PSA still best test to keep prostate cancer curable
When it comes to the subject of prostate health, Gary McIntire is more than willing to talk turkey.
The 65-year-old Upper Strasburg, Pennsylvania, turkey grower wants men to know that the prostate-specific antigen (PSA) test is only one tool to fight cancer.
"Every year since I was 57, the doctor would look at my score and say it was fine," McIntire says.
Four years ago during treatment for kidney stones, a local urologist, Louis Glass, noticed an abnormality during a digital rectal exam (DRE).
McIntire's PSA score of less than 1 didn't indicate the need for a biopsy. But he and his wife, Edwina, decided to proceed. The results were positive for cancer. His Gleason (a common cancer-grading scale) score was 6, indicating that there was a moderately aggressive tumor.
McIntire had surgery at The Johns Hopkins Hospital, where Dr. Patrick C. Walsh originated a nerve-sparing technique 20 years ago. "My surgeon, Dr. Jonathon Jarow, said in his 15 years there, he had never seen a patient with a PSA score of less than 1 who had cancer," McIntire says.
McIntire's experience is reinforced by a recent study in the New England Journal of Medicine. It showed that 15% of men with very low PSA levels (less than 4) who underwent a biopsy had cancer; of these men, 15% had worrisome Gleason scores of 7 or higher.
PSA tests were introduced in the 1980s. One drawback is that any prostate disease -- infection, benign enlargement, cancer -- causes PSA levels to rise. A biopsy is required to make the diagnosis.
"We need a better biomarker for prostate cancer, no doubt about it," says Richard Atkins, National Prostate Cancer Coalition CEO. "It will take research to find it. In the meantime, we need to use the PSA with appropriate follow-up measures to diagnose prostate cancer."
It also reinforces the importance of a DRE to screen for cancer. Yet a 2004 study in the Archives of Internal Medicine indicated that only 47% of men who had PSA tests had a DRE.
Changes over time in PSA scores may be the most valuable tool for interpreting PSA. Recent research indicates that a rapid increase in PSA levels may signal a life-threatening form of prostate cancer. The study suggests getting a first PSA test at age 40 to use as a baseline.
For men with low PSA levels (between 1 and 3), a new study shows increases as small as 0.2 nanogram per milliliter a year were cause for concern.
About 234,000 U.S. men will be diagnosed with prostate cancer this year. As many as 27,000 of them will die. Age, race, and family history remain the three greatest risk factors.
The good news is that prostate cancer death rates have dropped 32.5% in the past decade, possibly as a result of the dramatic increase in early detection.
"When caught early, prostate cancer has a 99% survival rate," Atkins says. "But only about half of all men at risk for prostate cancer get screened annually."
If prostate cancer has spread, the five-year survival rate is 34%. McIntire is a survivor who believes sharing his experience will save lives. "I want to get the word out that a 'normal' PSA score is a relative term," he says. "Don't avoid rectal exams. Do your own research and seek out second opinions."