New Options for Prostate Cancer Screening

Prostate-specific antigen or "PSA" is a blood test that screens for the level of a protein in the blood that can indicate prostate cancer. For many years, it has been the only screening tool for prostate cancer.

According to the Centers of Disease Control, approximately 30 million PSA screenings are done every year, and about 1.5 million of the screenings are found to be abnormal. Of the one million men who undergo a biopsy due to an abnormal PSA test, 250,000 are diagnosed with prostate cancer. This means that three of four men with an increased PSA are found to be negative for cancer after biopsy.

The American Urological Association (AUA) released its new clinical guidelines on prostate cancer screening in 2013, creating a stir of questions by patients. The panel decided that, from a public health perspective, the current strategy of PSA-based screening that measures the level of enzyme in the prostate provided highly rates of over-diagnosis, needless biopsies and over-treatment.

"We still believe the PSA test is standard ", says Dr. Alan Partin, M.D., Ph.D., chairman, professor and urologist-in-chief of the Department of Urology at the James Buchanan Brady Urological Institute at the Johns Hopkins Hospital. "However, in the past, when a elevated PSA was found and the biopsy was negative, we would routinely biopsy again. Today, due in part to research Johns Hopkins participated in, we can offer new tests: the Prostate Health Index (PHI) blood test and PCA3 urine test. As these tests become more widely available, urologists will be able to follow those 750,000 men each year and avoid performing some additional biopsies."

Marc Applestein, M.D, a urologist on staff at HCGH notes that, "These new tests will offer men new options. PHI testing will be more available soon and, at present, neither PHI nor PCA3 test are covered by insurance. There is still debate and a lack of consensus about recommendation for men about screening. Men should discuss their family history and when to start PSA testing as well as what new testing options are available with their urologists."


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