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Local urologist says both PSA and digital-rectal exam are needed
AUSTINTOWN
111Even facing those dire numbers, however, and given that most prostate cancers can be cured if they are discovered early enough, most men in the United States, including here in the Mahoning Valley, don’t get age-appropriate prostate-cancer screenings, said Dr. Daniel Ricchiuti of N.E.O. Urology Associates.
Part of the problem is a report by the U.S. Preventive Services Task Force a few years ago that discouraged the use of the prostate-specific antigen, or PSA, blood test to detect prostate cancer.
It is a complex argument that doctors understand but that the general public and media do not always comprehend, he said.
“The perception by the media and the public that the PSA test is discouraged has done massive damage,” Dr. Ricchiuti said. “Contributing to this is the belief of men that they will all get prostate cancer if they live long enough and that it isn’t serious and a screening exam isn’t needed.
“As a result, urologists across the country are seeing more men coming in with late-stage cancer. In my mind, there is no controversy. Both the PSA and digital examination are needed, and people should be at least having the conversation about this with their doctor,” Dr. Ricchiuti said.
The task force makes recommendations about the effectiveness of specific clinical preventive services for patients without related signs or symptoms.
It went on to say that clinicians should understand the evidence but individualize decision-making to the specific patient or situation.
Dr. Ricchiuti emphasized the task force did not recommend against using the PSA test, but strongly discouraged it.
“Guys need to go to the doctor to get checked. It’s just a prostate exam. It’s absolutely ridiculous. Don’t be afraid of it,” he said.
Dr. Ricchiuti recommends that men begin having conversations about prostate cancer with their family doctor or urologist at 40.
And if the time comes for prostate-cancer screening, he recommends that both the PSA blood test and a digital-rectal examination be employed. With many men, he said, suspicious findings may be detected by one method of examination and not the other.
The PSA test measures the blood level of a protein that is produced by the prostate gland. The higher a man’s PSA level, the more likely it is he has prostate cancer.
During a DRE, the physician inserts a gloved, lubricated finger into the rectum and examines the prostate for any irregularities in size, shape, and texture. Often, the digital exam can help urologists distinguish between prostate cancer and noncancerous conditions.
Another area of contention surrounding prostate cancer is biopsies. The question is when is a biopsy justified.
Advancing technology is helping answer the question, Dr. Ricchiuti said.
He noted that the 3 Tesla MRI (magnetic resonance imaging) technology enables doctors to get a better 3-D image of the prostate and potentially can eliminate some biopsies through more accurate diagnosis.
“The important thing people need to understand is that we see people dying, and one reason is because they don’t get screening early enough,” Dr. Ricchiuti. “Extremely aggressive prostate cancer is usually a late diagnosis; but the vast majority of prostate cancer can be detected and treated early, leading to a good prognosis.”
There is other advancing technology to help answer the biopsy question, said Dr. Richard A. Memo of N.E.O. Urology Associates.
“If you have negative digital- rectal and PSA results, you don’t need to go any further,” said Dr. Memo, who is chairman of the Urology Care Foundation of the American Urological Association and former treasurer of AUA.
If further testing is indicated, however, there is the emerging PCA3, a gene-based test carried out on a urine sample that may help determine if a biopsy is needed.
“The whole dynamic is changing. Doctors are now able to gather more information before doing a biopsy,” Dr. Memo said.
“The guy who has nodules on his prostate and has a high PSA needs a biopsy,” he said.
Ten years ago, only about one out of three biopsies were positive for cancer. Now, with better technology and data and a more-precise understanding of who is and isn’t at risk, about 60 percent of biopsies are positive, Dr. Memo said.