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Prostate blood test triggers debate

A blood test that checks for signs of prostate cancer has triggered a medical debate:

How valuable and advisable are the tests, and when should men start using them?

The “party line” for a so-called PSA test is once a year, starting at age 50, said Dr. Jeffrey Fegan, a Glenwood Springs urologist.



But some believe a test as early as age 40 is wise, he said.

The chestnut-sized prostate gland, part of the male reproductive system, is located just below the bladder. It produces the fluid that combines with sperm to form semen.



Screening for any disease can be a bit controversial, due to the difficulty of proving how many lives it saves compared to the cost of the test, Fegan said.

And because prostate cancer is a common ailment in older men, there’s a good chance they’ll die of something else even if they have the disease.

“The saying goes, `If you live long enough, you’re going to get prostate cancer,’ and that’s probably true,” Fegan said.

Studies of men who died from other causes show nearly half in their 50s had some evidence of prostate cancer, growing to 60 percent of men in their 60s, and 70 percent of men in their 70s.

Prostate cancer kills only 3 percent of men a year, although the rate climbs among older men. Many older men with microscopic evidence of prostate cancer are not going to be bothered by it, because it grows so slowly, Fegan said.

Younger men, however, stand a good chance of living long enough for it to grow into a problem, and younger men often get a more aggressive variety of the cancer.

Fegan said the youngest prostate cancer victim he has treated was 38. It is fairly rare for him to see patients in their 40s, but there’s a big jump in the number of patients in their 50s.

More prostate cancer was detected in the 1990s with increased use of the prostate specific antigen (PSA) blood test. That increase peaked in the late 1990s.

Some studies hold that the test often finds tumors so small and slow-growing they aren’t likely to do any harm, whereas dangerous tumors are likely to cause symptoms that would reveal the cancer without the need for a test. Others suggest a higher survival rate due to screening.

The debate is important because test findings can prompt expensive treatments with potentially serious side effects, including incontinence and impotence, and these treatments may or may not have been necessary.

“We do our best to try to figure out which cases are aggressive and which are not,” Fegan said.

It’s a bit of a guessing game; in one case a man underwent treatment, then died of a heart attack a year later.

Still, Fegan favors widespread screening.

“Nobody argues against mammograms, but men are playing catchup with their prostate,” he said.

Thanks to earlier screening and aggressive treatment where it appears warranted, younger men are getting cured, he said.

“We must be making a difference in a lot of lives. We must be saving a lot of them.”

At a recent prostate cancer conference, Fegan said experts suggest men get their first PSA test at age 40, again at 45 and 50, and every other year after that. This would set a baseline PSA level to monitor. The goal is to increase diagnosis among those under 50 and reduce costs with fewer screenings after 50.

Prostate cancer often shows no symptoms, so screening can make a difference. It is often curable when it remains localized, but poses the danger of spreading to a man’s bones, Fegan said.

While most prostate cancer can be detected with a PSA test, some forms of the cancer don’t produce the antigen that the test measures. As a result, men should also undergo a digital rectal exam, Fegan said.

When tests suggest a problem, a biopsy can be done to better diagnose the extent of the cancer.

Fegan said younger men are more likely than older ones to be encouraged to undergo aggressive treatment, which generally means surgery. The decision is a big one, given the possible side effects.

“But versus dying from cancer, that’s a risk they ought to be willing to take,” he said.

Radiation, another treatment option, can have the same side effects as surgery, and can injure the rectum and bladder, Fegan said. But he said it can have good results against the cancer, and the procedure has been improving in terms of reducing side effects.

Typically, insurance covers the cost of an annual PSA test, which is less than $100, said Fegan.

Fegan, 45, practices what he preaches.

“Sure have,” he said when asked if he’s been tested.

His father had prostate cancer surgery at age 57, and 10 years later is cancer-free. Fegan is considered to have a higher risk of prostate cancer due to his father’s medical history, so he had his first test at 40.


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