How Many Of Predicted 27,000 Prostate Cancer Deaths This Year Could Have Been Avoided By Screening?

Physicians typically use two tests to screen men for prostate cancer

. The first testis the digital examination during which the physician uses a gloved finger to conduct a physical examination of the prostate gland. Any findings that the gland is enlarged, hard, or has one or more nodules, could be a sign of cancer. The second test is the PSA blood test which measures the amount of prostate specific antigen in the bloodstream. Anything above 4.0 ng/mL is generally considered elevated. Given that prostate cancer increases PSA levels as the cancer grows and spreads, physicians generally advise a biopsy if the PSA test comes back high.

This is why physicians generally recommend that a biopsy should be ordered if a male patient's blood test shows a high PSA level. A biopsy is a procedure, normally performed under local anesthesia, whereby a probed is inserted into the rectum. The probe contains a needle which is used to take samples of the prostate tissue. Because the biopsy consists of samples, it is possible that the biopsy may yield a false negative, missing the cancer. This is why physicians also generally recommend that the biopsy be repeated every few months if the PSA levels remain elevated, especially after treatment for other possible causes.

A "false positive" PSA test occurs when the cause of a high PSA level is not prostate cancer. Biopsies have risks, including the risk of infection and the risk of excessive bleeding. Because of these two facts some physicians advise that male patients follow a plan of "watchful waiting." Under such a plan the physician monitors the patient's elevated PSA over a period of months or years. During this time some physicians advise that the patient try non cancer related treatments, for example, for infection, under the theory that if the PSA is elevated for a reason other than prostate cancer such treatments may bring the PSA back to normal levels.

Of course, with this approach the physician may wait too long before recommending a biopsy. As the PSA rises the likelihood increases that the rising levels are due to prostate cancer, as does the likelihood that the cancer has spread beyond the capsule. Men with prostate cancer who have a PSA concentration less than 10 ng/mL have a 70 to 80 percent chance of having organ-confined disease, compared to 50 percent for those with PSA levels 10 to 50 ng/mL, and only 25 percent with higher PSA levels

Physicians use the five year survival rate to classify, for each stage of the cancer at the time of diagnosis, the percentage of men so diagnosed who will survive the cancer for five years. While men with very aggressive forms of prostate cancer generally have a lower survival rate than men with a less aggressive cancer, when prostate cancer is diagnosed in the early stages, before it has a chance to spread outside the prostate gland itself, the five year survival rate is in the high ninety percent range.

When the cancer is not diagnosed until the late stages, after it has spread outside the prostate, there is no known cure at the current time. In general, men whose cancer has already reached stage 3 by the time they are diagnosed have about a 50-50 percent chance that the cancer will progress. When the prostate cancer is already at stage 4 and has reached the bone or other distant organ at the time of diagnosis, the patient generally only has a 2-3 year life expectancy. Treatment options are more limited and are generally meant to slow the spread and effects of the cancer. If in time the treatment stops being effective the disease becomes fatal.

Approximately 27,000 men are expected to die in the U.S. from advanced prostate cancer this year. We may never know how many of these deaths could have been prevented if the patient's doctor had screened them for prostate cancer or had ordered a biopsy as soon as any of the screening tests showed an abnormal result.

by: Joseph Hernandez

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