Sky Ridge's Position on Preventative PSA Screenings

As many people are aware, the U.S. Preventive Services Task Force has recently suggested that Prostate Specific Antigen (PSA) testing no longer be used to screen for prostate cancer. This has, understandably, made the front page of the newspaper and has created a degree of confusion and concern among patients. This release follows closely behind the Task Force’s recommendation to discontinue mammography for breast cancer screening in women younger than age 50.

Every physician at Urology Associates believes in the utility of PSA screening.

This belief is founded in our review of the literature and supported by our clinical experience. The American Urologic Association, in response to the Task Force’s recommendations, has revisited the debate and has provided strong support for annual PSA screening.

Unfortunately, we have seen the devastating consequences of metastatic prostate cancer. You might remember a time before PSA screenings when nearly 50 percent of newly diagnosed prostate cancer patients were diagnosed with metastatic disease. As a screening tool, it is imperfect – but all screening tools are. Regardless, the following table, taken from the SEER database, very clearly shows that our current regimen has resulted in a dramatic decrease in mortality. Please note that during the same time period depicted in the graph (1992-2007), the incidence of prostate cancer has remained constant, and the treatment for localized disease (surgery and radiation) and metastatic disease (hormonal therapy and palliative chemotherapy) has not changed. What did change is that PSA screening was introduced in 1992. The conclusion is straight forward – PSA screening saves lives by allowing for early detection of disease.

Prostate Cancer Mortality Chart

We are aware that prostate cancer is often times without pain and slow growing. The challenge is to identify and treat the aggressive forms of prostate cancer. Using the strict criteria of aged-matched PSA, PSA velocity, digital rectal exam, history of infection and family history, national data consistently shows that approximately one third of transrectal ultrasonic guided biopsies reveal prostate cancer. Of those, a substantial number will be high grade or high volume – aggressive malignancies which often require intervention. While we understand the need for national guidelines, we believe the Task Force recommendations to be irresponsible when applied to an individual patient requesting prostate cancer counseling.

We will always apply an individual approach and take great pleasure in talking with our patients and helping them make the best health decisions possible. At this time, we will continue to recommend yearly PSA screenings for appropriate patients. As always, we are happy to talk with you regarding any concerns or questions you may have. Find a Prostate Cancer Specialist at Sky Ridge

2014 Prostate Cancer Screening Results

2015 Prostate Cancer Screening Results

Guidelines: Prostate Conditions Education Council (PCEC) & American Cancer Society (ACS)
Date: 9/20/17
Participants: 86 community members
Outcomes: Total abnormal PSA (normal: < 1.5): 42; DRG: 44
44 abnormal DRE
  • 1 abnormal not suspicious
  • 3 abnormal – suspicious
  • 1 abnormal – suspicious nodule
  • 2 BPH 2+
  • 32 Mild BPH (does not require intervention per questionnaire)
  • 5 BPH or urinary symptoms

Follow up: Phone call if elevetaed to PSA or finding on DRE and letter of results were sent to all participants.

Effectiveness of Activity: Northwestern study indicating rise in later stage prostate cancer due to change in PSA screening guidelines. However, given lower incidence of prostate cancer in Sky Ridge service area, Sky Ridge will continue to offer this free screening to the community, but it will not be a primary focus area for outreach in 2017.