In response to “Navigating the PSA Screening Dilemma” (AJN Reports, January), it's apparent that the position of the U.S. Preventive Services Task Force (USPSTF)—recommending that prostate-specific antigen (PSA) levels no longer be used in primary care to screen for prostate cancer in all men—is not only premature but, as the article suggests, not validated by the American Association of Clinical Urologists, the American Society of Clinical Oncology, or the National Medical Association.
My husband was diagnosed with prostate cancer three years ago. His Gleason score was 7; it was stage IV metastatic cancer. He was asymptomatic at the time of diagnosis, and the nodule was “missed” by his general practitioner in a routine digital exam. With laboratory testing indicating a PSA of 181, we hurried to the urologist, and a biopsy proved the definitive diagnosis of prostate cancer.
The American Cancer Society's guidelines suggest that a PSA level of 4 ng/mL is a reasonable threshold for further evaluation.1 Although several studies have suggested that high PSA levels are not indicative of prostate cancer,2 there is still no reason to suggest that PSAs are not extremely beneficial for early detection.
The American Urological Association remains in disagreement with the USPSTF's recommendation,3 which doesn't suggest alternative methods of testing for prostate cancer. The USPSTF's recommendation can lead to potentially irreversible outcomes for some men and should be reevaluated.
Belita Adams, RN
1. Wolf AM, et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010 CA Cancer J Clin. 2010;60(2):70–98
2. Lynch T, Burgess M. Prostate-specific antigen test: an informed choice Primary Health Care. 2011;21(3):16–21
3. Carter HB, et al. Early detection of prostate cancer: AUA guideline J Urol. 2013 May 6. [Epub ahead of print.]