Your Prostate Specific Antigen screening test will be studied and evaluated by a pathologist like Michael J. Misialek, MD, FCAP. He says there’s a lot you need to understand about this test.
A fellow of the College of American Pathologists, Dr. Misialek is associate chair, Department of Pathology, Newton-Wellesley Hospital, and a clinical assistant professor in pathology, Tufts University School of Medicine in Massachusetts.
1. The test is simple, but the explanation isn’t.
The level of Prostate Specific Antigen is measured by analyzing the same type of blood sample that might be collected to check your cholesterol or blood sugar levels. Some doctors do not routinely include the PSA test in an annual physical exam.
As with other types of cancer screening, Dr. Misialek says your doctor must fully explain what the results might show and prepare you to think about the options that would be considered if the PSA levels are elevated.
2. There is no consensus about the right age to should start PSA screening.
“If you look at published guidelines, PSA screening is a moving target,” says Dr. Misialek.
“Criticism of early PSA screening often focuses on a cost-benefit analysis,” says Dr. Misialek. “Early screening could result in unnecessary testing and costly treatment of a cancer that may not be aggressive.”
Recently, the American College of Physicians’ High Value Care Task Force published new guidelines based on an analysis of the recommendations of several medical groups. Their conclusion: Americans are getting far too many cancer screening tests.
3. Elevated PSA doesn’t always mean you have cancer.
BPH (enlarged prostate) and inflammation can raise PSA in the absence of cancer, though about 80 percent of cancers will have an elevated PSA. “It’s still the best test we have for now,” says Dr. Misialek.
4. Newer tests in the pipeline might be more effective.
A new test called PHI (Prostate Health Index)— now in early clinical trials—shows promise that it may be more accurate in finding cancers than the PSA test, says Dr. Misialek.
5. Genetic testing may be appropriate for prostate cancer.
New research has shown that mutations of such genes as BRCA1 and BRCA2 may be linked to early onset prostate cancer. These are the same genes known to play roles in some breast and ovarian cancers. Arul Chinnaiyan, MD, PhD, FCAP, director of the University of Michigan’s Center for Translational Pathology, helped to lead the study.
About the College of American PathologistsAs the leading organization with more than 18,000 board-certified pathologists, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. The CAP’s Laboratory Improvement Programs, initiated 65 years ago, currently has customers in more than 100 countries, accrediting 7, 700 laboratories and providing proficiency testing to 20,000 laboratories worldwide. Find more information about the CAP at cap.org. Follow CAP on Twitter: @pathologists.
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