Dr. David Samadi, leading prostate cancer urologist, highlights the importance of the PSA screening test and digital rectal exam (DRE) for prostate cancer. Many patients are symptom-free when diagnosed with prostate cancer.
PSA screening should be done at age 40 as a baseline, and if normal repeated annually after age 45. The importance of the PSA is in monitoring the velocity or trend, not just in the value of one test.
Dr. Samadi acknowledges that not all prostate cancers are deadly, but says that the art of medicine, surgeon expertise, and the role of centers of excellence all ensure patient survival in evaluating prostate cancer.
Here is the full transcript:
“PSA is how you were diagnosed with prostate cancer. Digital Rectal Exam and PSA is the same as the mammogram for women. It’s a simple test. No one in their right mind should just act on one number and the PSA to do the biopsy, and that’s all we have. The problem with this is how to use it, since there are some indolent prostate cancers that may not affect you and you can go on for the rest of your life without dying from them and that’s the art of medicine. That’s where your doctor, that’s where the center of excellence, that’s where the research comes, to distinguish which one is going to die and who is going to do well. PSA screening has a very small yield.
What is the price of saving his life?
“I had no symptoms prior to the surgery. It was just a PSA test that identified the problem, so without the PSA test you wouldn’t even know that I had a cancer problem.” – Male patient
If you ask her there’s no price:
Wife of patient: “It would have put me in a position to not have him and that wouldn’t be good. So guys, this is not just about you, it’s about your families, it’s about the women who love you and the women who will have to be left without you.” – Wife of patient
If you ask the government, it’s just going to add to billions of dollars. For every one of you to be detected, we have screened thousands of people. That’s cost and that’s money and that’s the pressure. I’m sure that plays a big role, but we learn a lot from the US task force and I think they’re doing some good work, but we just need longer follow-up. If you look at the curves, at nine years there’s really no big difference between screening and not screening. But as you go further, by 14 years there’s a big difference and a big survival benefit from this. So we just need to stay put, continue to do the PSA, but be smart about it and make sure. The recommendation is that you get a baseline at 40 and if you’re not sure about what to do, always get a second and third opinion. We look at the velocity – if everything is normal, you have no risk. We go to 45 and we do it a year after that.”