PSA Screening Leads to Prostate Cancer Diagnosis
Oncologist George Kovach, M.D.,
who has diagnosed and treated
thousands of cancer patients over
the years, was diagnosed with
prostate cancer after a PSA
George Kovach, M.D., knew the routine. Get a physical and, at his age, 66, have your prostate checked as part of that physical.
But his screening for Prostate Specific Antigen (PSA) was anything but routine. PSA scores are like golf scores; the lower the better. A 33 is like 33 over par. While the PSA is notoriously fickle and increasingly controversial, a PSA score of 33 is considered to be a strong indicator of prostate cancer. According to WebMD, men with a PSA number between four and 10 have a 25 percent chance of having prostate cancer. If the PSA is higher than 10, the risk increases to 67 percent.
There was one thing not routine at all about Dr. Kovach’s diagnosis. He is an oncologist who has diagnosed and treated thousands of cancer patients himself.
Oncologists do get cancer
“Without any family history, I had some degree of security that I would not have prostate cancer but there are no guarantees for anyone, including cancer doctors,’’ said Dr. Kovach, who is an oncologist with Iowa Cancer Specialists and is affiliated with the Genesis Cancer Care Institute.
Prostate cancer is often an invisible cancer. There may be subtle symptoms like frequent urination, especially at night; painful urination; blood in the urine or semen; and, lower back pain. However, all of those symptoms could be related to something other than prostate cancer. “My symptoms were minimal to none,’’ Dr. Kovach explained.
He began treatment with the understanding that his prostate was probably going to be removed after more was learned from a biopsy. Clinical by nature and profession, Dr. Kovach did his own research. There were options available but only one seemed to be the best course.
“I reviewed the medical literature I respected and began to rank the treatment options based on the initial clinical pre-treatment staging,’’ he said. “The options considered included observation, surgery, or radiation therapy.”
Two of those options weren’t really viable. It was too late for observation because his PSA number was higher than 10. Radiation therapy was out because of the size of his prostate.
The best option was surgery. The last decision was open surgery or robotic surgery. Both are options at Genesis. Mark Milleman, M.D., of Urological Associates PC of Davenport offers both to patients.
“Most of my patients seem to make the decision to have the open surgical procedure, although I do the da Vinci robotic surgery, too,’’ Dr. Milleman said. “The average length of stay is shorter with the open procedure, and there have been studies indicating fewer side effects from the open surgical procedure. “There are possible side effects from surgery, but in the hands of someone who has done a high number of open procedures, the risk of side effects are lessened.”
PSA screening controversial
The side effects of prostate surgery can be serious, including incontinence, erectile dysfunction and infertility. The side effects have prompted a debate about the use of PSA screenings and aggressive treatment of prostate cancer.
The U.S Preventive Services Task Force said in a recent report that healthy men should no longer receive PSA screening. Creating firestorms is nothing new for the independent organization. Last year, the same task force reported that most women did not need a first mammogram until age 50, even though many breast cancers are discovered in women in the 40-to-50 age bracket.
Citing the serious side effects from surgery and the fact that prostate cancer is often a slow-growing cancer, the task force’s report said a PSA is unnecessary for most men.
“I would prefer they let the doctors and patients decide using the best information available and defer from blanket statements of policy,’’ Dr. Kovach said.
“Has there been an overtreatment of some men? Yes, there has,’’
Dr. Milleman conceded. “But the PSA is the best screening tool we have right now. It has probably saved hundreds of thousands of lives.”
Dr. Milleman added, “I don’t think anyone wants to be the guy who is told a PSA is unnecessary and then finds out he is dying of metastatic prostate cancer. I think you get the best information you can get; consider the patient and other factors; and, use the information to help the patient make the best decisions.”
Different direction for different men. One of the issues with prostate cancer, Dr. Milleman said, is there is no good method for determining how quickly a prostate cancer will grow.
The best course of action for one patient may be too aggressive for another. A number of factors are considered in determining treatment, including age, family history and general health of the individual.
"What we don’t know is how aggressive a cancer will be. A man of 80 who is otherwise healthy is probably not going to die of a newly diagnosed prostate cancer. He will die of something else,’’ Dr. Milleman said. “But someone in their 50s who has some underlying risk factors and has an abnormal PSA is someone you might treat more aggressively.
“It’s a complex issue, and there is a lot of gray to it. It isn’t black and white.’’ Father’s Day is a good day to remind the men in your life to ask about a PSA or a digital rectal exam.