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Should I go on the PSA screening test?

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FB Dr Soarawee
Soarawee Weerasopone, MD

Andrologist
Royal Phnom Penh hospital, Kingdom of Cambodia

I have been practiced in Urology office so far. A simply consulting from the other departments is about-the references of total PSA value from the screening test which is considered 4.0 ng/mL as normal reference. This kind of problem made the patients suffered a lot, especially psychological harm and I spent a bunch times to explain them for what is the big deal? Let me update you guys on PSA screening program.

If we questioned that “what kind of cancer screening test is the most concern in the world?” The answer is “Cervical cancer screening program” but what about prostate cancer? The answer is “not necessarily” I will tell you why.

In 2018, there was a very famous literature from USA studying on the PSA screening test recommendation and they concluded that not everyone should go on this screening test, if you do it, a little benefit for screening in age group 55 – 69 years old. Surprise? Let me tell you for the whole deals.

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Prostate cancer

PSA is an abbreviated from “Prostate Specific Antigen” which is enzyme that specifically produced in the prostate. This enzyme’s function is to liquefy semen from Gel-like into liquid after ejaculation. PSA is riched in the prostate tissue and low in concentration in the blood stream so that is mean any events that make prostate tissue breakdown, this enzyme enter the serum and was detected by the PSA blood test. The conditions for example, benign prostatic hyperplasia, prostatic infection and some minor manipulation can be raised this value which is called “False-positive” test.

Let’s get back to the famous US paper, the purpose of prostate cancer screening is trying to figure out the high-risk localized cancer that can be successfully treated. Why we don’t care about low-risk cancer? The answer is very simple, literally, you will die from the other causes before this cancer harm you. Mostly, the prostate cancer has no symptoms and the autopsy studied shown up to 33% of men who died from the other causes have been found prostate cancer. If we pay attention with the high-risk cancer, it’s only around 1 from 1,000 screening men will get benefit from the screening test and has no benefit when screening in men who are 70 years old up.

Blood sampling
PSA blood test is common tool for prostate cancer screening

Tons of harmful unnecessary PSA screening test had starting with when patients got false-positive PSA result. First of all is a psychological disturbance, next they may suffer from the complication of prostate biopsy such as a painful, a bloody urination, a bloody ejaculation and infection and it is not including complication from other prostate removal operation like erectile dysfunction and urinary incontinent.

So what should we do? If you are male and in the age group of 55 – 69 years old, you better discuss with your primary doctor and make a decision together in advance. It is your choice! If you got a problem or you have a question, please come to see me at my office.

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