Men don't get full benefit of
prostate cancer test
ANAHEIM, Calif., June
18, 2001 (Cancer Digest) -- Many men aren't benefiting from a
simple blood test for prostate cancer, because their urologists
aren't using the relatively new test called, a free-PSA, to eliminate
unnecessary and expensive prostate biopsies.
That's the conclusion
of a new survey of American urologists attending the American
Urological Association's annual conference, held last week in
Anaheim, Calif. The survey was conducted by the Men's Health
Network (MHN), which released the results today during National
Prostate Cancer Awareness week.
"The survey suggests
many doctors are not yet taking advantage of the risk-assessment
information that the free-PSA test provides about how likely
prostatic biopsies are to show cancers in individual cases,"
said Dr. William J. Catalona, of the Washington University School
of Medicine.
"That means patients
may not have all the information they need to make an informed
decision about whether or not to have a biopsy," says Catalona
who authored a major study on the free-PSA test that established
the test's role and effectiveness in detecting cancer while eliminating
unnecessary biopsies.
PSA, which stands for
prostate specific antigen, is a protein produced only by the
prostate gland. Small amounts of this substance may get into
the bloodstream and can be measured by the PSA test.
The free-PSA blood
test is a follow-up test to the total PSA and improves the accuracy
of prostate cancer testing. The prostate specific antigen can
be "bound" to other particles or they can be unbound
PSA molecules that float "freely" in the bloodstream.
A free PSA test measures these free PSA molecules.
The free-PSA test was
FDA-approved in 1998 and clinically proven to help detect prostate
cancer with great accuracy. Leading cancer researchers have concluded
the test can eliminate 20 percent of unnecessary biopsies, among
men who have moderately elevated levels of total PSA and a negative
digital rectal exam (DRE).
Prostate biopsies,
in which samples of prostate tissue are examined under a microsope
to determine the presence of cancer, routinely cost more than
$1,000, involve discomfort and anxiety, and can cause complications
such as infection, fever, urinary retention and rectal bleeding.
But the Men's Health
Network survey found most urologists do not perform a simple
free-PSA blood test before referring these men for biopsy.
American Cancer Society
guidelines clearly recognize the test's role in detecting cancer.
The guidelines say restricting biopsy "to men with less
than 20 percent PSA improves testing accuracy," and that
proper use of the free-PSA test "may result in a lower biopsy
rate compared with older strategies."
Nearly 90 percent of
urologists reported that when they recommend a prostate biopsy,
patients at least occasionally ask if there is an alternative.
Even though many urologists
do not perform a free-PSA blood test before referring men with
moderately elevated PSA levels for biopsy, most urologists do
nonetheless employ the test to assess these patients' conditions.
The large majority
of responding urologists recommends the test for men who have
a negative DRE and moderately elevated PSA levels, and especially
for men with moderately elevated PSA, a negative DRE and a negative
biopsy.
"PSA is the best
cancer tumor marker in all of medicine, but there has been understandable
pressure to improve its accuracy," said Dr. Catalona. "Free-PSA
is the best available way to improve the accuracy of total PSA
tests."
Dr. David Gremillion,
of the University of North Carolina School of Medicine, praised
PSA and free-PSA testing as providing "an opportunity for
men that can rival the benefits of regular preventive care that
women receive when they go for their annual Pap smears and screening
mammograms."
The survey of U.S.
urologists was performed by representatives of the Men's
Health Network from June 3-6, 2001. Beckman Coulter, which
manufactures the Hybritech free-PSA test, provided an educational
grant to conduct the survey.
|