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The importance of prostate cancer screening

Dr. J. Brantley Thrasher is professor, the William L. Valk Chair of Urology, and the co-director of Operative Services at the University of Kansas Medical Center in Kansas City, Kan. Dr. Thrasher is involved in both basic science and clinical research in the development of new diagnostic techniques and treatments for prostate, bladder, and kidney cancer. He is the principal investigator on numerous clinical and laboratory research protocols. Additionally, he is currently a co-investigator or collaborator in research funded by the Centers for Disease Control and Prevention and the Department of Defense.

Dr. Thrasher stresses that, although research trials in Europe and America have produced conflicting findings, PSA screening should be the starting point for most men.

"A 65-year-old doctor came to see me for his first PSA screening, and it showed that he had a very aggressive cancer," Thrasher said. "He had not been screened sooner because he'd heard it wasn't accurate or useful. If he'd been screened starting when he was about 40, there's a 25-year window in which we could have been watching, diagnosing, and treating."

According to Thrasher, "PSA screening is very, very important. It deserves at least a discussion with every man and his physician. Men ignore the screening to their own detriment."

He acknowledges that some over-treating has occurred following positive PSA screens, but he stresses that over-treating and over-diagnosing are entirely different issues. The screening, he says, can open up thoughtful discussions about whether to treat or watch, based on the man's risk factors (age, race, weight, family history), the PSA numbers, and the speed with which the numbers may be rising. A positive PSA does not have to mean overly aggressive treatment—and it's much riskier to avoid the screening altogether.

Thrasher also points out that men are fortunate to have a blood serum diagnostic for prostate cancer.

"The PSA is the best serum marker we've ever had and an excellent screening tool," he said. "Most cancers don't even have one that can alert us to the presence of cancer early on."

To back up that statement, he points out that since PSA screening began around 1988, there has been more than a 30 percent drop in deaths from prostate cancer. His recommendation mirrors that of the new prostate cancer screening guidelines that were just issued: Men should get a baseline PSA screen at age 40.