added.
A man with test results below a 2.5 are usually asked to test every two years; results between 2.5 and 4 may require annual testing; and levels over 4 often call for further evaluation, Bloiso said.
“You don’t rush to treatment,” he said, adding doctors will initiate active surveillance. “You could always intervene if the disease shows progression.”
Testing used to be recommended to the entirety of the older male population but the regulation change, made in April, allows doctors to screen their patients.
“It really needs to be geared toward the individual,” he said.
Now men between the ages of about 50 and 70 who are healthy and expected to live for at least another 10 years are typically the ones doctors recommend be tested.
Bloiso said this is because prostate cancer progresses slowly and is asymptomatic (or without symptoms) in its early stages, so men over the age of 70 are unlikely to be affected by it whereas undergoing treatment would severely lower their quality of life.
“There is absolutely no value for a man in his 80s to get this test,” he said.
Testing may be recommended by a physician during a regular doctors visit, or the patient might ask for it instead.
“It should be a conversation physicians and patients have on an annual basis,” Bloiso said.
By catching prostate cancer early, doctors can test further to verify the need for treatment. And earlier treatment can prevent the cancer from becoming metastatic, or spreading beyond the prostate.
When prostate cancer becomes metastatic, it can affect the urinary tract, causing urinary incontinence by blocking the urethra or in other ways. It can block the ureters, which carry urine from the kidneys to the bladder. It can even reach the spinal chord and enter the bone marrow, which can be extremely painful, Bloiso said. If the cancer metastasizes, “cure is necessary but, more often than not, it’s not possible because we missed the boat.
That’s the reason for early detection — to eradicate those morbidities,” he said.