Screening for prostate cancer
Many of you may have already read the New York Times article “PSA test found to save few lives” published on March 19 2009. http://www.nytimes.com/2009/03/19/health/19cancer.html
It is very difficult to say that we shouldn’t do PSA tests for healthy men or that we shouldn’t test for prostate cancer. In elderly men, age 85 and higher screening PSA tests are definitely overkilll if the intent is to cure prostate cancer. I high PSA test in someone who is 85 would be useful to know because the prostate cancer may have spread to the bones, cause pain, bleeding and bone fracture.
We are not sure if finding prostate cancer early is of much benefit to young 50 year old men. These latest two studies indicate that a lot of procedures, with side effects were done, to save few lives. It is hard to early to tell men NOT to be screened for prostate cancer and NOT to consider treatement if they are some risks factors for progression Gleason’s score 7 of 10 or higher, PSA greater then 10 or evidence of spread outside the prostate. Rectal exam and PSA are still the only tools screen. New better tools should be available in the next ten or fifteeen years. Stay tuned for a post on active surviellence for prostate cancer.
Robot Assisted Laparoscopic Radical Prostatectomy and new radiation techniques both minimize the morbidities of prostate cancer treatment. At Beth Israel Medical Center in Manhattan I offer both modalities to our patients. Patients who have radical prostatectomy with the Robot typically go home in two days. Patients who have radioactive seed implants go home the same day.
