In his 30 years as a physician, Dr. Thomas Pocock has given PSA tests to thousands of men. And he’s not about to stop now, despite a recent report from the U.S. Preventive Services Task Force recommending that doctors stop giving PSA tests to men who have no symptoms of prostate cancer.
Pocock, who practices internal medicine in Glendale, California, said the report “is foolish, shortsighted and doesn’t give a complete picture.” He’s not alone. The draft report has been roundly criticized by urologists and physicians who have routinely given PSA tests to men for decades.
PSA tests measure prostate specific antigen, a protein that circulates in the blood. High or rapidly rising levels of PSA could be a sign of prostate cancer growth. It takes a biopsy to confirm the diagnosis, which can then be followed by surgery, radiation, chemotherapy or hormone therapy. Many doctors also recommend “watchful waiting” for older patients who have slow growing cancers that don’t require immediate treatment.
The Preventive Services Task Force concluded that routine PSA screening of men at any age doesn’t save lives and often does more harm than good. Unnecessary biopsies and treatment can leave men with troubling side effects such as pain, impotence and incontinence. The task force made its recommendation after evaluating two large research studies conducted in Europe and the United States.
But Dr. Pocock says the recommendations “don’t jive with the studies.”
“The studies that they quote only dealt with men in the mid 60’s and onward,” said Pocock. “To blindly say we’re not going to screen anybody for prostate cancer when the studies didn’t even address younger onset prostate cancer I think is misleading. They’re essentially saying any young guy who gets aggressive prostate cancer, well, that’s tough luck.”
Pocock starts screening men in their 30’s for prostate cancer, using rectal exams and PSA tests. Even at that relatively young age, Pocock believes PSA tests are a valuable tool because they tell a doctor what a patient’s “normal” levels are for prostate specific antigen. As the patient ages, increasing PSA levels can be a red flag. But they don’t always mean cancer is present, since infections and prostatitis can also cause PSA levels to rise. Of the thousands of men Pocock has given the PSA test to, only six have been confirmed to have prostate cancer.
“The usual pattern you see in prostate cancer is an exponential rise in the PSA,” said Pocock. “It’ll go up a little bit the first year, more the second year and even more the third year. If you see that exponential rise of PSA doing them yearly, you have a 95 percent plus chance that there’s a prostate cancer in there. And it may take you seven years before you can even prove it on the biopsy.”
Pocock agrees that doctors should take a conservative approach to diagnosis and treatment, since they can result in side effects and complications. But he believes PSA tests should continue to be used liberally as a screening tool that can detect prostate cancer in its early stages.
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