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PSA testing: Should men with low-risk of prostate cancer be screened?

Photo for The Union by John Hart
John Hart | The Union

Norman Nielsen is not a statistic.

If the 70-something Nevada City resident was a statistic, he would not have met suggested guidelines to have a Prostate-Specific Antigen (PSA) screening each year because of his age and a new recommendation from the U.S. Preventative Services Task Force against the use of PSA-based test for prostate cancer.

He also would not have known that he had prostate cancer.



But Nielsen feels strongly about the important of an annual physical exam — including a PSA screen. That proactive approach to his health just may have saved Nielsen’s life.

“He’s one of the ones who clearly benefitted from a PSA at 74-75. … A lot of people would not have wanted to screen him,” said Dr. Richard Evans, a radiation oncologist at Sierra Nevada Memorial Hospital’s SNMH Community Cancer Center.




The new recommendations were released earlier this year by the U.S. Preventative Services Task Force, an independent panel of non-Federal experts in prevention and evidence-based medicine, composed of primary care providers, according to its website.

Their stance has unleashed a controversy in the national medical community, added a lot of complexity and confusion for the general public and has the federal government questioning coverage on PSA screening through Medicare.

Prostate cancer is the second leading cause of death among men in the U.S. In 2011, it is estimated that more than 33,000 men died from the disease, Dr. Evans said.

Those most at risk are men with a history of the cancer in their family, African Americans and age.

“The truth of it is, as men get older it’s a more common disease,” he said.

The controversy stems from those men with low-risk prostate cancer, Dr. Evans said.

It’s hard to show that if you treat those patients they will live any longer than if you didn’t, he explained. Experts who made the recommendations raised the issue of putting men through the rigors of cancer treatment, which may do little to nothing to improve their survival.

“We, as physicians, probably erred on the side of caution and probably treated a lot of men we shouldn’t have,” Dr. Evans said.

There are multiple ways for a physician to evaluate whether a man has low, intermediate or high-risk prostate cancer — including the Gleason score, PSA numbers and a digital rectal exam.

Dr. Evans’ believes it’s wrong to abandon the PSA screening. It should be the physicians who look closely at which patients diagnosed with prostate cancer should be treated and which are better left alone.

Pati Stinnet, the SNMH clinical research nurse coordinator agrees that men should continue with PSA screening.

“It’s more about having a baseline to work from and check over time,” Stinnet said.

Nielsen for example, had routine screening and knew what number came in year to year. So when his numbers jumped three times higher this year, both he and doctors knew it was time to retest and get a biopsy, Nielsen said.

The results weren’t good.

“I was considered at the high end of the high-risk category and to me this was devastating news, considering it was the first real serious health issue of my life,” Nielsen wrote about his experience.

Nielsen was hesitant at first to talk about his prostate cancer because he hasn’t told many people about his health.

“However, with all the controversy over PSA testing and Medicare not wanting to pay for it, I thought perhaps my experience could potentially save someone else’s life,” he said. “In my opinion the PSA test is the only early warning flag available and for me the simultaneous digital exam never indicated anything.”

SNMH’s Community Cancer Center will host a low-cost prostate cancer screening beginning at 5 p.m. today. The $20 fee includes a PSA blood test and a digital rectal exam by physicians from Sierra Nevada Urology Medical Associates. Appointments are required. To schedule, call (530) 274-6635.

All physicians providing care for patients at SNMH are members of the medical staff and are independent practitioners, not employees of the hospital.


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