As President and Founder of the Cedars Sinai Tower Urology Group in Los Angeles, I have been diagnosing and treating prostate cancer for nearly forty years.
For the U.S. Preventive Task Force to advise that healthy men should not get routine PSA testing does a distinct disservice to many men who would otherwise die a particularly unpleasant death from prostate cancer otherwise diagnosed at an early and curable stage.
Since the PSA era, prostate cancer deaths have been reduced by more that 30%. Prior to PSA screening, more than 80% of all the prostate cancers that I personally diagnosed (usually by finding an abnormality on the digital rectal exam – DRE) were incurable. Those of us who treat prostate cancer on a daily basis know that there are problems with the PSA and it cannot be viewed in a vacuum.
An abnormal PSA is not a disease but warrants further evaluation by a urologist. To diagnose a cancer does not mean that it must be treated. Indeed, over the past four years more and more patients enter the “active surveillance” or “watchful waiting” group. Interestingly, about one third of those men demonstrate progression of their disease and require treatment.
The PSA is far from perfect, but at present is the best marker for the early diagnosis of aggressive, organ confined and curable prostate cancer. Let’s not throw the baby out with the bath water.
Dudley Seth Danoff, MD, FACS