RESOLVING THE PSA SCREENING DEBATE
To screen, or not to screen? If Hamlet were alive and over 40, he might be asking this question about having his PSA (prostate specific antigen) level screened. After decades of encouraging men over 40 to have an annual PSA blood test, both patients and their doctors now face a polarized debate. That's because recently the U.S. Preventive Services Task Force made front page news by recommending that healthy men of all ages avoid routine PSA screening for prostate cancer.
Since the early 1990s, the death rate for prostate cancer has dropped significantly, possibly due to improvements in early detection and treatment. However, new data suggests that PSA screening is not worthwhile, except for cases with known risk factors. Why? The latest studies throw doubt on the claim that wide screening statistically adds a lifesaving advantage. Additionally their is concern that an elevated PSA can result in unnecessary testing, like a prostate biopsy.
As I see it, there are three problems with a conventional prostate biopsy performed on the heels of an elevated PSA:
1) The elevation may be due to something else besides cancer, so rushing to biopsy is costly and raises anxiety.all for nothing.
2) The conventional transrectal, ultrasound-guided biopsy.which obtains 10-14 core tissue samples.may result in false negatives or false positives, since ultrasound guidance alone lacks sufficient fidelity to locate small tumors and target biopsy needles into them.
3) Without sophisticated analysis of cancer cells (if found) to distinguish the slow-growing from the aggressive, a radical (whole gland) treatment may be overkill with damaging side effects.
In my practice, I offer an advanced approach to a biopsy that takes the guesswork out of an elevated PSA. My approach fuses a prostate MRI and Ultrasound image to help confirm if a biopsy is necessary, and if so, to selectively target the biopsy to areas of potential cancer. Furthermore, if a tissue sample is positive for prostate cancer, I use the most sophisticated analysis to help determine if active surveillance or treatment is the best course of care.
If treatment is warranted my goal is tailor the treatment to achieve the highest degree of cancer destruction while retaining the highest quality of life. To achieve this goal I offer state-of-the-art outpatient, targeted tumor ablation (destruction) treatments, like Cryotherapy and HIFU, that use minimal-to-noninvasive image-guided technologies. Depending on the size and location of a tumor,these treatments can spare both continence and potency while destroying the known cancer and keeping all future options open should cancer recur.
In my view, we should stop the debate around PSA screening and move ahead with an advanced approach to diagnosing prostate cancer along with minimally invasive targeted treatments.