Prostate Cancer Testing
Nor everyone agrees with the usefulness of PSA. A publication in the Journal of Urology (v 172, p1297, 2004) by the original discoverer of PSA, challenges the whole notion of using PSA tests. Dr. Thomas Stamey and co-researchers examined a total of 1,317 radical prostatectomies (removal of the prostate) between August 1983 and July 2003. Each removed prostate was screened by a pathologist to determine the largest cancer volume as well as other cancer-related parameters. Consider the four 5-year periods between 1983 to 2003 - in the first period (1983-1987)the pathologist found conspicuous nodules of cancer in 91% of the removed prostates, the mean PSA was 25 ng/ml, and the largest cancer volume was 5.3 cc. In the last period (1998-2003) only 7% of the removed prostates had such nodules, the mean serum PSA was 8, and the largest cancer was 2.4 cc. In the first period, 6 histological cancer parameters were correlated with the PSA level. In the last - PSA was related only to the prostate size!
What this means is that in recent years, a large number of prostates with very small cancers are being removed, just because the PSA is above a specific limit. This cause numerous cases of impotence and incontinence to decrease the risk of prostate cancer, that to begin with was very low. Most of these cancers would not be fatal, since they develop very slowly. These conclusions agree with the previous studies we have reviewed - only those cases associated with a rapidly rising PSA are strongly correlated with the more rapidly developing cancer that needs immediate attention; a "wait and see" approach should be adequate for the others, providing many more years of quality sexual and urinary functions. For additional information we refer you to the Medscape interview with Dr. Stamey.