One of the most important parts of a man’s checkup is prostate screening, often the Prostate Specific Antigen (PSA) test. According to the American Cancer Society, there will be over 220,000 new cases of prostate cancer by the end of 2015. While these numbers can easily convince frequent screening, pathologists now believe that more testing is not always the most effective course.
PSA screenings and biopsies are studied and evaluated by a pathologist like Michael J. Misialek, MD, FCAP, associate chair, Department of Pathology, Newton-Wellesley Hospital, and a clinical assistant professor in pathology, Tufts University School of Medicine in Massachusetts. He is also a fellow of the College of American Pathologists (CAP).
PSA Tests:1. There is no consensus about when to start PSA screening, or with what frequency it should continue.“A cost-benefit analysis of early testing usually leads to questions surrounding its necessity,” says Dr. Misialek. “It could result in costly treatment of a cancer that may not be aggressive.” However, he suggests that once the average male reaches 40, its best they speak with their doctor about screening.
According to guidelines published by the American College of Physicians’ High Value Care Task Force, Americans are getting far too many cancer screening tests.
2. The test may be simple, but the results require a full explanation. A PSA is conducted 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, so speak to your physician about your medical history and the need for a test.
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.
3. Elevated PSA doesn’t always mean you have cancer.“It provides a good indicator, but there are other conditions that may raise a patient’s PSA,” says Dr. Misialek. An enlarged prostate or inflammation can throw off a test in the absence of cancer, though about 80 percent of cancers will have an elevated PSA.
4. A biopsy likely confirms diagnosis.After elevated levels of PSA, a pathologist will study samples from a biopsy to determine the presence and type of cancer.
5. Request a pathology report.Upon undergoing a biopsy, ask to see your pathology report and have your pathologist explain your diagnosis.
6. Be part of your care plan. “Several clinicians—including your pathologist—will take part in outlining your care plan,” says Dr. Misialek, “but patients can help make the best decisions for their own care.”
7. There are many approaches to care. “Rushing into surgery and intense treatment is not always the best course for a patient,” says Dr. Misialek. He says it is sometimes best to begin a period of “active surveillance” to monitor the cancer’s growth. If necessary, surgery can be followed by radiation, chemotherapy, or hormonal treatment. A particular patient’s cancer can differ drastically from another, and your care team will help decide the best method of treatment based on the diagnosis originally made by the pathologist.
More Test Options:1. Some tests in development might be more effective.A new test called Prostate Health Index (PHI)—now in early clinical trials—shows promise that it may be more accurate in finding cancers than the PSA test, says Dr. Misialek.
2. Genetic testing could predict risk of prostate cancer.The same genes thought to cause some breast and ovarian cancers, BRCA1 and BRCA2, may be linked to early onset prostate cancer, according to research by Arul Chinnaiyan, MD, PhD, FCAP, director of the University of Michigan’s Center for Translational Pathology, who helped to lead the study. Be sure to tell your doctor your family’s medical history to help determine your risk.
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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