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"You have turned my life around"
 

I am 87 years old, with a problem of the prostate gland. Before I met Dr. Baum, I went to the bathroom every 30-60 minutes. After Dr. Baum's treatment on my prostate, I go only 5 times per day and only 1 time at night! You turned my life around. I am so very grateful!

-Sidney Daigle


I want to thank you for your due diligence. You saved my life. I highly recommend you!

-Dwight Bastian


Thank you Dr. Baum! Because of you I'm back in the "rodeo"!

-Gerald Wallace

 


WHAT IS PSA, AND HOW DO WE MEASURE IT?
PSA stands for Prostate Specific Antigen and is a blood test. The PSA blood test, along with a digital rectal examination (DRE), is used to screen for the presence of prostate cancer.

The prostate is the gland, found only in men, which is located between the urinary bladder and the urethra (the urinary channel that runs through the penis). The prostate's function is to make seminal fluid or semen that is ejaculated during intercourse. Note that sperm is made in the testicles and is only a small fraction of the seminal fluid. Antigen is a medical or biological term for a substance, usually a protein, that stimulates the body to make antibodies.

PSA is, therefore, a protein found in the serum (serum is the fluid portion of blood) that is unique or specific for the prostate. No other human tissue or body part can make PSA except for the prostate. The PSA levels can be measured in an individual's serum and with this information we are able to screen for prostate cancer.

WHY USE PSA TO SCREEN FOR PROSTATE CANCER?
The routine use of PSA testing along with rectal examination of the prostate has dramatically improved our ability to find prostate cancer earlier, and possibly at a more curable stage, than ever before. Controversy exists as to whether screening with PSA will decrease the death rate from prostate cancer.

WHERE DO THE NATIONAL MEDICAL GROUPS STAND ABOUT PSA SCREENING?
The American Cancer Society's new policy was released in 1997 and its guidelines were accepted by the American Urological Association. The guidelines are as follows:

"Both PSA and DRE should be offered annually, beginning at age 50 years, to men who have at least a 10-year life expectancy, and to younger men who are at high risk. Information should be provided to patients regarding potential risks and benefits of intervention."

American Academy of Family Physicians, November 1996
Men age 50 to 65 should be counselled about the known risks and uncertain benefits of screening.

American College of Physicians March 1997
Physicians should describe the potential benefits and known harms of screening, diagnosis, and treatment, listen to the patient's concerns, and then individualize the decision to screen.

American College of Radiology 1991
A combination of DRE and PSA level should be used as an initial screening procedure. Use trans-rectal ultrasound to evaluate men who have an abnormal DRE or PSA level.

United States Prevention Services Task Force December 1995
Routine screening with DRE, PSA, and TRUS is not recommended.

DISCUSSION
Screening for prostate cancer in asymptomatic men can detect tumors at a more favorable stage (anatomic extent of disease). There has been a recent reduction in the "death rate" from prostate cancer, but it has not been established that this is a direct result of screening.

An abnormal PSA test result has been defined as a value of above 4.0 ng/ml. Age adjusted values are used by many physicians. For instance, men under age 60 may use an upper value of 2.5 ng/ml. An elevated PSA does NOT mean that cancer is present. Only a biopsy can prove the presence of cancer. A negative biopsy does not rule out cancer and multiple biopsy sessions may be needed in patients with elevated or rising PSA levels and prior negative biopsies. Some elevations in PSA may be due to benign conditions of the prostate.

The DRE of the prostate should be performed by health care workers skilled in recognizing subtle prostate abnormalities. DRE, as the sole screening tool, is less effective in detecting prostate carcinoma compared with PSA.

In summary, the controversy about screening revolves around the potential risks and benefits of both the diagnostic tests and the earlier finding of the prostate cancer. There is no question that screening for prostate cancer in men who have no symptoms can detect more curable prostate cancers. And while there has been a reduction in the overall mortality from prostate cancer in recent years, there is still no definitive proof that this is as a direct result of the screening. The risks of screening include the pain and discomfort from biopsies and ultrasound. These risks include bleeding and infection, although the percentage of patients that become seriously ill from such diagnostic tests is well less than 1%. Another issue that concerns health care investigators are the significant costs required to screen all men on a regular basis. With a shrinking health care dollar seen in the future, money might be more wisely spent elsewhere if the benefits of PSA screening in only marginal.

While it may be intuitive that prostate cancer found at an earlier stage should be more curable, there is yet no proof to that statement. Screening programs for cervical cancer with Pap smears and breast cancer with mammograms have been shown to be effective. At the same time screening chest x-rays looking for lung cancer did not prove to be helpful and has since been stopped.

The final result of the effectiveness of screening for prostate cancer is yet to be determined, although there was strong enough evidence for the Congress to pass laws that allow Medicare to start paying for PSA screening in the year 2000. Some controversies still exist about the age at which screening should begin. Most studies have suggested that screening should start around age 50 except for people in high risk groups which would include men with a history of prostate cancer in their family, or in men of African descent. These two groups have a higher incidence of cancer and at an earlier age and screening should probably begin at age 40.

The screening should continue until about age 75 where the benefits of early diagnosis are much more difficult to prove. There have been many studies which suggest that the 10 year survival rates for people with early prostate cancer are not different between observation or radical treatment. This being the case, screening after age 75 where the survival rate may be no more than 10 years would seem to have less benefit and possibly even more risk. Certainly in men with a life expectancy of less than 10 years such as those with severe emphysema or heart disease there can be little grounds for recommending routine screening.

If you have any further questions about the early detection of prostate cancer and the use of PSA, please don't hesitate to ask us.