Prostate Cancer and Prostate-Specific Antigen (PSA)
by S. Terry Kraus, M.D.
In 2008 the United States preventative Services Task Force determined that obtaining a PSA did not influence the survival rate. This was done by following the men who did not have PSA versus men who had a PSA. However, the study was flawed. 90% of the men who did not have PSA initially had PSA testing during the study. If they had suspicion of recurrence, as determined by elevated PSAs and perhaps further workup, they were effectively treated. Thus, it was not possible to determine whether the PSA screening reduced prostate cancer deaths.
This is likely comparing “”apples to apples” to find out which “apple is an orange”. Should all men regardless of age not have PSA? I do not believe this is valid. Each and every management should be evaluated in terms of age and coexisting medical conditions.
Dr. Gulati, in the journal Cancer, 2014 did a study on the impact of discontinuing PSA screening. It was determined that a 46% to 57% increase in metastasis and an additional 36,002 to 57,000 prostate cancer deaths could occur.
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